Hyperechoic Lesions on Breast Ultrasound: All Things Bright and Beautiful?

Ultrasound (US) lexicon of the Breast Imaging Reporting and Data System (BI-RADS) defines an echogenic breast mass as a lesion that is hyperechoic in comparison with subcutaneous adipose tissue. However, at sonography, only 0.6 to 5.6% of breast masses are echogenic and the majority of these lesions are benign. approximately, 0.5% of malignant breast lesions appear hyperechoic. The various benign pathologic entities that appear echogenic on US are lipoma, hematoma, seroma, fat necrosis, abscess, pseudoangiomatous stromal hyperplasia, galactocele, etc. The malignant diagnoses that may present as hyperechoic lesions on breast US are invasive ductal carcinoma, invasive lobular carcinoma, metastasis, lymphoma, and angiosarcoma. Echogenic breast masses need to be correlated with mammographic findings and clinical history. Lesions with worrisome features such as a spiculated margin, interval enlargement, interval vascularity, or association with suspicious microcalcifications on mammography require biopsy. In this article, we would like to present a pictorial review of patients who presented to our department with echogenic breast masses and were subsequently found to have various malignant as well as benign etiologies on histopathology.

Incidence of internal mammary node in locally advanced breast cancer and its correlation with metastatic disease: a retrospective observational study.

OBJECTIVE: To determine incidence of internal mammary nodes (IMN) at baseline CT of locally advanced breast cancer (LABC) and ascertain prognostic implication. METHODS AND MATERIALS: Retrospective review of all LABC patients from 1 January 2012 through 31 December 2014 was performed after approval from institutional review board. CTs of 182 patients enrolled were reviewed by two radiologists independently, and IMNs were documented based on size, location and relation with location of breast primary. 3-year follow-up was analysed and incidence of metastases was calculated as overall incidence, incidence in patients with and without discernible IMN at baseline imaging. Results are presented as numbers and percentages. Differences in metastases of two groups were compared using χ2 test. 95% CI was calculated and p < 0.05 was considered significant. RESULTS: 77 of 182 had identifiable IMN (42.3% incidence). Majority of identifiable nodes were on ipsilateral side of primary (incidence 90.90%) with higher incidence in patients with upper-outer quadrant tumours (55.9%). Majority were seen in second intercostal space (44.4%). 36 (19.7%) developed distant metastases within 3 years of therapy. Of these, 21 (27.3%) had IMN as compared with 15 (14.3 %) without IMN on baseline imaging. Patients with identifiable IMN on baseline CT had significantly higher incidence of distant metastases (p = 0.0321). CONCLUSION: Significant number LABC patients have identifiable IMN on baseline imaging with patients showing IMN on baseline CT showing significantly higher rate of metastatic disease following therapy. ADVANCES IN KNOWLEDGE: Many LABC patients have identifiable IMNs on baseline imaging which show higher incidence of subsequent metastatic disease.

Does Computed Tomography Have the Ability to Differentiate Aggressive From Nonaggressive Solid Pseudopapillary Neoplasm?

OBJECTIVE: The aim of the study was to assess the ability of contrast-enhanced computed tomography (CECT) to differentiate aggressive from nonaggressive solid pseudopapillary neoplasms (SPNs). MATERIALS AND METHODS: Forty treatment-naive patients with pathologically proven pancreatic SPNs were included. Imaging characteristics were determined by consensus of 3 radiologists blinded to histopathologic aggressiveness. All patients underwent 4-phase CECT using a pancreatic protocol. The regions of interest of the tumor and the normal pancreas were documented on all phases. Lymph nodes were considered metastatic if greater than 1.0 cm in short-axis diameter.Fisher exact and Wilcoxon rank-sum tests were used to compare between aggressive and nonaggressive tumors. RESULTS: No significant difference was noted between imaging covariates, such as internal hemorrhage, calcification, wall thickness perceptibility, vascular invasion, margins, cystic component, and pancreatic and biliary ductal dilation. Tumors with greater than 62.5 Hounsfield units and progressive enhancement during the delayed phase had aggressive characteristics (P = 0.03). CONCLUSIONS: On delayed phase CECT, pathologically aggressive SPNs may show greater enhancement than nonaggressive SPNs.

A case series of metastases to the breast from extramammary malignancies.

Metastases to the breast from extra-mammary malignancies are extremely uncommon. The discovery of a breast mass in a patient with a known primary tumor elsewhere poses a diagnostic challenge to the clinician. An awareness of the various malignancies that can metastasize to the breast and accurate diagnosis of the same is essential to avoid an unnecessary mastectomy and to guide further therapy. In this case series, we describe such clinical scenarios with an emphasis on the imaging features of metastases to the breast, which will enable radiologists to recognize this entity with greater ease.

Imaging of the treated breast post breast conservation surgery/oncoplasty: Pictorial review.

Mammographic appearance of the normal breast is altered in the post-operative setting. It is essential to be aware of the normal findings as well as to identify features of recurrent disease with particular emphasis on radiological-pathological concordance. Digital breast tomosynthesis and volumetric breast density add incremental value in this clinical setting. We present a pictorial review of various cases to illustrate normal post-operative findings as well as mammographic features suspicious for recurrent disease.

Utility of gray-scale ultrasound to differentiate benign from malignant thyroid nodules.

OBJECTIVE: The objective was to assess the utility of gray-scale USG to identify patterns of thyroid nodules and to correlate the characteristics of benign and malignant nodules with pathological diagnosis. MATERIALS AND METHODS: From September 2009 to August 2010, a total of 203 patients (17 males and 186 females), with 240 nodules detected at USG, were included in this study. The characteristics of each nodule were determined. The results were then compared with fine needle aspiration (FNA)/histopathological diagnosis. RESULTS: Of the 240 nodules examined, 44 (18.33%) were found to be malignant on cytopathology. The malignant nodules demonstrated solid or predominantly solid composition (sensitivity 88.6%, specificity 53.5%); presence of microcalcification (sensitivity 65.9%, specificity 97.9%); irregular or poorly defined margins (sensitivity 84%, specificity 88.7%); anteroposterior (AP) diameter > transverse diameter (sensitivity 77.2%, specificity 80.1%); absent or thick incomplete halo (sensitivity 70.4%, specificity 65.8%); and markedly hypoechoic character (sensitivity 65.9%, specificity 84.6%). Among males, malignant nodules were found in 36.8%, whereas in females the occurrence was 16.7%. CONCLUSION: Gray-scale USG features of thyroid nodules are useful to distinguish patients with clinically significant thyroid nodules from those with innocuous nodules despite the overlap of findings. From our study, it is apparent that the USG findings of poorly defined margins, marked hypoechogenicity, microcalcifications, and a taller-than-wider shape have a high diagnostic accuracy for identifying malignant thyroid nodules.