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Pure lobular carcinoma of the breast presenting as a hyperechoic mass: incidence and imaging characteristics.
AJR Am J Roentgenol. 2013 Nov; 201(5):W765-9.AA

Abstract

OBJECTIVE

The purpose of this study was to determine the proportion of invasive lobular carcinomas with increased sonographic echogenicity.

MATERIALS AND METHODS

A retrospective review of mammographic and sonographic findings included cases of pure invasive lobular carcinoma with available images from January 1998 to June 2010. We assessed ultrasound images for the presence of a mass, internal echogenicity, margin characteristics, and attenuation effects. In hyperechoic tumors, more than 90% of the mass had increased echogenicity compared with surrounding fat. In heterogeneously echogenic tumors, the echogenic component constituted 20-90% of the tumor. Findings at mammography, MRI, and surgery were correlated with sonographic findings. A breast pathologist reviewed histologic findings and confirmed the diagnosis of pure invasive lobular carcinoma.

RESULTS

Of 509 invasive lobular carcinomas, 27 (5%) were hyperechoic, of which 13 (48%) were associated with posterior acoustic shadowing. Heterogeneously echogenic cancer was seen in 57 (11%) cases. The most common sonographic finding was a hypoechoic, irregular mass with or without posterior shadowing (n = 323; 63%). In 66 (13%) lesions, focal shadowing was seen without a discrete mass. Fourteen (3%) lesions were isoechoic with respect to surrounding normal adipose tissue without acoustic shadowing. Twenty-two (4%) of the malignant tumors were not identified sonographically. Of these, 15 (68%) had mammographic abnormalities, one (5%) was seen at MRI, and six (27%) presented as palpable masses that were surgically excised.

CONCLUSION

Pure invasive lobular carcinomas can present as a hyperechoic mass or with substantial hyperechoic component. All sonographic lesion characteristics should be evaluated and biopsy recommended when there are suspicious features, even in a lesion that is predominantly hyperechoic.

Authors+Show Affiliations

1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24147507

Citation

Jones, Katie N., et al. "Pure Lobular Carcinoma of the Breast Presenting as a Hyperechoic Mass: Incidence and Imaging Characteristics." AJR. American Journal of Roentgenology, vol. 201, no. 5, 2013, pp. W765-9.
Jones KN, Magut M, Henrichsen TL, et al. Pure lobular carcinoma of the breast presenting as a hyperechoic mass: incidence and imaging characteristics. AJR Am J Roentgenol. 2013;201(5):W765-9.
Jones, K. N., Magut, M., Henrichsen, T. L., Boughey, J. C., Reynolds, C., & Glazebrook, K. N. (2013). Pure lobular carcinoma of the breast presenting as a hyperechoic mass: incidence and imaging characteristics. AJR. American Journal of Roentgenology, 201(5), W765-9. https://doi.org/10.2214/AJR.12.9742
Jones KN, et al. Pure Lobular Carcinoma of the Breast Presenting as a Hyperechoic Mass: Incidence and Imaging Characteristics. AJR Am J Roentgenol. 2013;201(5):W765-9. PubMed PMID: 24147507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Pure lobular carcinoma of the breast presenting as a hyperechoic mass: incidence and imaging characteristics. AU - Jones,Katie N, AU - Magut,Maureen, AU - Henrichsen,Tara L, AU - Boughey,Judy C, AU - Reynolds,Carol, AU - Glazebrook,Katrina N, PY - 2013/10/24/entrez PY - 2013/10/24/pubmed PY - 2014/1/10/medline SP - W765 EP - 9 JF - AJR. American journal of roentgenology JO - AJR Am J Roentgenol VL - 201 IS - 5 N2 - OBJECTIVE: The purpose of this study was to determine the proportion of invasive lobular carcinomas with increased sonographic echogenicity. MATERIALS AND METHODS: A retrospective review of mammographic and sonographic findings included cases of pure invasive lobular carcinoma with available images from January 1998 to June 2010. We assessed ultrasound images for the presence of a mass, internal echogenicity, margin characteristics, and attenuation effects. In hyperechoic tumors, more than 90% of the mass had increased echogenicity compared with surrounding fat. In heterogeneously echogenic tumors, the echogenic component constituted 20-90% of the tumor. Findings at mammography, MRI, and surgery were correlated with sonographic findings. A breast pathologist reviewed histologic findings and confirmed the diagnosis of pure invasive lobular carcinoma. RESULTS: Of 509 invasive lobular carcinomas, 27 (5%) were hyperechoic, of which 13 (48%) were associated with posterior acoustic shadowing. Heterogeneously echogenic cancer was seen in 57 (11%) cases. The most common sonographic finding was a hypoechoic, irregular mass with or without posterior shadowing (n = 323; 63%). In 66 (13%) lesions, focal shadowing was seen without a discrete mass. Fourteen (3%) lesions were isoechoic with respect to surrounding normal adipose tissue without acoustic shadowing. Twenty-two (4%) of the malignant tumors were not identified sonographically. Of these, 15 (68%) had mammographic abnormalities, one (5%) was seen at MRI, and six (27%) presented as palpable masses that were surgically excised. CONCLUSION: Pure invasive lobular carcinomas can present as a hyperechoic mass or with substantial hyperechoic component. All sonographic lesion characteristics should be evaluated and biopsy recommended when there are suspicious features, even in a lesion that is predominantly hyperechoic. SN - 1546-3141 UR - https://www.unboundmedicine.com/medline/citation/24147507/Pure_lobular_carcinoma_of_the_breast_presenting_as_a_hyperechoic_mass:_incidence_and_imaging_characteristics_ L2 - https://www.ajronline.org/doi/10.2214/AJR.12.9742 DB - PRIME DP - Unbound Medicine ER -