Ultrasound of breast disease: A pictorial review

Purpose: To understand the indications for breast ultrasound and its importance in aiding the diagnosis of various breast diseases. In this pictorial review, the ultrasound characteristics of a variety of breast disorders are presented with histopathologic correlation. Points to aid differentiation between various breast diseases are provided.

Material and methods: Ultrasound images were selected from the department database to illustrate various breast pathology for this pictorial review.

Results: Cases include the following;

Benign breast disorders:

1.1 Fibroadenoma of the breast – A circumscribed hypoechoic, retroareolar nodule. Biopsy showed a fibroepithelial lesion favoring fibroadenoma.

1.2 Breast abscess – A heterogeneously hypoechoic mass in the periareolar region. 5 ml of pus admixed with blood was aspirated.

Borderline breast disorders:

2.1 Phyllodes tumor – A large, irregular, heterogeneously hypoechoic mass with internal vascularity on colour doppler. Excisional biopsy revealed borderline phyllodes tumor.

Malignant breast disorders:

3.1 Ductal carcinoma in situ – Ultrasound shows two microlobulated irregular hypoechoic masses with no posterior shadowing or enhancement. Biopsy revealed DCIS.

3.2 Invasive ductal carcinoma – Ultrasound shows an angular irregular mass with posterior acoustic shadowing. Biopsy revealed invasive ductal carcinoma.

3.3 Invasive lobular carcinoma – Ultrasound revealed an irregular heterogeneously hypoechoic mass. Biopsy showed invasive lobular carcinoma.

Fig. 1: Invasive Ductal Carcinoma

Conclusion: This pictorial review illustrates the ultrasound characteristics of a variety of benign and malignant breast disorders. The radiologist should be aware of benign ultrasound features to avoid unnecessary biopsies and at the same time be aware of suspicious features to avoid delay in the diagnosis of breast malignancy.