Breast Biopsy Avoidance: The Value of Normal Mammograms and Normal Sonograms in the Setting of a Palpable Lump1
Mark A. Dennis, MD,
Steve H. Parker, MD,
Anita J. Klaus, MD,
A. Thomas Stavros, MD,
Terese I. Kaske, MD and
Sallie B. Clark, MD
1 From the Sally Jobe Breast Centers, Radiology Imaging Associates, 8200 E Belleview Ave, Suite 102, Englewood, CO 80111 (M.A.D., S.H.P., A.J.K., A.T.S., T.I.K.); and Surgical Consultants of Aurora, Colo (S.B.C.). Received May 7, 2000; revision requested July 24; revision received August 14; accepted August 30. Address correspondence to M.A.D. (e-mail: mark.dennis@riaco.com).
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Figure 1. Sonogram obtained in a 45-year-old woman with a hard mass at breast self-examination shows subcutaneous adipose tissue (long straight arrow), type 1 hyperechoic tissue with thin branching hypoechoic structures (curved arrows), and pectoralis muscle (short straight arrow).
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Figure 2. Sonogram obtained in a 51-year-old woman with an elongated mass reported by the primary care physician shows relatively isoechoic tissue (short straight arrow) anteriorly, a type 2 hyperechoic band (curved arrows), and posterior or retromammary isoechoic tissue (long straight arrow).
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Figure 3. Sonogram obtained in a 52-year-old woman with thickening at physical examination shows type 3 mixture of isoechoic tissue and relatively hyperechoic tissue. The pectoralis muscle (arrow) also is shown.
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Figure 4. Sonogram obtained in a 60-year-old woman who presented with a discrete mass shows a type 4 prominent, upwardly convex peak of hyperechoic tissue. Black arrows define the upper surface of the prominence. White arrow points to the pectoralis muscle.
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Figure 5. Split-screen sonogram obtained in a 31-year-old woman with focal breast thickening shows the noncompressed (NON COMP) fat lobule (short curved arrows) on the left screen compared with the same lobule in the compressed (COMP) state (long curved arrows) on the right screen; these findings suggest a type 5 tissue pattern and that there is no underlying isoechoic pathologic process.
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Figure 6. Sonogram obtained in a 45-year-old woman who reported having a small lump shows an isoechoic structure (arrows) completely surrounded by hyperechoic tissue; hence the term "trapped lobule," or type 6 tissue pattern.
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Figure 7. Sonogram obtained in a 45-year-old woman with a periareolar "ropey" lump shows a type 7 prominent anechoic tubular structure or ectatic duct (arrows).
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Figure A1. Flow diagram of algorithm used to evaluate palpable abnormalities. ALCB = automated large-core biopsy, PROB = probability, F/U = follow-up, SONO = sonography.
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Copyright © 2001 by the Radiological Society of North America.
