Benign and Malignant Ultrasound Semiology

Abstract

Ultrasound (US) is the method of choice to differentiate cystic from solid masses seen by mammography and evaluate palpable lumps in women under the age of 30. With the advances in equipment technology and radiologist experience, differentiating benign and malignant ultrasound abnormalities although challenging is still achievable. The simple breast cyst is the most common benign abnormality. The clinical value of documenting a mammographic density by US as cystic alleviates the need for biopsy or aspiration and reduces the BIRADS score from 3 to 2. Types of cysts whether simple, complicated or complex will be discussed together with their diagnostic criteria. Characteristics of benign and malignant solid masses will be described along with specific pathological types and their key diagnostic principles. The theory of the sick lobe has correlated the radiologic—pathologic diagnosis of multifocality/multicentricity, intraductal spread and tumour extent with the principle that breast cancer is not necessarily small at its earliest stages of development; on the contrary, it is widespread and multifocal in the majority of cases.

A perfect world is one in which a radiologist can ideally differentiate a benign from a malignant breast abnormality. However, differences in operator experience, equipment and diversity of abnormalities have made this a difficult task. The large number of unnecessary biopsies performed worldwide has led to a rising concern and adverse effect on women, decreasing their appetite for screening. Ultrasound definitely has an important role in the workup of a screening or diagnostic mammogram and in guiding interventional procedures. Understanding breast anatomy within the concept of the sick lobe theory is an important factor in implementing diagnostic criteria.