Reproducibility of US BI-RADS terminology is good except for margin evaluation. A trend toward lower concordance was noted for the evaluation of small masses and malignant lesions. Classification into subdivisions 4a, 4b, and 4c was poorly reproducible.

Malignancy grade was slightly to moderately predicted by margin, lesion boundary, and acoustic sonographic features. In particular, grade 3 invasive ductal breast carcinomas were more likely than expected to display microlobulated margins, abrupt interfaces, and posterior enhancement.

The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.

Specimen sonography is an effective procedure for identifying the presence of the lesion within the specimen; however, it is of limited value in cases of small hypoechoic lesions against a fatty background. Assessment of margins is limited by both false-positive and false-negative results.

No abstract

Sonographic features of BRCA-associated and sporadic breast carcinomas do not differ substantially. BRCA1-associated breast carcinomas trend toward less malignant sonographic characteristics, but strict application of the BI-RADS categorizations demands that they be classified as category 4 or 5.

Although some sonographic features could favor a benign diagnosis, when a core biopsy yields the diagnosis of a papillary lesion, surgical excision is recommended to definitely exclude malignancy.

No statistically significant difference was found between mammographic presentation and postsurgical outcome of LCIS versus ALH lesions. Surgical excision of these lesions is recommended as long as no evident criteria are provided to differentiate those that might be associated with an underlying malignancy.