Hyperechoic breast lesions: anatomopathological correlation and differential sonographic diagnosis

Abstract

Hyperechoic lesions are not a frequent finding at breasts ultrasonography, and most of times are associated with benign pathologies that do not require further evaluation. However, some neoplasms such as invasive breast carcinomas and metastases may present with hyperechogenicity. Thus, the knowledge about differential diagnoses and identification of signs of lesion aggressiveness are of great relevance to avoid unnecessary procedures or underdiagnosis, and to support the correct clinical/surgical approach. On the basis of such concepts, the present essay describes and illustrates the main features of hyperechoic lesions at breast ultrasonography in different cases, with anatomopathological correlation.

Hyperechoic malignancies of the breast: Underlying pathologic features correlating with this unusual appearance on ultrasound

“…Similar findings, supporting hyperechogenicity as a benign feature, have been reported in subsequent studies . A pattern that is hyperechoic is often indicative of a lesion having a component of adipose tissue in addition to fibrous tissue (eg, angiolipomas, myofibroblastomas, hamartomas, and fat necrosis) . The secretions associated with lactational adenomas, the densely packed vessels filled with blood in benign vascular lesions, and blood accumulated in chronic hematomas have also been associated with a hyperechoic pattern .…”

“…Of the 45 reported hyperechoic malignancies, 62% are invasive ductal carcinomas, 16% invasive lobular carcinomas or carcinomas with lobular features, 7% mucinous carcinomas, 7% lymphomas, 7% metastases, and there is a single case of ductal carcinoma in situ (Table ). Other types of breast malignancies that can present as hyperechoic masses are angiosarcomas, liposarcomas, and phyllodes tumors …”

“…In an important study by Stavros and colleagues, strictly defined hyperechoic lesions had a 100% negative predictive value for malignancy . However, rare malignant hyperechoic lesions have been reported . The US patterns associated with these lesions and the pathologic features underlying why these malignancies give rise to this type of echogenic pattern have not been well described.…”

A Citologia Mamária Na Detecção Precoce Do Câncer De Mama: Uma Revisão

“…É muito temido, pois causa não só prejuízos ao organismo da paciente, mas também causa um grande impacto psicológico e social. As maiores taxas de incidência são em mulheres a partir dos 35 anos, porém as alterações mamárias podem ocorrer em qualquer idade (INCA, 2018, MEDEIROS, et al, 2016. As taxas de mortalidade associadas ao câncer de mama no Brasil são alarmantes entre as mulheres no período da menopausa, pois essa fase é um fator de risco, e as mulheres que demorarem a procurar orientação médica acabam por receber um diagnóstico tardio, quando a doença já está em estágio avançado (INCA, 2018).…”

Juvenile fibroadenoma

“…A unilateral increase in breast size is most commonly related to abnormal breast development, whereas nodules in the breast are most commonly related to fibroadenoma. Such nodules present a low risk of becoming malignant, are hormone-dependent, and can shrink after menopause ( 1 ) .…”