The biology of malignant breast tumors has an impact on the presentation in ultrasound: an analysis of 315 casesReport as inadecuate

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BMC Women-s Health

, 13:47

Breast cancer and breast health health


BackgroundThe aim of this study was to evaluate the relation of some ultrasound morphological parameters to biological characteristics in breast carcinoma.

MethodsUltrasound data from 315 breast masses were collected. We analyzed the ultrasound features of the tumors according to the ACR BI-RADS®-US classification system stratified by hormone receptor status, HER2 status, histology grade, tumor type ductal versus lobular, triple-negativity, breast density, tumor size, lymph node involvement and patient’s age.

ResultsWe found a variety of ultrasound features that varied between the groups. Invasive lobular tumors were more likely to have an angulated margin 39% versus 22%, p = 0.040 and less likely to show posterior acoustic enhancement 3% versus 16%, p = 0.023 compared to invasive ductal carcinoma. G3 tumors were linked to a higher chance of posterior acoustic enhancement and less shadowing and the margin of G3 tumors was more often described as lobulated or microlobulated compared to G1-G2 tumors 67% versus 46%, p = 0.001. Tumors with an over-expression of HER2 exhibited a higher rate of architectural distortions in the surrounding tissue, but there were no differences regarding the other features. Hormone receptor negative tumors were more likely to exhibit a lobulated or microlobulated margin 67% versus 50%, p = 0.037 and less likely to have an echogenic halo 39% versus 64%, p = 0.001. Furthermore, the posterior acoustic feature was more often described as enhancement 33% versus 13%, p = 0.001 and less often as shadowing 20% versus 47%, p < 0.001 compared to hormone receptor positive tumors.

ConclusionDepending on their biological and clinical profile, breast cancers are more or less likely to exhibit the typical criteria for malignancy in ultrasound. Moreover, certain types of breast cancer tend to possess criteria that are usually associated with benign masses. False-negative diagnosis may result in serious consequences for the patient. For the sonographer it is essential to be well aware of potential variations in the ultrasound morphology of breast tumors, as described in this paper.

KeywordsBreast ultrasound Cancer detection Ultrasound features Tumor biology AbbreviationsACRAmerican College of Radiology


DCISDuctal carcinoma in situ

EREstrogen receptor

FISHFluorescent in situ hybridization


HER2Human epidermal growth factor receptor 2

HRHormone receptor


IDCInvasive ductal carcinoma

ILCInvasive lobular carcinoma



LNLymph node


n.anot applicable

n.snot significant

NHGNottingham Histology Grade


PAFPosterior acoustic features

PRProgesterone receptor

TNBCTriple-negative breast cancer


Electronic supplementary materialThe online version of this article doi:10.1186-1472-6874-13-47 contains supplementary material, which is available to authorized users.

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Author: S Wojcinski - N Stefanidou - P Hillemanns - F Degenhardt


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