Sonomammographic characteristics of invasive lobular carcinoma

Figures & data

Video abstract

Figure 1 A 51-year-old female presented with hard right breast after suffering from right breast trauma 2 months previously. (A and B) Craniocaudal and mediolateral mammogram of the right breast revealed a dense breast with architectural distortion noted at upper outer quadrant (more evident on craniocaudal view). (C) Ultrasound revealed an ill-defined irregular hypoechoic mass with posterior acoustic shadowing at 9 o’clock of the right breast.

Note: The longitudinal axis of the mass was parallel to that of the skin.

Figure 2 A 48-year-old female patient presented with palpable right axillary lymph node. (A and B) Craniocaudal and mediolateral mammogram revealed asymmetric breast density with no definite masses. (C and D) Ultrasound revealed three small hypoechoic masses at 1–11 o’clock of the right breast (only two are displayed here).

Note: The masses have smooth margins, posterior acoustic shadowing, and their long axis was parallel to that of the skin.

Figure 3 A 58-year-old female with palpable mass in the left breast. (A and B) CC and ML mammogram films revealed ill-defined dense opacity with spiculated margins surrounded by architectural distortion at the lower central area of the breast, which looks to be attached to the pectoralis muscle posteriorly. (C) On ultrasound, ill-defined, spiculated, hypoechoic, solid mass with posterior shadowing measuring 16 × 13 mm is seen at 5 o’clock of the breast.

Notes: The mass was inseparable from the underlying muscle. Another smaller, similar hypoechoic mass is seen close by measuring 6 × 5 mm.
Abbreviations: CC, craniocaudal; ML, mediolateral.

Figure 4 A 72-year-old female with left breast mass. (A and B) Craniocaudal and mediolateral mammogram of left breast revealed an irregular spiculated, dense mass (35 × 25 mm) in the upper outer quadrant close to the pectoral muscle. Single benign macrocalcification is noted in the central area. (C) Ultrasound of the left breast revealed a spiculated, hypoechoic, solid mass (30 × 23 mm) with strong acoustic shadow at 3–4 o’clock.

Note: The mass extends to the pectoralis muscle with its long axis perpendicular to the skin.
Abbreviations: CC, craniocaudal; ML, mediolateral.

Figure 5 A 48-year-old female patient presented with hard right breast mass of 2 months duration. (A–C) CC, ML, and magnified mammogram views of the right breast revealed an irregular spiculated dense mass at the lower outer quadrant of the right breast. A magnified view shows clusters of pleomorphic microcalcifications within the lesion (arrows). Four foci of calcifications are seen away from the lesion. (D) Ultrasound revealed an ill-defined mass of heterogeneous echopattern at 8 o’clock of left breast.

Note: The mass shows foci of microcalcifications (arrows).
Abbreviations: CC, craniocaudal; ML, mediolateral.

Table 1 Mammographic findings of 32 cases of invasive lobular carcinoma

Feature	Number of cases/masses	Notes
Density
Mass	21	Total number of single masses = 30
Single	15
Multifocal/multicentric	6	Four cases had architectural distortion associated with mass
Bilateral	0
Asymmetry	3
Architectural distortion	12
Size
<1 cm	3
1–3 cm	21
>3 cm	5
Margins
Speculated	25
Smooth	4
Calcifications
Microcalcifications	8
Macrocalcifications	1
Skin thickening	5
Nipple retraction	None

Table 2 Sonographic findings in 32 cases of invasive lobular carcinoma

Feature	Number of cases/masses	Notes
Masses	24	Total number of masses = 35
Single	16
Multifocal/multicentric	8	One case was reported normal on ultrasound
Bilateral	0
Focal shadowing without mass	1
Architectural distortion	6
Size
<1 cm	7
1–3 cm	25
>3 cm	3
Mass
Hypoechoic	27
Mixed heterogeneous	8
Margins
Irregular, infiltrating	28
Rounded, smooth	7
Calcifications
Microcalcifications	5
Posterior acoustic features
Shadowing	23
No shadowing	11
Acoustic enhancement	1
Longitudinal axis
Perpendicular to skin	26
Parallel to skin	9
Associated fibroadenosis	10
Associated duct dilatation	3
Skin thickening	5