Breast carcinomas: variations in sonoelastographic appearance

Figures & data

Figure 1 Classification used and proposed by authors.

Note: Assessment of breast masses during compression and after decompression of breast parenchyma, where scores of 1, 2, and 3 indicate benign masses, and a score of 4 is suspicious for malignancy.

Table 1 Distribution of histopathologic results by sonoelastographic scores (%)

	Score 2	Score 3	Score 4	Total
Group 1
DCIS	–	2 (2.4)	2 (2.4)	4 (4.8)
Papillary	1 (1.2)	1 (1.2)	–	2 (2.4)
Mucinous	–	–	1 (1.2)	1 (1.2)
Carcinoid	1 (1.2)	–	–	1 (1.2)
Total	2 (2.4)	3 (3.6)	3 (3.6)	8 (9.5)
Group 2
IDC	–	2 (2.4)	61 (72.6)	63 (75)
ILC	–	2 (2.4)	11 (13.1)	13 (15.5)
Total	–	4 (4.8)	72 (85.7)	76 (90.5)
Total	2(2.4)	7 (8.3)	75 (89.3)	84

Notes: Group 1 corresponds to soft carcinomas, Group 2 to hard carcinomas, scores 2 and 3 to false-negative results, and score 4 to true-positive results.

Abbreviation: DCIS, ductal carcinoma in situ; IDC, invasive ductal carcinoma; ILC, invasive lobular carcinoma.

Figure 2 Age distribution for false-negative (group 1) and true-positive (group 2) results.

Note: No significant difference in mean age was observed between the two groups (P=0.4946, Student’s t-test).

Table 2 Chi-square test to verify association between sonoelastographic scores and histologic groups

	Group 1 (soft lesions)	Group 2 (hard lesions)	Total
OF – observed frequencies
TP	3	72	75
FN	4	5	9
EF – expected frequencies
TP	6.25	68.75	75
FN	0.75	8.25	9
Difference OF × EF
TP	1.69	0.15	1.84
FN	14.08	1.28	15.36
Total	7	77	84

Notes: χ² cal =12.32; χ² tab =3.84; P=0.00045. Scores of 2 and 3 were considered FN and a score of 4 indicated TP, where group 1 contained soft lesions and group 2 hard lesions.

Abbreviations: FN, false-negative; TP, true-positive; OF, observed frequency; EF, expected frequency; cal, calculated; tab, tabulated.

Figure 3 Size distribution for false-negative (group 1) and true-positive (group 2) results.

Note: No significant difference in median size was observed between the two groups (Mann–Whitney U test; P=0.9712).

Figure 4 Atypical presentation of invasive ductal carcinoma in a 40-year-old patient, presenting as a palpable mass.

Notes: Conventional ultrasound shows a hyperechoic and circumscribed mass (arrow), classified as BI-RADS^® 4a (A). On sonoelastography, the lesion appears as a hard mass, classified as score 4 (B). Histology confirmed the lesion as intermediate-grade invasive ductal carcinoma (C).
Abbreviation: BI-RADS, Breast Imaging and Reporting Data System.

Figure 5 Heterogeneous mass in the left breast of a 45-year-old patient.

Notes: Classified as BI-RADS^® 5 by conventional ultrasound, with a diameter of 3.0 cm (A). Sonoelastography shows the behavior of a soft lesion, classified as score 2 (B). Magnetic resonance imaging confirmed the heterogeneity of the lesion, with areas suggestive of interspersed necrosis, indicated by the full arrow (C). Histology confirmed areas of necrosis in a high-grade invasive ductal carcinoma, indicated by arrowhead (D).
Abbreviation: BI-RADS, Breast Imaging and Reporting Data System.

Figure 6 Clustered retroareolar microcalcifications in the right breast of a 52-year-old patient.

Notes: (A) shows mammogram classified as BI-RADS^® 4c. (B) shows a magnification of the microcalcifications (solid arrow). (C) shows the correlation between microcalcifications and ultrasound, which shows as a nonmass lesion (open arrow). On sonoelastography, it was not possible to characterize the lesion, which was classified as score 1 (D). Histology confirmed ductal carcinoma in situ with associated microcalcifications (E). The inset shows the microscopic playstation of the lesion.
Abbreviation: BI-RADS, Breast Imaging and Reporting Data System; CCD, right craniocaudal view.

Figure 7 Mucinous carcinoma in a 58-year-old patient.

Notes: The mammogram shows focal asymmetry with indistinct margins in the medial quadrant of the left breast, indicated by the filled arrow (A). The mass was classified as score 3 on sonoelastography because of the soft areas observed at the periphery of the lesion, indicated by the arrowhead (B). Ultrasound examination showed an irregular mass in the topography of the lesion classified as BI-RADS^® 4c, indicated by double arrows (C). Histology confirmed a medullary carcinoma (D). The inset shows the microscopic playstation of the lesion.
Abbreviation: BI-RADS, Breast Imaging and Reporting Data System; CCD, right craniocaudal view; CCE, left craniocaudal view.

Figure 8 Invasive ductal carcinoma of intermediate grade in a 63-year-old patient.

Notes: Characterized as an irregular mass on ultrasonography and classified as BI-RADS^® 5, with a diameter of 3.5 cm (A). Sonoelastography shows the behavior of a rigid lesion, classified as score 4 (B). Histology confirmed invasive ductal carcinoma (C).
Abbreviation: BI-RADS, Breast Imaging and Reporting Data System.