Nassar Lara, Issa Ghada, Farah Zeina, El Zein Youssef, Berjawi Ghina
Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
Epidemiological Surveillance Program, Ministry of Public Health, Beirut, Lebanon.
J Ultrasound Med. 2016 Apr;35(4):783-90. doi: 10.7863/ultra.15.05020. Epub 2016 Mar 11.
Hyperechogenicity has been strongly associated with benign breast lesions. Although it is correct in most cases, hyperechogenicity must not always be considered synonymous with benignancy, as hyperechoic breast cancers do occur. The purpose of this study was to review clinical and imaging characteristics of hyperechoic breast lesions, looking for features associated with malignancy.
Institutional Review Board approval was granted for this research. A total of 19,417 sonographic examinations were performed between January 2009 and June 2013. Among these, hyperechoic lesions with histologic diagnoses, stability on long-term followup, or characteristic imaging appearances were included in the study. The patients' clinical charts, mammograms, and sonograms were reviewed. The clinical and imaging features were recorded, and the data was analyzed by the χ(2) test, Fisher exact test, and independent-samples t test, looking for statistically significant predictors of malignancy.
Among the 19,417 scans, 42 patients (0.2%) with 44 hyperechoic lesions were identified. Twenty-six lesions fulfilling the inclusion criteria were included in the study: 5 malignancies (3 invasive ductal carcinomas, 1 invasive lobular carcinoma, and 1 invasive mucinous cancer) and 21 benign lesions. An irregular shape, a nonparallel orientation, and noncircumscribed margins were significantly associated with the risk of malignancy (P = .002, .02, and .01, respectively).
A hyperechoic breast lesion must not always be assumed to be benign. Instead, a full sonographic assessment according to the American College of Radiology Breast Imaging Reporting and Data System descriptors is needed for correct characterization and avoidance of misdiagnosis.
高回声与乳腺良性病变密切相关。虽然在大多数情况下这是正确的，但高回声并不总是等同于良性，因为确实存在高回声型乳腺癌。本研究的目的是回顾高回声乳腺病变的临床和影像学特征，寻找与恶性肿瘤相关的特征。
本研究获得了机构审查委员会的批准。2009年1月至2013年6月期间共进行了19417次超声检查。其中，具有组织学诊断、长期随访稳定或具有特征性影像学表现的高回声病变被纳入研究。回顾了患者的临床病历、乳房X线照片和超声检查结果。记录临床和影像学特征，并通过χ²检验、Fisher精确检验和独立样本t检验分析数据，寻找具有统计学意义的恶性肿瘤预测指标。
在19417次扫描中，发现42例患者（0.2%）有44个高回声病变。符合纳入标准的26个病变被纳入研究：5个恶性病变（3例浸润性导管癌、1例浸润性小叶癌和1例浸润性黏液癌）和21个良性病变。不规则形状、非平行方向和边界不清与恶性风险显著相关（P分别为0.002、0.02和0.01）。
不能总是认为高回声乳腺病变是良性的。相反，需要根据美国放射学会乳腺影像报告和数据系统描述符进行全面的超声评估，以正确定性并避免误诊。
