OBJECTIVE. The purposes of our study were, first, to evaluate the frequency, clinical
presentation, and associated imaging findings of malignant breast lesions presenting as
hyperechoic nodules in a large series of consecutive sonographically guided core needle
biopsies (CNBs) and, second, to investigate sonographic features that are able to predict
malignancy in hyperechoic breast lesions.
MATERIALS AND METHODS. The radiologic and pathologic records for 4511
consecutive sonographically guided CNBs were retrospectively reviewed. Hyperechoic
lesions were identified, and clinical notes and related mammography or MRI reports were
reviewed. The sonographic images were evaluated according to the BI-RADS lexicon by
two experienced breast radiologists. Surgical pathology results and follow-up served as
the reference standard for lesions diagnosed as malignant or high-risk and benign at CNB,
respectively. The frequency of hyperechoic carcinomas among all carcinomas was calculated.
Differences in sonographic appearance between hyperechoic benign and malignant lesions
were evaluated using the chi-square test or the Fisher exact test.
RESULTS. Of all biopsied lesions, 25 (0.6%) were hyperechoic. Among the 1849 malignant
lesions, nine (0.4%) were hyperechoic. The remaining 16 were benign. None of the hyperechoic
malignancies was a “purely” sonographic lesion, because all were palpable, mammographically
visible, or detectable on breast MRI. Malignant lesions were more likely than benign lesions
to have noncircumscribed margins (9/9 vs 7/16; p = 0.008) and nonparallel orientation (6/9 vs
1/16; p = 0.003).
CONCLUSION. When encountering a hyperechoic nodule, malignant nature cannot be
excluded. Suspicious sonographic signs and correlation with other imaging techniques may
help avoid misdiagnosis.
