How to Evaluate a Breast Nodule on Ultrasound of the Breast?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • You first evaluate the lesion for:
    • Any of the 10 malignant signs:
      • Shadowing
      • Hypoechoic echotexture
      • Spiculation
      • Angular margins
      • Thick echogenic halo
      • Microlobulation
      • Taller than wide
      • Duct extension
      • Branching pattern
    • Calcifications
  • Finding none:
    • You move on to the second step in the evaluation process:
      • Specifically look for one of the 3 strictly defined benign signs:
        • If any of them are found:
          • The lesion can be considered BIRADS 3:
            • A 6-month follow-up ultrasound would be appropriate unless the anxiety of the patient makes core biopsy a better option
    • The 3 benign findings defined by Stavros are:
      • A purely hyperechoic lesion:
        • With no hypoechoic area larger than a normal duct or lobule
      • Elliptical, wider than tall, well-circumscribed and thin echogenic capsule
      • Gently lobulated, wider than tall, well-circumscribed and thin echogenic capsule
      • Combining the elliptical or gently lobulated shapes:
        • With the presence of a complete, thin echogenic capsule:
          • Is necessary because many circumscribed carcinomas and most ductal carcinoma in situ are encompassed in a thin, echogenic capsule:
            • However, the shape of circumscribed invasive carcinoma or pure ductal carcinoma in situ:
              • Is rarely elliptical or gently lobulated:
  • References:
    • Madjar H, Mendelson EB. The Practice of Breast Ultrasound. 2nd ed. Thieme; 2008;141-144.
    • Stavros AT. Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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