What is these Lesion in the Breast?

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • In a postmenopausal woman who is not taking hormone therapy:
    • The new development of a cyst would be uncommon
Diagnostic ultrasound images of nodular density
  • The lesion contains diffuse internal echoes:
    • So it is sonographically compatible with a complicated cyst
  • Low-grade carcinomas, especially ER+ tumors:
    • Grow slowly enough that one would not expect a mammogram 2 years earlier in such a patient to be completely normal
    • In addition, a low-grade carcinoma grows slowly enough to allow desmoplasia to occur:
      • Creating spicules
    • Low-grade carcinomas are less cellular than high-grade tumors, and have more collagen and less water:
      • These factors contribute to posterior shadowing:
        • Especially in lesions 1.5 cm or larger
    • A high-grade carcinoma:
      • Grows so rapidly that desmoplasia does not have time to develop
      • They are more cellular, evoke an inflammatory rather than fibroelastotic response, have more water content, and frequently have cystic or hemorrhagic necrosis:
        • All of these factors contribute to posterior enhancement rather than shadowing
  • Triple-negative breast cancer:
    • Can frequently be confused with a benign lesion on both mammogram and ultrasound due to its unique biological characteristics
    • Being a highly metabolically active cancer:
      • Its shape is usually round, oval and/ or lobulated, not spiculated like lower grade breast malignancies, and it often lacks an echogenic rim
    • As in other high-grade cancers, posterior acoustical enhancement rather than shadowing is seen
    • Astute sonographers will be able to demonstrate its low elasticity using specialized features on their ultrasound machine or by increasing transducer probe pressure
  • References
    • Dogan BE, Tumbull LW. Imaging of triple-negative breast cancer. Ann Oncol. 2012;23(Suppl 6):vi23-vi29
    • Kojima Y, Tsunoda H. Mammography and ultrasound features of triple-negative breast cancer. Breast Cancer. 2011;18(3):146-151.
    • Stavros AT. Ultrasound of solid breast nodules: distinguishing benign for malignant. In: Stavros AT. Breast Ultrasound. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:445-527.
    • Wojcinski S, Soliman AA, Schmidt J, Makowski L, Degenhardt F, Hillemanns P. Sonographic features of triple-negative and non-triple-negative breast cancer. J Ultrasound Med. 2012;31(10):1531-1541.
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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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