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© 2005 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 24:635-641 • 0278-4297

Risk of Malignancy in Solid Breast Nodules According to Their Sonographic Features

Régis Resende Paulinelli, MD, Ruffo Freitas-Júnior, MD, PhD, Marise Amaral Rebouças Moreira, PhD, Vardeli Alves de Moraes, MD, PhD, Júlio Roberto M. Bernardes-Júnior, MD, PhD, Célio da Silva Rocha Vidal, MD, Alessandro Naldi Ruiz, MD and Miliana Tostes Lucato, MD

Departments of Gynecology and Obstetrics (R.R.P., R.F.-J., V.A.d.M., J.R.M.B.-J, C.d.S.R.V., A.N.R., M.T.L.) and Pathology and Imaging (M.A.R.M.), School of Medicine, Federal University of Goiás, Goiás, Brazil.

Address correspondence to Ruffo Freitas-Júnior, MD, PhD, Alameda das Rosas, 533 Setor Oeste, CEP:74110-060 Goiânia, Goiás, Brazil. E-mail: ruffojr{at}terra.com.br.

Objective. The purpose of this study was to assess the risk of malignancy for each type of sonographic feature in solid breast nodules. Methods. The study included 304 patients from the Department of Gynecology and Obstetrics of the Federal University of Goiás who had solid breast nodules. A medical trainee, working under the supervision of a preceptor, obtained the sonographic images of the breast, and the features were recorded in a questionnaire. Each sonographic feature was analyzed and compared with the anatomic and pathologic findings after the lesion was excised. Results. Of the 304 patients included in the study, 292 (96%) had a conclusive diagnosis. Among these women, 216 (74%) had benign tumors and 76 (26%) had malignant tumors. The odds ratio of malignancy in breast nodules, as calculated by multivariate analysis, was as follows: lesions without circumscribed margins, 17.02 (95% confidence interval, 5.28–54.90); lesions with heterogeneous echo texture, 7.70 (2.99–19.84); lesions with thickened Cooper ligaments, 15.61 (1.08–225.10); nodules whose anteroposterior dimension was larger than their width, 3.29 (1.09–9.96); those with an anterior echogenic rim, 2.59 (0.80–8.40); and those with posterior shadowing, 1.57 (0.62–4.01). Among the 133 cases that had all the sonographic features of a benign lesion, 3 nodules (2.3%) had a histologic diagnosis of malignant. Conclusions. Sonography is a diagnostic method that can help establish the differentiation between benign and malignant solid tumors. A lack of circumscribed margins, heterogeneous echo patterns, thickened Cooper ligaments, and an increased anteroposterior dimension can indicate a higher probability of malignancy in solid breast nodules.

Key Words: breast • breast neoplasms • diagnosis • sonography

Abbreviations: BI-RADS, Breast Imaging Reporting and Data System




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