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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:911-920 • 0278-4297

Contrast-Enhanced Breast Ultrasonography

Imaging Features With Histopathologic Correlation

He Liu, MD, Yu-Xin Jiang, MD, Ji-Bin Liu, MD, Qing-Li Zhu, MD, Qiang Sun, MD and Xiao-Yan Chang, MD

Departments of Diagnostic Ultrasound (H.L., Y.-X.J., Q.-L.Z.), Surgery (Q.C.), and Pathology (X.-Y.C.), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania USA (J.-B.L.).

Address correspondence to Yu-Xin Jiang, MD, Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Wangfujing, 100730 Beijing, China., E-mail: yuxinjiangxh{at}yahoo.com.cn

Objective. The purpose of this study was to identify histopathologic correlates for the varied appearances of breast masses on contrast-enhanced ultrasonography (CEUS). Methods. Contrast-enhanced ultrasonography was performed in 104 patients (age range, 19–86 years) after administration of a sulfur hexafluoride microbubble contrast agent, and enhancement patterns were classified as no enhancement, peripheral enhancement, homogeneous enhancement, regional enhancement, and heterogeneous enhancement. All patients’ histologic slides were reviewed and correlated with CEUS findings. Results. In malignant masses, heterogeneous enhancement corresponded to tumor cell cords or clusters in a variable amount of desmoplastic stroma. Homogeneous enhancement corresponded to hypercellularity in the whole mass, or ductal carcinoma in situ (DCIS) was predominant. Regional enhancement corresponded to a DCIS component. Peripheral enhancement corresponded to a DCIS component, hypercellularity or adenosis at the periphery, and low-degree cellularity, degeneration, fibrosis, or necrosis in the center. No enhancement was present in 1 case of low-grade DCIS. In benign masses, heterogeneous enhancement corresponded to loose cell proliferation in a more sclerotic stroma. Homogeneous enhancement corresponded to diffuse hypercellularity, an inflammatory cell infiltrate, or intraductal papilloma. Regional enhancement corresponded to focal hypercellularity or intraductal papilloma within a dilated duct. No enhancement corresponded to desmoplastic stroma. Peripheral enhancement was shown in 1 case of granulomatous mastitis with an inflammatory infiltrate at the periphery and necrosis in the center. Conclusions. Breast mass CEUS findings correlated with histologic features.

Key Words: breast neoplasm • contrast-enhanced ultrasonography • pathologic correlation

Abbreviations: CEUS, contrast-enhanced ultrasonography • DCIS, ductal carcinoma in situ • H&E, hematoxylin-eosin • IDC, invasive ductal carcinoma

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Copyright © 2009 by the American Institute of Ultrasound in Medicine.