title: Predictors of Malignancy in Hyperechoic Breast Lesions.
abstract: OBJECTIVE
  Hyperechogenicity has been strongly associated with benign breast lesions. Although it is correct in most cases, hyperechogenicity must not always be considered synonymous with benignancy, as hyperechoic breast cancers do occur. The purpose of this study was to review clinical and imaging characteristics of hyperechoic breast lesions, looking for features associated with malignancy.
  
  
  METHODS
  Institutional Review Board approval was granted for this research. A total of 19,417 sonographic examinations were performed between January 2009 and June 2013. Among these, hyperechoic lesions with histologic diagnoses, stability on long-term followup, or characteristic imaging appearances were included in the study. The patients' clinical charts, mammograms, and sonograms were reviewed. The clinical and imaging features were recorded, and the data was analyzed by the χ(2) test, Fisher exact test, and independent-samples t test, looking for statistically significant predictors of malignancy.
  
  
  RESULTS
  Among the 19,417 scans, 42 patients (0.2%) with 44 hyperechoic lesions were identified. Twenty-six lesions fulfilling the inclusion criteria were included in the study: 5 malignancies (3 invasive ductal carcinomas, 1 invasive lobular carcinoma, and 1 invasive mucinous cancer) and 21 benign lesions. An irregular shape, a nonparallel orientation, and noncircumscribed margins were significantly associated with the risk of malignancy (P = .002, .02, and .01, respectively).
  
  
  CONCLUSIONS
  A hyperechoic breast lesion must not always be assumed to be benign. Instead, a full sonographic assessment according to the American College of Radiology Breast Imaging Reporting and Data System descriptors is needed for correct characterization and avoidance of misdiagnosis.
authors.affiliation: Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Lara
authors.initials: L
authors.lastname: Nassar
authors.affiliation: Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Ghada
authors.initials: G
authors.lastname: Issa
authors.affiliation: Epidemiological Surveillance Program, Ministry of Public Health, Beirut, Lebanon.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Farah
authors.affiliation: Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
authors.forename: Youssef
authors.initials: Y
authors.lastname: El Zein
authors.affiliation: Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon gb02@aub.edu.lb.
authors.forename: Ghina
authors.initials: G
authors.lastname: Berjawi
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016217:Ultrasonography, Mammary / Q000379:methods* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: breast; breast ultrasound; hyperechoic; malignancy; sonography