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Application of Sonographic BI-RADS to Synchronous Breast Nodules Detected in Patients with Breast Cancer

Suk Jung Kim1,2, Eun Young Ko1, Jung Hee Shin1, Seok Seon Kang1, Sung Hee Mun1,3, Boo-Kyung Han1 and Eun Yoon Cho4

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-ku, Seoul 135-710, Korea.
2 Department of Radiology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea.
3 Department of Radiology, Catholic University of Daegu, College of Medicine, Daegu, Korea.
4 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.


Figure 1
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  		Fig. 1 —Flow diagram of synchronous nodules.

 

Figure 2
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  		Fig. 2A —49-year-old woman with invasive ductal carcinoma in upper outer quadrant of left breast managed with partial mastectomy. Preoperative sonograms show malignant mass in upper outer quadrant of left breast (A) and synchronous nodule (arrow) in upper outer quadrant of contralateral breast (B). Synchronous nodule was flat and isoechoic and classified category 3. However, nodule was confirmed to be ductal carcinoma in situ.

 

Figure 3
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  		Fig. 2B —49-year-old woman with invasive ductal carcinoma in upper outer quadrant of left breast managed with partial mastectomy. Preoperative sonograms show malignant mass in upper outer quadrant of left breast (A) and synchronous nodule (arrow) in upper outer quadrant of contralateral breast (B). Synchronous nodule was flat and isoechoic and classified category 3. However, nodule was confirmed to be ductal carcinoma in situ.

 

Figure 4
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  		Fig. 3 —44-year-old woman with invasive ductal carcinoma in upper outer quadrant of right breast managed with breast-conserving surgery. Preoperative sonogram shows malignant mass (M) in upper outer quadrant of right breast and synchronous nodule (arrow). Synchronous nodule was irregular hypoechoic mass classified category 5. However, nodule was confirmed to be stromal fibrosis.

 

Figure 5
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  		Fig. 4A —50-year-old woman with invasive ductal carcinoma in upper inner quadrant and microinvasive ductal carcinoma in lower inner quadrant of right breast managed with modified radical mastectomy. Preoperative sonograms show malignant masses in upper inner quadrant (A) and lower inner quadrant (B) of right breast and synchronous nodule (arrow) in contralateral breast (C). Synchronous nodule was well-circumscribed oval hypoechoic mass classified category 3. Nodule was confirmed to be intraductal papilloma.

 

Figure 6
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  		Fig. 4B —50-year-old woman with invasive ductal carcinoma in upper inner quadrant and microinvasive ductal carcinoma in lower inner quadrant of right breast managed with modified radical mastectomy. Preoperative sonograms show malignant masses in upper inner quadrant (A) and lower inner quadrant (B) of right breast and synchronous nodule (arrow) in contralateral breast (C). Synchronous nodule was well-circumscribed oval hypoechoic mass classified category 3. Nodule was confirmed to be intraductal papilloma.

 

Figure 7
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  		Fig. 4C —50-year-old woman with invasive ductal carcinoma in upper inner quadrant and microinvasive ductal carcinoma in lower inner quadrant of right breast managed with modified radical mastectomy. Preoperative sonograms show malignant masses in upper inner quadrant (A) and lower inner quadrant (B) of right breast and synchronous nodule (arrow) in contralateral breast (C). Synchronous nodule was well-circumscribed oval hypoechoic mass classified category 3. Nodule was confirmed to be intraductal papilloma.

 

Figure 8
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  		Fig. 5A —43-year-old woman with invasive ductal carcinoma in upper outer quadrant of right breast managed with breast-conserving surgery. Preoperative sonograms show malignant mass in upper outer quadrant of right breast (A) and two synchronous nodules in same (B) and different (upper inner) (C) quadrants of ipsilateral breast. One nodule (arrow, B) in same quadrant is well-circumscribed oval hypoechoic mass classified category 3. Lesion in different quadrant (arrow, C) is cluster of small cystic nodules classified category 3. However, these lesions were confirmed as another focus of invasive ductal carcinoma and ductal carcinoma in situ, respectively.

 

Figure 9
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  		Fig. 5B —43-year-old woman with invasive ductal carcinoma in upper outer quadrant of right breast managed with breast-conserving surgery. Preoperative sonograms show malignant mass in upper outer quadrant of right breast (A) and two synchronous nodules in same (B) and different (upper inner) (C) quadrants of ipsilateral breast. One nodule (arrow, B) in same quadrant is well-circumscribed oval hypoechoic mass classified category 3. Lesion in different quadrant (arrow, C) is cluster of small cystic nodules classified category 3. However, these lesions were confirmed as another focus of invasive ductal carcinoma and ductal carcinoma in situ, respectively.

 

Figure 10
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  		Fig. 5C —43-year-old woman with invasive ductal carcinoma in upper outer quadrant of right breast managed with breast-conserving surgery. Preoperative sonograms show malignant mass in upper outer quadrant of right breast (A) and two synchronous nodules in same (B) and different (upper inner) (C) quadrants of ipsilateral breast. One nodule (arrow, B) in same quadrant is well-circumscribed oval hypoechoic mass classified category 3. Lesion in different quadrant (arrow, C) is cluster of small cystic nodules classified category 3. However, these lesions were confirmed as another focus of invasive ductal carcinoma and ductal carcinoma in situ, respectively.

 

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