How to find an isoechoic lesion with breast US

Breast ultrasonography (US) is recognized as a useful diagnostic tool for palpable or nonpalpable breast masses, but isoechoic lesions surrounded by fat can be a challenge for radiologists and can result in false-negative interpretations and a delayed diagnosis of breast cancer. Identifying isoechoic lesions surrounded with fat by using breast US requires meticulous evaluation with B-mode US in correlation with mammography. For correlation between mammography and US, the location, surrounding tissue, and lesion characteristics, including size, shape, and internal contents, must be considered. Complementary tools to B-mode US in the evaluation of isoechoic breast lesions include spatial compound imaging, tissue harmonic imaging, US elastography, color or power Doppler imaging, power Doppler vocal fremitus imaging, and contrast agent enhancement. Specimen radiography after breast biopsy can be helpful in evaluating the adequacy of tissue sampling and the appropriateness of lesion targeting and localization, evaluations that increase confidence in the findings from tissue acquisition.