Nonmasslike lesions on breast sonography: comparison between benign and malignant lesions

To compare the imaging and clinical features of benign and malignant nonmasslike lesions in the breast.

During a 2-year period at a single institution, 186 nonmasslike lesions in 158 women were pathologically confirmed through surgery or sonographically guided biopsy. The sonographic patterns (mottled, geographic, and indistinct) and distributions (focal and regional) were compared between benign and malignant lesions. The presence of sonographically visible calcifications, amount of color Doppler signals, presence of positive findings on mammography, and presence of symptoms were also compared between the two groups.

A total of 156 lesions (84%) were confirmed as benign and 30 (16%) as malignant. On sonography, malignant nonmasslike lesions more frequently had mottled and geographic patterns and regional distribution than benign lesions (P < .0001). Malignant lesions also more frequently had sonographically visible calcifications (40% versus 0%; P < 0.0001) and a greater amount of color Doppler signals than benign lesions (P < .0001). On mammography, malignant lesions more frequently had densities and calcifications than benign lesions (30.4% versus 7.1%; P = 0.0052; 73.9% versus 6.1%; P < .0001, respectively). Clinically, malignant lesions were more frequently palpable and accompanied by localized pain than benign lesions (50% versus 2.6%; P< .0001; 13.3% versus 0.6%; P = .0025).

The imaging and clinical features of malignant nonmasslike lesions differed significantly from those of benign nonmasslike lesions.