OBJECTIVETo evaluate the incidences of hyperechoic breast lesions and hyperechoic breast cancers in lesions categorized as Breast Imaging Reporting and Data System (BI-RADS) 4 and 5 on ultrasound and investigate their sonographic features and the underlying histological causes.

METHODSThe pathologic records for 848 sonographically guided core needle biopsies or surgical resection were retrospectively reviewed from June 2012 to March 2014. Hyperechoic lesions were identified and their sonographic features were evaluated. The incidence of hyperechoic breast lesions and the frequency of hyperechoic cancers among all hyperechoic breast lesions were calculated.

RESULTSOf all 848 lesions, 0.9% (8/848) were hyperechoic. Twenty-five percent (2/8) of the hyperechoic lesions were malignant and the remaining six were benign. Among the 280 malignant lesions, 0.7%(2/280) were hyperechoic. The pathological basis of breast lesions presenting as hyperechoic nodules included inflammatory edema, galactoceles, and grit calcifications. Little difference of sonographic feature was found between benign and malignant hyperechoic lesions in this study.

CONCLUSIONSHyperechoic breast lesions are rare conditions but can be associated with a high ratio of breast cancer. History-taking and imaging techniques may help to avoid misdiagnosis.