Poor Quality Ultrasound Hides Cancer

IMAGING FINDINGS: ​

​A mediolateral oblique view demonstrates a large mass with obscured margins in the superior left breast.  There are also enlarged left axillary lymph nodes. An ultrasound image demonstrates a large “anechoic” mass.

​This was said to be a “cyst” by the sonographer.  However, the gain is incorrect on this image. With appropriate sonographic settings this proved to be a suspicious hypoechoic mass and ultimately an invasive ductal carcinoma (which is what was expected based on the mammographic findings.) 

WHY IT MATTERS:

1. Ultrasound evaluation is operator dependent. It is possible to create artifactual “masses” and to turn almost any abnormality into a “cyst”  if appropriate settings are not employed.
2. The radiologist should review (and preferably scan themselves) all diagnostic patients before they are let go.

FURTHER READING:
Breast Ultrasonography: State of the Art (Radiology 2013)