What does a malignant breast nodule look like? The shape, margins, and aspect ratio have these characteristics!

Author: Chen Wen, Chief Physician, Peking University Third Hospital

Reviewer: Liang Zhen, Chief Physician, Peking University Cancer Hospital

"Breast nodules" is a term we often see in breast ultrasound examination reports. Some friends get very nervous when they see the word "nodules", worrying that they might get breast cancer.

What kind of breast nodules may be malignant? We can make a preliminary judgment based on the ultrasound report's description of the nodule's morphology, margins, aspect ratio, blood flow, etc.

1. Breast ultrasound description: What is the relationship between round, oval, and irregular shapes and the benign or malignant nature of nodules?

Relatively speaking, among these three words, oval is the favorite word of ultrasound doctors because most benign nodules are oval, so when a nodule is described as oval, the probability of it being benign is a little higher.

The round and irregular shapes have many meanings. They may be benign nodules or malignant nodules. At this time, it is necessary to combine other ultrasound signs to make a joint judgment. A nodule cannot be considered a malignant nodule simply because it is round or irregular.

Figure 1 Original copyright image, no permission to reprint

2. Breast ultrasound description: What do the following mean for nodule with clear edge, smooth, angulated, burred, and microlobed?

For ultrasound doctors, smooth and clear nodule edges are a very important ultrasound sign. It means that the nodule is clearly demarcated from other surrounding tissues and does not infiltrate or invade the surrounding tissues. In most cases, it means that the nodule is benign.

The angled edge of the nodule indicates that part of the nodule structure extends into the surrounding tissue like a bull's horn. In most cases, it means that the nodule is growing locally rapidly, which is a relatively dangerous ultrasound sign.

Burrs actually have similar symptoms, except that they appear as thinner linear structures that penetrate into the surrounding tissues, which is also a dangerous sign.

Microlobulation is manifested as some very small, petal-like local protrusions around a nodule, a bit like many small grape beads stacked together. This sign is common in breast ductal carcinoma in situ, so it is also a dangerous sign that deserves the attention of ultrasound doctors.

Figure 2 Original copyright image, no permission to reprint

3. Breast ultrasound description: What is the significance of the horizontal diameter and anterior-posterior diameter of the nodule?

When measuring a nodule, the diameter parallel to the skin is called the horizontal diameter, and the diameter perpendicular to the skin is called the anterior-posterior diameter.

For a breast nodule smaller than 1 cm, if its horizontal diameter is smaller than its anterior-posterior diameter, which is commonly known as "growing vertically", the risk of malignancy of the nodule is higher and ultrasound physicians will pay special attention to it.

When the horizontal diameter of a nodule is larger than the anterior-posterior diameter, which is commonly referred to as "growing horizontally", although the nodule is more likely to be benign, it still needs to be combined with other signs to determine its benign or malignant nature.

4. Breast ultrasound description: Does CDFI showing visible blood flow signals in the nodule mean that it is malignant?

The full Chinese name of CDFI is Color Doppler Flow Imaging, which is used to check whether there are blood vessels running in normal or abnormal tissues of the human body.

In fact, any solid or cystic nodule in our human body, whether benign or malignant, must have blood vessels running inside to provide it with nutrition. However, when the nodule is relatively small, the blood vessels inside are often relatively thin, and existing ultrasound technology may not be able to detect it. The ultrasound description will write "CDFI shows no obvious blood flow signal in the nodule."

However, as the nodule grows, the blood vessels inside it may become thicker and more numerous, and can be detected by existing ultrasound technology. The ultrasound description will write "CDFI shows visible blood flow signals in the nodule." This only means that the blood vessels in a nodule can be discovered, and does not mean that the nodule is benign or malignant.

Relatively speaking, the blood flow signals in malignant nodules will be more numerous and more complex, but these manifestations must be combined with other ultrasound signs to make a joint judgment on the benign or malignant nature of the nodule.