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Background <p>Ultrasound (US) imaging of breast lymphoma often reveals a variety of internal echo patterns, making differentiation from breast cancer challenging. This study aimed to correlate pathological findings with US imaging features of breast lymphoma to enhance biopsy accuracy and diagnostic precision.</p> Materials and methods <p>We retrospectively analyzed 37 lesions (36 cases) with available US images and needle biopsy pathology specimens from breast lymphoma patients at our hospital between 2010 and 2021. The area ratios of tumor cells, mammary gland tissue, and adipose tissue in pathology specimens were compared with internal echo patterns on US. Additionally, we assessed US images during the healing process in cases with complete resolution following treatment.</p> Results <p>US identified 34 of 37 lesions (92%) as masses. Of these, 23 (68%) exhibited mixed internal echoes, while 11 (32%) were hypoechoic. Among the mixed echo lesions, 9 (27%) displayed a mixed hyper-to-hypoechoic pattern, and 14 (41%) showed a mixed iso-to-hypoechoic pattern. Pathological analysis revealed that the tumor cell median area ratio was highest in hypoechoic masses, mammary gland tissue median ratio was highest in mixed iso-to-hypoechoic masses, and adipose tissue median ratio was highest in mixed hyper-to-hypoechoic masses. During healing, the mass changed to non-mass abnormalities in 10 cases (77%) and decreased in size while retaining its shape in 3 cases (23%).</p> Conclusion <p>The internal echo patterns of breast lymphoma varied depending on three factors: the proportion of tumor cells; the presence of regions with low tumor cell density; and adipose tissue infiltration. Hypoechoic areas likely reflected tumor cells, isoechoic areas mammary gland tissue, and hyperechoic areas adipose tissue infiltration. These findings suggest that biopsy from hypoechoic regions is recommended for accurate diagnosis.</p>

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Causes of varied internal echo patterns in ultrasound imaging of breast lymphoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月7日

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  • Yumi Kokubu,
  • Tomo Osako,
  • Takehiko Sakai,
  • Yui Tomita,
  • Chieko Kato,
  • Yuri Maruoka,
  • Masashi Akiya,
  • Chikako Takahata,
  • Takayuki Ueno,
  • Kiyoshi Matsueda

摘要

Background

Ultrasound (US) imaging of breast lymphoma often reveals a variety of internal echo patterns, making differentiation from breast cancer challenging. This study aimed to correlate pathological findings with US imaging features of breast lymphoma to enhance biopsy accuracy and diagnostic precision.

Materials and methods

We retrospectively analyzed 37 lesions (36 cases) with available US images and needle biopsy pathology specimens from breast lymphoma patients at our hospital between 2010 and 2021. The area ratios of tumor cells, mammary gland tissue, and adipose tissue in pathology specimens were compared with internal echo patterns on US. Additionally, we assessed US images during the healing process in cases with complete resolution following treatment.

Results

US identified 34 of 37 lesions (92%) as masses. Of these, 23 (68%) exhibited mixed internal echoes, while 11 (32%) were hypoechoic. Among the mixed echo lesions, 9 (27%) displayed a mixed hyper-to-hypoechoic pattern, and 14 (41%) showed a mixed iso-to-hypoechoic pattern. Pathological analysis revealed that the tumor cell median area ratio was highest in hypoechoic masses, mammary gland tissue median ratio was highest in mixed iso-to-hypoechoic masses, and adipose tissue median ratio was highest in mixed hyper-to-hypoechoic masses. During healing, the mass changed to non-mass abnormalities in 10 cases (77%) and decreased in size while retaining its shape in 3 cases (23%).

Conclusion

The internal echo patterns of breast lymphoma varied depending on three factors: the proportion of tumor cells; the presence of regions with low tumor cell density; and adipose tissue infiltration. Hypoechoic areas likely reflected tumor cells, isoechoic areas mammary gland tissue, and hyperechoic areas adipose tissue infiltration. These findings suggest that biopsy from hypoechoic regions is recommended for accurate diagnosis.