We are seeing a lot more triple negative cancers. These seem to be very hypoechoic ! With post enhancement and often have peripheral flow rather than internal flow and have been called complex cyts. On bx proven to be cancers
These are certainly tricky and it highlights that not all breast cancers are shadowing lesions. In the presentation I showed several examples of proven papillary or mucinous cancers that have acoustic enhancement. We have to be particularly careful to assess each lesion honestly. This is where the modern machines are particularly helpful. A generation ago in technology and these lesions appear echo free as the real low level echoes are not detected due to the poorer contrast resolution and sensitivity to low level echoes. The new machines show these low level echoes more reliably. It is so critical that the sonographer does not simply turn the gain down a bit to make something appear anechoic and call it a cyst. If there are real low level echoes in the lesion it must make you consider that it is a solid lesion. The presence of flow within or adjacent to the lesion adds to the case that it is a solid lesion. If there is any doubt persisting the debate can be resolved by a fine needle aspiration. You will either drain a cyst with internal low level echoes in the fluid or you will discover a solid, cellular lesion to send off for path.