Breast echotexture

Last revised by Andrew Murphy on 23 Mar 2023

Breast echotexture refers to the background tissue appearance on breast sonography, analogous to breast density/amount of fibroglandular tissue on mammography and MRI. There are three categories of tissue composition according to the BI-RADS lexicon 1:

  • homogeneous background echotexture – fat
    • the bulk of the breast is comprised of fat lobules and uniformly echogenic bands of connective tissue
  • homogeneous background echotexture – fibroglandular
    • deep to a thin hypoechoic layer of subcutaneous fat, there is a thick zone of homogeneously echogenic fibroglandular tissue (with hypoechoic ducts interspersed)
  • heterogeneous​
    • there are multiple areas of increased and decreased echogenicity, with shadowing at the fat-fibroglandular interfaces

These terms are only used in screening ultrasounds and not in the diagnostic setting. The implication of heterogeneous background echotexture is that it may interfere with the detection of small/subtle lesions 1. This pattern is more common in young patients and those with heterogeneously dense breasts on mammography 1.

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