Ultrasound Finding May Help Spot Breast Cancer: Echogenic Rind Linked to Suspicious Tumors

Recent research published in the  American Journal of Roentgenology (AJR) indicate the presence of an echogenic rind around suspicious breast masses on ultrasound is a specific, though not highly sensitive, marker of breast malignancy. This finding shows strong associations with invasive cancers and certain molecular subtypes.

“In our review of more than 500 suspicious breast masses, echogenic rinds were more often seen in invasive ductal and lobular carcinomas than in ductal carcinoma in situ,” explained lead researcher Derek L. Nguyen, MD, of Duke University School of Medicine and 2022 Roentgen Fund recipient. “Including the rind in size measurements also reduced underestimation of tumor size compared with surgical pathology.”

Nguyen and colleagues conducted a single-center study analyzing 583 suspicious breast masses (BI-RADS 4 or 5) in 511 patients who underwent ultrasound and subsequent biopsy between July 2022 and June 2023. Two fellowship-trained breast radiologists independently assessed whether echogenic rinds covered at least 25% of the mass circumference. Their findings were compared against histopathology.

Detection of echogenic rinds showed moderate accuracy: one reader reported sensitivity of 59% and specificity of 81%, while the other found 51% sensitivity and 85% specificity. Associations were strongest for invasive cancers (invasive ductal carcinoma: 62% and 53%; invasive lobular carcinoma: 57% and 53%), as well as luminal A and HER2-enriched molecular subtypes. Interreader agreement was moderate (κ = 0.60).

When echogenic rinds were included in ultrasound size estimates, the average difference from surgical pathology decreased—from 4 mm to 3 mm for one reader and from 7 mm to 5 mm for the other.

“These results suggest that recognizing echogenic rinds may give radiologists greater diagnostic confidence and improve preoperative tumor sizing,” the authors concluded. “Our findings support incorporating echogenic rind as a descriptive feature in the upcoming 6th edition of the BI-RADS ultrasound lexicon.”