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The purpose of this study was to evaluate different sonographic settings (tissue harmonic, frequency compounding, and conventional imaging) and to determine which setting optimizes breast lesion detection and lesion characterization.Four hundred thirteen consecutive breast lesions (249 benign and 164 malignant) were evaluated by sonography using 4 different modes (conventional imaging at 14 MHz, tissue harmonic imaging at 14 MHz [THI], and frequency compound imaging at 10 MHz [CI10] and 14 MHz [CI14]). The images were reviewed by consensus by 2 breast radiologists. For each image, the lesion was graded for conspicuity, mass margin assessment, echo texture assessment, overall image quality, and posterior acoustic features.For lesion conspicuity, THI and CI14 were better than conventional imaging (P.01) and CI10 (P.01) particularly against a fatty background (P.01 for THI versus conventional for a fatty background versus P = .13 for a dense background). Frequency compound imaging at 10 MHz performed the best in echo texture assessment (P.01), as well as overall image quality (P.01). For margin assessment, CI10 performed better for deep and large (or =1.5-cm) lesions, whereas CI14 performed better for small (1.5-cm) and superficial lesions. Finally, THI and CI14 increased posterior shadowing (P.01) and posterior enhancement (P.01).The standard breast examination incorporates 2 distinct processes, lesion detection and lesion characterization. With respect to detection, THI is useful, especially in fatty breasts. With respect to characterization, compound imaging improves lesion echo texture assessment. No single setting in isolation can provide the necessary optimized information for both of these tasks. As such, a combination approach is best.

Objective The purpose of this study was to retrospectively compare conventional imaging, frequency compound imaging (CI), and tissue harmonic imaging (THI) in interventional breast sonography. Methods Institutional Review Board approval and patient informed consent were not required. The authors reviewed 104 sonographically guided breast procedures in 83 patients. For each biopsy, 4 images obtained with conventional imaging, frequency CI at 10 and 14 MHz (CI10 and CI14), and THI were graded independently by 2 radiologists for lesion conspicuity, needle conspicuity, lesion and needle conspicuity, and overall image quality. Frequency CI at 10 MHz, CI14, and THI were compared with conventional imaging. Different clinical scenarios (fatty versus glandular background, fine needle versus core needle, and oblique versus horizontal needle direction) were evaluated. Results Statistical analysis showed that for overall image quality, CI10 was the best setting (odds ratios [OR], 3.67 and 7.48). For lesion conspicuity, CI14 (OR, 3.55) and THI (OR, 1.77) improved lesion visibility in a fatty background, whereas THI (OR, 0.26) was very limited in a glandular background. For needle conspicuity, no setting was better than conventional, whereas THI was the least valuable setting (OR, 0.011 and 0.049). For lesion and needle conspicuity, CI10 showed significantly better results than conventional for a dense background (P = .0268 and .4028; OR, 2.435 and 1.383) with 1 reviewer, whereas THI was the least valuable setting (OR, 0.014 and 0.042). Conclusions Conventional imaging provided the best assessment of lesion and needle conspicuity. Frequency compounding is a useful setting for dense breast and for fine-needle aspiration. Tissue harmonic imaging has a role in the visualization of a lesion against a fatty background but is of limited value in needle visualization.