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Ultrasound breast

Ultrasound breast. Kanjanaporn Mahatthanaphak. Objectives. Indication of breast ultrasound Technique of breast ultrasound Ultrasound interpretation. Diagnosis of breast diseases. History Physical examination Breast imaging Biopsy. Breast Imaging. Mammography Ultrasonography (US)

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Ultrasound breast

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  1. Ultrasound breast KanjanapornMahatthanaphak

  2. Objectives • Indication of breast ultrasound • Technique of breast ultrasound • Ultrasound interpretation

  3. Diagnosis of breast diseases • History • Physical examination • Breast imaging • Biopsy

  4. Breast Imaging • Mammography • Ultrasonography (US) • Magnetic resonance imaging (MRI) • Nuclear medicine • Sentinel node (Tc99m-sulfur colloid) • Breast specific gamma imaging (Tc99m-sestamibi) • PET (positron emission tomogram)

  5. Ultrasonography Advantage Disadvantage Need high resolution US for breast Operator dependent • Cheap • No radiation • Non invasive • Widely available

  6. Indications for US • Differentiate cyst from solid mass • Palpable mass in women < 30 yrs, pregnant and lactation • Evaluate dense breast with palpable mass • Evaluation for breast abscess • Evaluation problem with breast implants • Interventional procedure • Evaluation for multicentric or multifocal CA, bilateral CA, axillary lymph node involvement • Evaluate focal asymmetry seen on mammogram • Breast cancer screening

  7. Cyst Fibroadenoma 1.Differentiate cyst from solid mass seen on mammogram

  8. 2.Palpable mass in women <30 yrs, pregnant and lactation • Most common masses in women <35 yr are fibroadenoma and cyst

  9. 3. Palpable mass in dense mammogram 41 yr, palpable mass RUOQ Spiculated margin, irregular shaped, hypoechoic mass

  10. 4.Evaluation for breast abscess

  11. 5. Evaluation problems with breast implants • Questionable implants leak or rupture • MRI is the best imaging modality • US can be used in substituition

  12. 6.Interventional procedure • Cyst aspiration • Drainage • Guided fine needle aspiration • Guided core biopsy • Mark skin for excisional biopsy

  13. Drainage pus

  14. US Guided fine needle aspiration

  15. 7. Evaluation for multifocality, multicentricity

  16. 8. Evaluation for focal asymmetrical density • Focal asymmetrical density could be from • Normal variation • Breast mass (benign, malignant) • Check if there is associated palpable mass

  17. 9. Breast cancer screening • Decrease sensitivity of dense breast on screening mammogram • US can be used in addition to find underlying mass

  18. Ultrasound technique • lighting • patient positioning: support elbow, flat, supine • ergonomics • probe: linear array 7-13 MHz • scanning: radial/antiradial • clock face with distance from nipple • only caliper things that are REAL • correct depth (skin to pectoral fascia) and correct focal zone (up to 2 is OK) • dynamic range: some settings can make a cystic lesion look solid and vice versa

  19. Ultrasound interpretation • Breast Composition • Mass • Calcifications • Associated features

  20. Breast composition • composition of breast tissue • Glandular tissue (soft tissue density) • Connective tissue (soft tissue density) • Fat (fat density) Young women : glandular tissue > fat Older women : fat > glandular tissue More glandular tissue  dense breast on mammogram

  21. Breast Composition: • Homogeneous echotexture - fat • Homogeneous echotexture - fibroglandular • Heterogeneous echotexture

  22. Mass • Shape • Margin • Orientation • Echo pattern • Posterior features

  23. Breast mass Shape

  24. Breast mass Margin

  25. Orientation: • unique to US-imaging, and defined as parallel (benign) or not parallel (suspicious finding) to the skin.

  26. Echo pattern • Anechoic • Hypoechoic, • Complex cystic • Solid:isoechoic, hyperechoic, heterogeneous.

  27. Posterior features: • Enhancement • Shadowing.

  28. Calcifications: • On US poorly characterized compared with mammography, but can be recognized as echogenic foci, particularly when in a mass.

  29. Associated features: • Architectural distortion • Duct changes • Skin changes • Edema • Vascularity • Elasticity assessment

  30. Findings suggestive of malignancy Spiculation or thick echogenic halo Angular margin Microlobulation Shape taller than wide Duct extension or branch pattern Acoustic shadowing Microcalcifications Hypoechogenicity

  31. Findings suggestive of benign • No suggestive findings of malignancy • Hyperechogenicity (compare to fat) • Wider than tall • Well circumscribed, less than 3 lobulations • Thin echogenic pseudocapsule

  32. Ultrasound Features Suggestive of Benign and Malignant Nodules.

  33. Special cases cases with a unique diagnosis or pathognomonic ultrasound appearance: • Simple cyst • Complicated cyst • Clustered microcysts • Mass in or on skin • Foreign body including implants • Lympnodes- intramammary • Lymph nodes- axillary • Vascular abnormalities • Postsurgical fluid collection • Fat necrosis

  34. Simple cyst

  35. Complicated cyst

  36. Clustered microcysts

  37. Breast abscess

  38. Lymph nodes

  39. BreastImagingReportingAndDataSystem(BI-RADS)

  40. BreastImagingReportingAndDataSystem(BI-RADS) Mammography • Category 0 ...incomplete assessment additional imaging is needed • Category I ...negative routine follow up (1 year) • Category II … benign finding  routine follow up (1 year) • Category III … probably benign finding  follow up 6 months • Category IV … suspicious abnormality  biopsy • Category V… highly suggestive of malignancy  biopsy • Category VI …known biopsy proven malignancy appropriate treatment Help clinicians for management

  41. http://www.radiologyassistant.nl/

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