Ultrasound of the Breast BASICS FOR THE ORDERING CLINICIAN
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1 Ultrasound of the Breast BASICS FOR THE ORDERING CLINICIAN
2 Breast Ultrasound Anatomy Skin Breast Parenchyma Pectoralis Fascia Pectoralis
3 Breast Ultrasound Anatomy
4 Indications for Breast Ultrasound Palpable lesion of any age. Evaluation of a breast mass/lump in a patient younger than 30 skip straight to US. Differentiation of mammographic breast mass or nodule as solid or cystic. Interventional procedures.
5 Indications for Breast Ultrasound Interventional procedures. US guided core bx s FNA Cyst aspirations Needle localization Magnetic or radioactive seed placement
6 Breast Ultrasound Advantages No radiation Evaluation of the breast during pregnancy Real-time imaging Assessment of vascularity Dense breast evaluation No compression Good for ductal evaluation Comfort during procedures
7 Breast Ultrasound Weaknesses Operator dependent Experience Speed Lesion appearance Poor at evaluating microcalcifications Deep lesions Post-op breast Scar tissue
8 Malignant Breast Masses
9 Characteristics of Malignancy Hypoechoic Taller than wide Shadowing Spiculation or Angular Borders Microlobulation Ductal Extension Calcification Penetrating vascularity
10 Hypoechoic Breast Mass Differential Diagnosis Breast cancer Complex cyst Fibroadenoma Traumatic hematoma Abscess Post-op collection Fibrocystic changes Intraductal papilloma Sebaceous cyst Intramammary lymph node Benign breast lesions of pregnancy
11 Malignant Breast Masses Spiculations Posterior acoustic shadowing Angular margins
12 Malignant Breast Masses Duct Mass Ductal extension
13 Malignant Breast Masses Ductal extension
14 Malignant Breast Masses
15 Malignant Breast Masses Microlobulations Microlobulations
16 Malignant Breast Masses
17 Malignant Breast Masses
18 Malignant Breast Masses Indistinct margins
19 Benign Breast Masses
20 Benign Breast Masses Smoothly marginated Wider than tall Anechoic or Uniformly Hyperechoic Posterior acoustic enhancement (through transmission) Thin echogenic capsule 2-3 gentle lobulations or macrolobulations
21 Benign Breast Masses Posterior acoustic enhancement
22 Benign Breast Masses
23 Benign Breast Masses
24 Benign Breast Masses Gentle lobulations
25 Benign Breast Masses Thin echogenic pseudocapsule
26 Benign Breast Masses
27 Benign Breast Masses
28 Benign Breast Masses
29 Breast Lesions of Pregnancy
30 Breast Lesions of Pregnancy Mastitis with Abscess Lactating Adenoma Galactocele Fibroadenoma Can enlarge during pregnancy Breast cancer
31 Breast Abscess
32 Breast Abscess
33 Fibroadenoma
34 Galactocele Benign fat-containing breast mass Presentation may be delayed up to 6-10 months after cessation of breast feeding Aspiration is diagnostic and curative
35 Galactocele
36 Galactocele
37 Lactating Adenoma Can occur in any pregnant woman (not just breast feeding women) Can enlarge rapidly during 1 st and 2 nd trimester Usually regress after cessation of breast feeding
38 Lactating Adenoma
39 Lactating Adenoma
40 Problematic Lesions
41 Intraductal Papilloma Can mimic inspissated secretions or ductal debri Benign Surgically removed due to risk of upgraded pathology on excision 10% atypical or high risk lesion 6.5% carcinoma
42 Intraductal Papilloma
43 Intraductal Papilloma
44 Intraductal Papilloma
45 Phyllodes Tumor Often have characteristics similar to a fibroadenoma Gently lobulated borders Hypoechoic Well-circumscribed Through transmission Rapidly growing tumor usually in middle-aged women Consider PT if >20% increase in diameter in 6 months 75% Benign, 16% borderline, and 9% malignant Pathology may vary throughout the same tumor Tx: Surgical excision
46 Phyllodes Tumor
47 Phyllodes Tumor
48 Phyllodes Tumor
49 Papillary Carcinoma Uncommon (<2% of breast cancers) Good prognosis. Axillary node mets are very rare. Often well-circumscribed Often at least partially cystic with through transmission
50 Papillary Carcinoma
51 Papillary Carcinoma
52 Papillary Carcinoma
53 Papillary Carcinoma
54 Mucinous Carcinoma Rare (1-4% of breast cancers) Often well-circumscribed with through transmission Iso or slightly hypoechoic
55 Mucinous Carcinoma
56 Mucinous Carcinoma
57 Benign vs Malignant
58 Benign or Malignant?
59 Benign or Malignant?
60 Benign or Malignant?
61 Benign or Malignant?
62 Benign or Malignant?
63 Benign or Malignant?
64 References Smith, DS. Radiographic Clinics of North America 2001; 39: Stravos, et al. Radiology 1995; 196: Hooley R J, et al. Radiology 2013; 268: Raza S, Baum. Radiology 1997; 203: Reeder, MM. Gamuts in Radiology, 4 th edition Case courtesy of Dr Alexandra Stanislavsky, Radiopaedia.org, rid: Case courtesy of Radswiki, Radiopaedia.org, rid: Egan, Breast Imaging, 3 rd Ed ultrasoundcases.info
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