Ultrasound of the Breast BASICS FOR THE ORDERING CLINICIAN

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Transcription:

Ultrasound of the Breast BASICS FOR THE ORDERING CLINICIAN

Breast Ultrasound Anatomy Skin Breast Parenchyma Pectoralis Fascia Pectoralis

Breast Ultrasound Anatomy

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.

Indications for Breast Ultrasound Interventional procedures. US guided core bx s FNA Cyst aspirations Needle localization Magnetic or radioactive seed placement

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

Breast Ultrasound Weaknesses Operator dependent Experience Speed Lesion appearance Poor at evaluating microcalcifications Deep lesions Post-op breast Scar tissue

Malignant Breast Masses

Characteristics of Malignancy Hypoechoic Taller than wide Shadowing Spiculation or Angular Borders Microlobulation Ductal Extension Calcification Penetrating vascularity

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

Malignant Breast Masses Spiculations Posterior acoustic shadowing Angular margins

Malignant Breast Masses Duct Mass Ductal extension

Malignant Breast Masses Ductal extension

Malignant Breast Masses

Malignant Breast Masses Microlobulations Microlobulations

Malignant Breast Masses

Malignant Breast Masses

Malignant Breast Masses Indistinct margins

Benign Breast Masses

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

Benign Breast Masses Posterior acoustic enhancement

Benign Breast Masses

Benign Breast Masses

Benign Breast Masses Gentle lobulations

Benign Breast Masses Thin echogenic pseudocapsule

Benign Breast Masses

Benign Breast Masses

Benign Breast Masses

Breast Lesions of Pregnancy

Breast Lesions of Pregnancy Mastitis with Abscess Lactating Adenoma Galactocele Fibroadenoma Can enlarge during pregnancy Breast cancer

Breast Abscess

Breast Abscess

Fibroadenoma

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

Galactocele

Galactocele

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

Lactating Adenoma

Lactating Adenoma

Problematic Lesions

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

Intraductal Papilloma

Intraductal Papilloma

Intraductal Papilloma

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

Phyllodes Tumor

Phyllodes Tumor

Phyllodes Tumor

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

Papillary Carcinoma

Papillary Carcinoma

Papillary Carcinoma

Papillary Carcinoma

Mucinous Carcinoma Rare (1-4% of breast cancers) Often well-circumscribed with through transmission Iso or slightly hypoechoic

Mucinous Carcinoma

Mucinous Carcinoma

Benign vs Malignant

Benign or Malignant?

Benign or Malignant?

Benign or Malignant?

Benign or Malignant?

Benign or Malignant?

Benign or Malignant?

References Smith, DS. Radiographic Clinics of North America 2001; 39:485-496. Stravos, et al. Radiology 1995; 196: 123-134. Hooley R J, et al. Radiology 2013; 268: 642-659. Raza S, Baum. Radiology 1997; 203: 164-168. Reeder, MM. Gamuts in Radiology, 4 th edition. 2003. Case courtesy of Dr Alexandra Stanislavsky, Radiopaedia.org, rid: 31416 Case courtesy of Radswiki, Radiopaedia.org, rid: 11735 Egan, Breast Imaging, 3 rd Ed https://my.statdx.com/document/papillary-carcinoma-invasive/ ultrasoundcases.info

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