Breast Flashcards
USF of breast cysts
Simple cyst: Anechoic round or oval mass with circumscribed imperceptible walls • Complicated cyst: Similar features to that of a simple cyst but with internal echoes • Complex cystic mass: Mass with both cystic (anechoic) and solid (hypo, iso, or hyperechoic) components
Checklist for breast cysts
Simple cyst: Anechoic with imperceptible walls ~ benign • Complicated cyst: Low level internal echoes, fluid-debris levels, or mobile debris which can be difficult to distinguish from a solid mass ~ aspirate if new or enlarging • Complex cystic mass: Solid component, thick (> 0.5 mm) wall or septations, irregular margins ~ suspicious = biopsy
USF for DCIS
50% occur in upper outer quadrant • Most often hypoechoic irregular mass • Can be isoechoic, Circumscribed and/or lobulated • Uniformly hyperechoic lesions most often benign • Ultrasound can localize solid component in area of mammographic calcifications Pathology • Invasive ductal: 65-80% of all breast cancers • Mucinous, medullary and tubular generally have better prognosis Clinical Issues • Prevalence of- 2.3 million women in the USA • Breast MR becoming more widely used to increase sensitivity of detection • Ultrasound can be used to assess for pathologic lymph nodes in axilla
Checklist for DCIS
Breast MR in high-risk patients or those with dense tissue to assess for multicentric or multifocal disease • Circumscribed masses can be malignant
Checklist for solid non malignant breast mass
Excisional biopsy is mandatory if core biopsy pathology benign yet imaging characteristics suspicious • Biopsy is often necessary to distinguish benign from malignant masses • Goal of sonography is to identify those lesions where suspicion of malignancy is so low that biopsy can be avoided • Negative predictive value of classification of a lesion as sonographically benign reported as high as 99.5
USF for fat necrosis
Round, oval, or lobulated lucent mass • Isolated calcifications • Spiculated or irregular mass/asymmetry • Band-like density • Sonographic appearances evolve over time • Protocol advice: Perform ultrasound if mammogram negative, inconclusive, or shows asymmetry or ill-defined mass
Checklist for fat necrosis
Imaging findings overlap with malignancy • Proper clinical history helpful: Trauma, surgery • Fat necrosis mass should decrease over time • Calcifications develop 1.5-5 yrs (or later) post-trauma, coarsen over time • Calcification at lumpectomy site within first 1.S yrs more likely residual carcinoma
USF for breast abscess
Hypoechoic, irregular, complex sonographic mass with surrounding increased echogenicity (edema) • May have fluid/debris level or septation • Gentle probe pressure may show movement of thick, purulent fluid within the cavity • May see tract extending from the abscess cavity toward skin surface or into deeper tissues
Hyperemia in surrounding tissue common • Ultrasound: Modality of choice for diagnosis and treatment
Checklist for breast abscess
Clinical presentation key to selecting appropriate imaging
USF for intraductal papilloma
Best diagnostic clue: Solid mass within a dilated duct m~~ • Difficult to identify the lesion if involved duct ISnot dilated • Power Doppler: Often has visible internal vascularity • Attempt to localize discharging duct mifice • Scan radially around nipple • Use “rolled nipple” imaging technique • Confirm intraductal lesion in radial and antiradial views
Checklist for intraductal papilloma
Negative ultrasound in a patient with nipple discharge does not exclude papilloma as mass may not be seen if duct not distended with fluid at time of scan • Attempt to straighten duct to avoid false positives • Image along long axis of duct for best resolution
USF for ductal ectasia
Tubular or branching structure(s) most commonly in the subareolar regions of both breasts on mammography • Calcifications may be present within or around ducts • US: Anechoic fluid, or hypoechoic debris in dilated subareolar ducts • Debris may be mobile • Intraluminal masses may be demonstrated • Debris may be difficult to differentiate from masses • Inspissated secretions or intraluminal blood collapse with transducer pressure • Intraluminal mass will not compress with pressure • Internal flow distinguishes mass from inspissated secretions
Checklist for ductal ectasia
Consider CHECKLIST • Duct ectasia is common and almost always benign • General path comments o Dilated major subareolar ducts • Occasional involvement of smaller ducts o Thick or granular secretions • Etiology o May be secondary to inflammation, obstruction, glandular atrophy and stasis o Not related to parity or breast-feeding
Image Interpretation Pearls
• Presence of a peripheral tubular mammographic structure should lead to further investigation o Finding may require biopsy o Papilloma, DCIS may manifest with this appearance
UFS for gynaecomastia
Asymmetric in- 70% • Early nodular phase: Circumscribed subareolar mass, usually with a lobulated border • Late fibrous dendritic phase: Stellate margin, “finger-like” projections • Hyperechoic tissue in diffuse glandular pattern • Power Doppler: May have vascularity within the area • Mammography may be only exam required • Ultrasound used as adjunct
Checklist for gynaecomastia
Testicular or other neoplasm causing secondary gynecomastia • Mammography often is the only study required in evaluating suspected gynecomastia
