Breast Powerpoint Flashcards
Indications
Palpable breast lump Correlation with mammography or MRI Fibrocystic changes Pregnant or lactating patients Breast augmentation Axillary lump Post-surgical or post irradiated breast Guidance for interventional procedures
Main purpose of breast evaluation is the
detection and diagnosis of breast cancer in its early and curable stages
Three general categories of breast imaging, two of which involve breast ultrasound
Breast cancer screening (does not generally involve ultrasound)
Diagnostic (consultive; problem solving; workup) breast imaging
Diagnostic and interventional breast procedures
Regular clinical breast exams
by a physician every three years until age 40 then yearly
Screening mammography begins at age 40
Ultrasound of the breast is
safer and more accurate in young dense breast
Ultrasound can differentiate
solid masses from fluid filled cysts
can visualize tissue adjacent to implants or other structures that limit mammography
Interventional breast procedures
Cyst aspirations can be performed
to assess the lesion as a complex cyst or mass
Interventional breast procedures
Under sonographic guidance
needle guidance in an attempt to aspirate fluid, which would be diagnostic of a complex cyst
used to guide a fine-needle aspiration cytology (FNAC), abscess or seroma drainage and large-core needle biopsy (for tissue diagnosis)
Interventional breast procedures
Needle localization
preoperative wire localization and injection of radioactive tracer for sentinel node identification
Interventional breast procedures
The key to needle visualization is
to keep the needle as to the transducer face as possible
Interventional breast procedures
Main hazard is
piercing of the chest wall
Pathology -benign
Cyst
clinical signs- discomfort, palpable lump, mobility
smooth walls, anechoic, posterior enhancement
Pathology -benign
Complicated cyst
clinical signs- may be related to inflammation or hemorrhage within a cyst
Pathology -benign
Sonographic findings
wall thickening or irregularities, septations, internal echos
Solid mass- benign
Fibroadenoma
Most common breast tumor
Primarily in young women
Growth stimulated by estrogen
Solid mass- benign
Fibroadenoma
Clinical Findings
Firm, rubbery, freely mobile
Slow growing
Solid mass- benign
Fibroadenoma
Sonographic Appearance
Smooth, rounded margins
Low-level homogeneous internal echos
Possible posterior acoustic enhancement
Typically hypoechoic
Lipoma- fatty tumor-benign
May grow large before being clinically detected
Usually found in middle-aged/postmenopausal women
Large, soft, poorly demarcated difficult to delineate from surrounding tissue
Lipoma- fatty tumor-benign
Sonographic Findings
Typically smooth walls
Hypoechoic similar to breast fat
Posterior acoustic enhancement
Easily compressible
Fat Necrosis- benign
Caused by trauma, surgery, radiation treatment, mastitis
Spherical nodule, superficial under layer of calcified necrosis
Fat Necrosis- benign
Sonographic Findings
Irregular
Complex low-level echos
May mimic malignant mass
Acoustic shadowing may or may not be present
Abscess-benign
Pain
Swelling
Febrile
Enlarged axillary nodes
Abscess-benign
Complex
Diffuse increased echogenicity of the breast (if mastitis)
Hyperemia with color and or/ power Doppler
Papillomas -benign
arise from lining of breast ducts, retroareolar area most common
Bloody discharge from single duct
Papillomas -benign
Sonographic Findings
Tiny papilloma may not be detected
May cause dilatation of a single duct
Papillomas -benign
Intracystic papillomas
soft tissue mass growing into lumen of cystic lesion
Sebaceous cysts-benign
obstruction of sebaceous gland or hair follicle within dermal layer of skin
Sebaceous cysts-benign
Sonographic Findings
Rounded, well defined mass with low to medium level echogenicity
Wall calcification possible
Phyllodes- benign/malignant
borderline or transitional form between benign and malignant tumor
Can grow quite large
Develop in women between ages 40-60
Phyllodes- benign/malignant
Sonographic Findings
Well-defined, lobulated solid mass with possible internal cystic spaces
Solid mass - malignant
Ductal non-invasive carcinoma in-situ (DCIS) Lobular carcinoma-in situ (LCIS) Invasive ductal carcinoma in-situ (IDC) Invasive lobular carcinoma (ILC) Medullary Colloid /Mucinous Papillary
Ductal carcinoma in-situ
most common non-invasive carcinoma
Asymptomatic, palpable mass, nipple discharge
Ductal carcinoma in-situ
Mammography findings
microcalcifications
Ductal carcinoma in-situ
Sonographic findings
intraductal mass
microcalcifications
irregular ductal dilatation
architectural distortion
Lobular carcinoma in-situ (LCIS)
generally affects premenopausal women
distinct tumor not a feature
Lobular carcinoma in-situ (LCIS)
Sonographic Appearance
bilateral, multicentric
mimics fibrocystic disease
Invasive ductal carcinoma-IDC
Most common malignancy
Hard fixed mass
Skin dimpling or skin/nipple retraction
Invasive ductal carcinoma-IDC
Mammography findings
Asymmetric
Radiopaque speculated mass
Microcalcifications
Thickened and retracted Cooper’s ligament
Invasive ductal carcinoma-IDC
Sonographic findings
Solid mass Hypoechoic Heterogeneous Taller than wide orientation Distal acoustic shadowing Possible- microlobulations, microcalcification, ductal extension branch pattern, fascial plane disruption
Invasive lobular carcinoma-(ILC)
Mammography can underestimate the extent
Invasive lobular carcinoma-(ILC)
Sonographic Findings
Possible speculated mass mimicking invasive ductal carcinoma
Architectural distortion
Medullary
Circumscribed, non-tender, often large palpable mass May be mildly compressible and movable Often located in peripheral breast Low incidence of lymph node involvement Prevalence in younger females
Medullary
Sonographic findings
Solid hypoechoic mass; round, oval, or lobulated shape
Circumscribed margins; surface irregularities possible
Homogeneous/mildly heterogeneous
Acoustic enhancement
Hemorrhage or cystic degeneration may be noted
Colloid/Mucinous
Sonographic Findings
Well-defined margins
Hypoechoic or isoechoic to fat
Homogeneous
Possible microlobulations
Papillary
Subareolar palpable mass May protrude and effect skin May cause skin dimpling and retraction Possible bloody nipple discharge Mimics non-invasive papillary carcinoma or papilloma
Breast implants
Can be challenging to scan
Can be even more challenging to biopsy
