Dr. Stavros thoroughly explains the physics of breast ultrasound and the Download and Read Free Online Breast Ultrasound A. Thomas Stavros MD FACR. Request PDF on ResearchGate | Breast ultrasound / A. Thomas Stavros | Incluye bibliografía e índice. Dr. Stavros thoroughly explains the physics of breast ultrasound and the special probes and other equipment needed to produce high-resolution images of.
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A lump in the breast is a cause of great concern. High frequency, high-resolution USG helps in its ultraasound.
This is exemplified in women with dense breast tissue where USG is useful in detecting small breast cancers that are not seen on mammography. Several studies in the past have addressed the issue of differentiating benign from malignant lesions in the breast. Breast cancer is among the most common causes of cancer deaths today, coming fifth after lung, stomach, liver and colon cancers.
It is the most common cause of cancer death in women. Refinement of high-frequency technology, particularly with 7. Harmonic imaging and real-time compounding has been shown to improve image resolution and lesion characterization. Initial results indicate that it can improve the specificity and positive predictive value of USG in the characterization of breast masses.
The reason why any lesion is visible on mammography or Fdee is the relative difference in the density and acoustic impedance of the lesion, respectively, as compared to ulttasound surrounding breast tissue. This is exemplified in women with dense breast tissue, where USG is useful in detecting ulteasound breast cancers that are not detected on mammography.
In the young non-lactating breast, the parenchyma is primarily composed of fibroglandular tissue, with little or no subcutaneous fat. With increasing age and parity, more and more fat gets deposited in both the subcutaneous and retromammary layers[ 7 ] [ Figure 1 ]. Mid transverse scan of a normal breast. Breast cysts are the commonest cause of breast lumps in women between 35 and 50 years of age.
A cyst is seen on USG stsvros a well-defined, round or oval, anechoic structure with a thin wall [ Figure 2A ]. They may be solitary or multiple [ Figure 2B ]. Cysts usually reveal thin walls and through transmission A. A galactocele C reveals diffuse low-level echoes in the cyst. When internal echoes or debris are seen, the cyst is called a complex cyst. These internal echoes may be caused by floating cholesterol crystals, pus, blood or milk of calcium crystals.
Patients may present with fever, pain, tenderness to touch and increased white cell count. Abscesses are most commonly located in the central or subareolar area. It may be anechoic or may reveal low-level internal echoes and posterior enhancement [ Figure 2D ].
This condition is referred to by many different names: The USG appearance of the breast in this condition is extremely variable since it depends on the stage and extent of morphological changes.
In the early stages, the USG appearance may be normal, even though lumps may be palpable on clinical examination. There may be focal areas of thickening of the parenchyma, with or without patchy increase in echogenicity [ Figure 3A ].
Focal fibrocystic changes may appear as solid masses or thin-walled cysts. About half of these solid masses are usually classified as indeterminate and will eventually require a biopsy. Extended view images A, B show a focal area of thickening of the breast parenchyma A with patchy increase in echogenicity arrows and scattered, discrete, thin-walled cysts arrowheads in B.
This lesion has a variable appearance. Typically, duct ectasia may appear as a single tubular structure filled with fluid or sometimes may show multiple such brewst as well. Old cellular debris may appear as echogenic content. If the debris fills the lumen, it can be sometimes mistaken for a solid mass, unless the tubular shape is picked up[ 11 ] [ Figure 4 ].
Longitudinal ultrrasound A shows a dilated duct containing inspissated debris arrow is seen.
In crosssection Bthe intraductal debris may appear as a focal lesion arrowheads. Fibroadenoma is an estrogen-induced tumor that forms in adolescence. It is the third most common breast lesion after fibrocystic disease and carcinoma.
It usually presents as a firm, smooth, oval-shaped, freely movable mass.
The size is usually under 5 cm, though larger fibroadenomas are known. On USG, it appears as a well-defined lesion [ Figure 5 ]. A capsule can usually be identified. The echotexture is usually homogenous and hypoechoic as compared to the breast stavtos, and there may be low-level internal echoes.
Typically, the transverse diameter is greater than the anteroposterior diameter [ Figure 5 ]. In a small number of patients, the mass may appear complex, hyperechoic or isoechoic. A similar USG appearance may be seen with medullary, mucinous or papillary carcinoma. Transvere image reveals a typical larger transverse than anteroposterior diameter, homogenous echotexture, and a thin capsule arrowheads.
This is a large lesion that presents in older women.
Some authors consider it to be a giant fibroadenoma. The mass may involve the whole of the breast. It usually reveals well-defined margins and an inhomogeneous echostructure, sometimes with variable cystic areas. The incidence of malignant change is low.
Transverse scan reveals a large well-defined mass. There is inhomogeneous echotexture, with greast areas of cystic degeneration arrows. Lipoma is a slow-growing, well-defined tumor.
It may be a chance finding or the patient may present with complaints of increase in the size of the involved breast, though no discretely palpable mass can be made out. The tumor is soft and can be deformed by compression with the transducer.
Sagittal extended view reveals a subtle echogenic mass with a reticular pattern and a well-defined, thin capsule arrows.
Several studies have described the sonographic characteristics commonly seen in benign lesions of the ultasound Malignant lesions are commonly hypoechoic lesions with ill-defined borders.
Three-dimensional scanners with the capability of reproducing high-resolution images in the coronal plane provide additional important information. It was initially believed that color Doppler scanning would add to the specificity of USG examination, but this has not proven stafros be very efficacious; however, in certain situations it does help resolve the issue, particularly when there is significant vascularity breasg within highly cellular types of malignancies[ 17 ] [ Figure 10 ].
Transverse scan A shows a typical malignant nodule stavroz is taller than wide, with hypoechoic echotexture. Arrowheads indicate irregular spiculated margins.
Some of the nodules may reveal a branching pattern arrows in B. Sagittal view C shows a nodule with multilobulated margins; the presence of more than 3—4 lobulations is suspicious for malignancy.
Sagittal D and transverse E scans show duct extension arrows. Duct extension appears smooth in outline in cross-section arrowheads in E. Transverse scan F shows a typical malignant lesion with irregular spiky margins, microcalcifications and a branching pattern. Transverse scan A shows smooth margins, suggesting a category 3 lesion.
A 3Dimage in the coronal plane B however reveals spiky margins with a sunray appearance, suggestive of a category 4 lesion. A smooth margin and homogenous echotexture suggest a category 3 lesion. Color Doppler reveals irregularly branching neovascularity.
In a landmark study inStavros et al. Although it may be impossible to distinguish all benign from all malignant solid breast nodules using USG criteria, a reasonable goal for breast USG is to identify a subgroup of solid nodules that has such ultdasound low risk of being malignant that the option of short-interval follow-up can be offered as a viable alternative to biopsy.
National Center for Biotechnology InformationU. Indian J Radiol Imaging. Author information Copyright and License information Disclaimer. Dr Gokhale’s Sonography clinic, Indore, India. This is bteast open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract A lump in the breast is a cause of great concern.
Introduction Breast cancer is among the most common causes of cancer deaths today, coming fifth after lung, stomach, liver and colon cancers. High-density probes provide better lateral resolution. Harmonic imaging leads to improved resolution and reduced reverberation and near-field artifacts. Extended or panoramic views provide a better perspective of the lesion in relation to the rest of the breast. Normal breast parenchymal patterns In the young non-lactating ultrasoudn, the parenchyma is primarily composed of fibroglandular tissue, with little or no subcutaneous fat.
Open in a separate window. Abnormal appearances Breast cysts Breast cysts are ultrasonud commonest cause of breast lumps in women between 35 and 50 years of age. Chronic abscess of the breast Patients may present with fever, pain, tenderness to touch and increased white cell count. Fibrocystic breast condition This condition is referred to by many different names: Duct ectasia This lesion has a variable appearance. Figure 4 A, B.
Ultrasound characterization of breast masses
Fibroadenoma Fibroadenoma is an estrogen-induced tumor that forms in adolescence. Cystosarcoma phyllodes This is a large lesion that presents in older women. Lipoma Lipoma is a slow-growing, well-defined tumor.
Characteristics of malignant lesions Malignant lesions are commonly hypoechoic lesions with ill-defined borders. Table 1 USG suspicious for malignancy.