BR5. ï‚‍ A circumscribed breast mass is defined as a round or oval breast lesion well demarcated ï‚‍ It may correspond to different diagnosis - Benign lesion

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Text of BR5. ï‚‍ A circumscribed breast mass is defined as a round or oval breast lesion well...

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  • BR5
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  • A circumscribed breast mass is defined as a round or oval breast lesion well demarcated It may correspond to different diagnosis - Benign lesion dominated by cyst and fibroadenoma - Malignant lesion such as medullary, papillary or mucinous carcinoma or well circumscribed ductal carcinoma
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  • The aim of our work is to analyze the mammographic and ultrasonographic criteria of benignity and malignancy of circumscribed breast masses through a serie of 55 observations
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  • This is a serie of 55 women The age is ranging from 28 to 76 old years All patients have received a mammogram and a breast ultasound 43 of them underwent biopsy under ultrasound guidance, the others 12 patients were monitored ( followed up ) by breast ultrasound
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  • On mammography : The masses density was : - high in 25 cases - low in 26 cases - Radiolucent in one case - Mixed in three cases Calcifications were present in 10 cases which two were benign popcorn like in fibroadenoma and eight were malignant in invasive ductal carcinoma
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  • On mammography : The halo sign was present in 19 cases The margin was: - regular in 17 cases - lobulated in 21 cases - spiculated in 17 cases
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  • CYSTFIBROADEMA FIBROADENOMA with popcorn like calcifications WELL DEMARCATED AND SLIGHTLY DENSE MASSES
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  • WELL DEMARCATED MASSES CONTAINING FAT DENSITY LIPOMA HAMARTOMA HAMARTOMA with calcifications
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  • LOBULATED AND STRONGLY DENSE MASSES INFILTRATING DUCTAL CARCINOMA
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  • SPICULATED MASSES WITH BRANCHED AND VERMICULAR CALCIFICATIONS INFILTRATING DUCTAL CARCINOMA
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  • WELL DEMARCATED MASS ILL DEMARCATED MASSES INFILTRATING DUCTAL CARCINOMA
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  • In ultrasound : The lesions echogenecity was : - Hypoechoic in 47 cases in whoum 20 were homogenous and 27 were heteregenous - Hyperechoic in 7 cases - Anechoic in one case The long axis was : - Wider then tall in 28 cases - Taller then wide 27 cases
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  • Posterior acoustic feature was : - A shadowing in 15 cases - An enhancement in 15 cases - Unaffected in 13 cases
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  • WELL DEFINED HOMOGENOUS MASSES WITH POSTERIOR ACOUSTIC ENHANCEMENT AND WIDER THEN TALL LONG AXIS FIBROADENOMA
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  • CONTAINING LITTLE CYSTS CONTAINING POP CORN LIKE CALCIFICATIONS
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  • FIBROADENOMA STRONGLY CALCIFICATEDLOBULATED
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  • HAMARTOMA FIBROCYSTIC MASTOPATHY WELL DEFINED HETEROGENOUS MASS ISOECHOIC TO THE MAMMARY GLAND LOBULATED HYOECHOIC MASS CONTAINING LITTLE CYSTS
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  • LOBULATED HETEROGENOUS MASSES WITH TALLER THAN WIDE LONG AXIS INFILTRATING DUCTAL CARCINOMA
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  • SPICULATED MASSES WITH POSTERIOR SHADOWING INFILTRATING DUCTAL CARCINOMA
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  • Of the 43 patients who underwent biopsy the pathology result shows : - Infiltrating ductal carcinoma in 24 cases - A metastasis of melanoma in one case - A fibroadenoma in 11 cases - A fibrocystic mastopathy in 8 cases - A lipoma in one case - An hamartoma in 2 cases
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  • The large number of biopsies performed for benign breast abnormalities has long been recognized as a serious problem. the mammographic and ultrasonographic features for differentiating benign from malignant solid mass can help to decrease the number of biopsies performed for benign solid masses.
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  • In order to detect small cancers in breast screening, it is essential to have high quality images. Radiologists reading mammograms shoud be trained in the recognition of the malignant and benign signs of breast masses, because breast cancer may not show typical malignant features.
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  • The mammograhic features of a breast mass are essentially: - the shape - the margin - the mass density - the calcifications Skin thikening, nipple retraction and architectural distorsion associated to a breast mass can be malignant signs
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  • Shape Round / oval with light center stellar Margin circumscribedSpiculated/ microlobulated/ indistinct/ obscured Mass density Low/ fat containingHigh/ dense center calcifications annular/ regular/ clear centre as an eggshell/lucent centred/ Coarse or popcorn like/ large rod like Skin or dermal and vascular one Size : uniform Distribution : any Density : sparse Vermicular/ irregular/ polyhedral/ pleomorphic/ Fine/ branched and numerous Size : heterogenous Distribution : clustered/ segmental Density : high
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  • Ultrasonography does contribuate the differentiation of benign versus malignant if the mass is not visible at mammography. In women youger than 30 years, in whom mammography is less useful, ultrasonography is often considered the modality of choice to initiate the evaluation of a breast mass.
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  • The ultrasonographic features of a breast mass are essentially: - the shape - the margin - the orientation or long axis - the echotexture - the posterior acoustic features - the lesion boundary
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  • Benign breast massesmammographyultrasound CYST Circular or oval low- density mass with smooth margins Well defined shaped lesion without internal echoes and with posterior acoustic enhancement SEBACEOUS CYST Cyst like mass under the skin A mass lieing entirely within the skin surrounded by a hyperechoic band clow sign FIBROADENOMA Well defined or lobulated mass wicth can contain pop corn like calcifications An isoechoic mass with wider than tall orientation and distal acoustic enhancement LIPOMA A fat density mass with a thin capsula Isoechoic or mildly hyperechoic mass HAMARTOMA Well defined heterogenous mass with halo sign and fat density Well defined mass with a same echotexture than the mammary gland INTRAMAMMARY LYMPH NODE Well limited low density mass with fatty hilum Hypoechoic nodule with an echogenic hilum
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  • The radiologist must be informed about the radiological criteria of benignity and malignancy of circumscribed breast mass. Given the frequency of breast cancer, which affects one in ten women, in any doubt a biopsy should be indicated to give the definitive diagnosis.
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  • Stephen A. feig, MD.Breast masses-mammographic and sonographic evalution Radio Clin North Am 30:67-90,1992 Lowerence W. Bassett, MD. Mammographic analysis of calcifications Radio Clin North Am 30:93-105,1992 Stavros AT, Thickman D. Solid breast nodules: use of sonography to distinguish between benign and malignant lesions. Radiology 1995;196(1):123134 Sughra Raza, MD Allison L. US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management RadioGraphics 2010; 30(5): 1199 1213 Breast calcifications: which are malignant Muttarak M, Kongmebhol P, Sukhamwang Singapore Med J 2009; 50(9) : 907 N Shah, SB Patell Well circumscribed breast carcinoma : Mammographic and sonographic finding report of fine cas 2005 Linda Moy, MD, Priscilla J.Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review
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