Breast Sonography

7/25/2019 Breast Sonography

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Breastsonography


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High frequency transducers (min 7MHz) tominimize volume averaging

The depth of focal zone must be adjusted tothe depth of any lesion to minimize volumeaveraging and mischaracterization of thelesion

!olume averaging can alter the chogenicityso much that cystic lesions falsely appearsolid and hypoechoic solid lesions becomeisoechoic and inconspicuous


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in very super"cially located lesion#stando$ of gel is used to minimize

volume averagingMisposition focal zines can lead to

severe volume averaging andmischaracterization of even midsized

lesions# particularly if the focal zonesare positioned much too deeply


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Breast composed of %

&'* lobes % +obar duct

,maller branch duct

+obules

,upporting stromal tissues %

-ompact interlobular stromal "brous tissue +oose periductal stromal "brous tissue

.ntralobular stromal "brous tissue

/at


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/unctional unit of the breast is Terminal0uctolobular 1nit (T0+1) consists of %

+obule# consists of % .ntralobular segment of the terminal duct

.ntralobular segment of the ductules

+oose intralobular stromal "brous tissue

23tralobular terminal duct


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Breast divided into 4 zones % 5remammary zone 6 subcutaneous zone % lies

beteen the s8in and the anterior mammary fascia Mammaryzone % lies beteen anterior mammary

fascia and the posterior mammary fascia# contains %lobar ducts# their branches# most of the T0+1s andthe most of the "brous stromal elements of breast

9etromammary zones % fat# blood vessels#

lymphatics less apparent on sonogram becausesonographic compression :attens theretromammary zones against the chest all


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;ormal anatomic structures of thebreast %

Hyperechoic % compact interlobularstromal "brous tissue# anterior andposterior mammary fasciae# cooper


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;ormal mammary ducts that are not ectaticcan appear %

5urely isoechoic# hen the centrallylocated hyperechoic duct all cannot bevisualizzed because a poor angle ofincidence or suboptimal transducer

=r as a central# bright echo surrounded byisoechoic loose tissue hen the apposedalls of the central duct can be optimallydemonstrated


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These are maneuvers to visualize theducts ithin the nipple% 5eripheral compression techniqueTo handed compression technique

9olled nipple technique

1seful for evaluating patient ith nipple

discharge


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;ormal T+01s are about mm indiameter# but may be as large as ' mm

in patients ith "brocystic change#adenosis

.n patients ho are pregnant orlactating and adenosis# T0+1s enlarged

and increased in number


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=ne of the most valuable features ofhigh frequency coded harmonic imaging

is that it tends to ma8e pathologic solidnodules appear relatively morehypoechoic and conspicuous in abac8ground of isoechoic tissues


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+ymphatic drainage % deep super"cialsubdermal lymphatic netor8

periareolar ple3us (,appey


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4 level of a3illary lymph node % +evel &% lie peripheral to the inferolateral edge of the

pectoralis minor

+evel % lie posterior to the pectoralis minor

+evel 4 % lie pro3imal to the superomedial border ofthe pectoralis minor (infraclavicular nodes)

/rom level 4 nodes metastases may progress tointernal jugular or supraclavicular lymph nodes

9otter nodes % lie beteen the pectoralis majorand minor a frequent source of chest allrecurrences


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Metastase can involve thesupraclavicular lymph node# but

metastases must involve levels and4 a3illary lymph nodes or internalmammary and internal jugular lymphnodes "rst


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B.9>0, Birads & % sonographically normal

tissues that cause mammographic or

clinical abnormalities Birads % benign entities and include

intramammary lymph nodes# ectaticducts# all simple and many complicated

cysts# and de"nitively benign solidnodules# such as lipoma and hamartoma


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Birads 4 % ?probably benign@ lesions# andincludes some complicated and comple3

cysts# small intraductal papillomas and asubset of "broadenomas

Birads A % ?suspicious% Aa % ?mildly suspicious@

Ab % ?moderately suspicious@

Ac % ris8 of malignancy is greater than '* toless than C'

Birads ' % ?malignant@


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Birads & and routine screeningfollo up

Birads 4 surgical biopsy# imageguided needle biopsy# or short intervalsonographic follo up

Birads A biopsy


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,pecial Breast Technique +esion that are more than 4* compressible

are fatty ith a high degree of certainty D

either a normal fat lobule or a benign lipomaHeeling and toeing of the transducer

minimizing critical angle shadoing arisingfrom -ooper


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0oppler ultrasound assessment dependsin compression pressure blood :o

can easily be decreased if compressionis too vigorous

5ositional changes are important inassessment of comple3 cyst# :uiddebris

levels# mil8 of calcium# fat:uid levels


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Main indication 5alpable lump /or tiny and super"cial lesion just under

the s8in 0ense tissue in the area of the palpable

lump


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-riteria to evaluate ,ize correlation Measurement a lesion (hich has a ater

density in mammography) should bemade outside to outside to include thecapsule that surrounds the cyst and solidnodule# because the capsule is aterdensity and ill be included in the

measurement of the lesion onmammogram


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,hape -orrelation Must consider phenomena %

5artial compressibility 9otary forces

5artially compressible lesions that appearspherical on mammography are oval shapedon sonography

Ehen the lesion is spherical in mammographyand incompressible# the shape ill bespherical in sonography


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Mammographic and sonographiccompression apply di$erent rotatory

forces on lesions that are not sphericalMammographic compression pulls lesions

aay from the chest all# and tends torotate the lesion so that its long a3is liesperpendicular to the chest all

,onographic compression

push lesioncloser to the chest all and tends to rotatethe lesion


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+ocation or 5osition -orrelation Mammographic compression pulls a lesion

aay from the chest all ,onographic compression pushes the

lesion closer to the chest all

The lesion ill loo8 deeper in sonography

than in mamography


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,urrounding tissue density correlation 23% a lesion that protrudes into the

subcutaneous fatfrom the mammaryzone# should lie at the junction of thesubcutaneous fat and mammary zonealso on the sonogram


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,onographic /inding ;ormal tissue and variations .ncluding % duct ectasia# "brocystic change#

benign proliferative disorders

can causemammographic and sonographic abnormalities>;0.s (>berrations of normaldevelopmentand involution)

>;0.s can also presents as cysts and solidnodule in sonography false positive result atbiopsy

>;0.s can be characterized as B.9>0, #4# or A


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,imple cyst 0e"nitively benign

.f strict criteria for a simple cyst are met#the lesion is B.9>0,

-omplicated and comple3 cyst can becharacterized as B.9>0, #4# and A


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,olid ;odules >utomatically indication for biopsy

.f it B.9>0, 4 must have a or loerris8 of being malignant

,piculated and circumscribed cancersdi$er greatly

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Breast Sonography