Breast lecture
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Breast sonography plays an important role in both primary and secondary screening for breast cancer. It can detect carcinomas missed by mammography due to a lack of calcification or dense breast tissue. Sonography guidelines outline standardized documentation and a BI-RADS assessment system to communicate risk levels. Common benign findings include simple cysts, fibroadenomas, and fibrocystic changes. Malignant lesions demonstrate signs like an irregular mass, spiculated margins, or architectural distortion. Sonography helps diagnose palpable lumps and guides biopsies of suspicious findings while avoiding unnecessary procedures for clearly benign lesions.
Breast lecture
- 1. INTRODUCTION TOINTRODUCTION TO BREAST SonographyBREAST Sonography DR : AYYAZ MAHMOOD RADIOLOGY SPECIALIST KFH
- 2. ROLE OF SONOGRAPHYROLE OF SONOGRAPHY PRIMARY SCREENING SECONDARY SCREENING DIAGNOSIS
- 3. PRIMARY SCREENINGPRIMARY SCREENING SECONDARY SCREENING KOLB et al ( 2- STUDIES ) BUCHBERGE R et al KAPLAN et al
- 4. Usg Detected 3Usg Detected 3 CARCINOMAS missed byCARCINOMAS missed by mamo /1000mamo /1000 NO CALCIFICATION OBSURED BY SURROUNDING OR SUPERIMPOSED DENSE TISSUE ON MAMMO VALUE OF USG AS SECONDARY SCREENING
- 5. DIAGNOSIS….proven &DIAGNOSIS….proven & approved roleapproved role SPECIFIC GOALS PREVENT BIOPSIES &SHORT INTERVAL FOLLOW UP GUIDE INTERVENTIONS GIVE FEED BACK THAT IMPROVE CLINICAL & MAMOGRAPHIC SKILLS DETECT MALIGNANCIES MISSED BY MAMMO
- 6. EQUIPMENTEQUIPMENT HIGH FREQUENCY TRANSDUCERS Optimised for near field imaging ACS , ACR , AIUM Minimum FREQUENCY 7 MHZ
- 7. DOCUMENTATIONDOCUMENTATION Side Clock face position Distance from nipple Transducer orientation 2 orthogonal planes SURFACE INTERNAL ARCHITECTURE MAXIMUM DIAMETER
- 8. BIRADSBIRADS ….(Breast imaging reporting & data system.)….(Breast imaging reporting & data system.) Standardizing reporting and data 1 1 , 2 , 3 , 4a , 4b , 5 1 : sonographic normal tissue , mammographic or clinical abnormalities 2: benign entities ( intramammery lymph nodes ,ectatic ducts , simple cysts , definitely benign solid nodules as LIPOMA 3: probably benign ….2 % or less chances as complex cysts ,small intraductal papillomas , subset of fibroadenoma .
- 9. BIRADSBIRADS ….(Breast imaging reporting & data….(Breast imaging reporting & data system.)system.) 4: suspicious , two categories 4a…….mildly suspicious 3- 49 % 4b…….modera suspicious 50- 89 % 5: malignant ….. 90 % or greater
- 10. MANAGEMENT RULESMANAGEMENT RULES 1 – 2 ……ROUTINE SCREENING & FOLLOW UP 3 ……….SURGICAL BIOPSY , IMAGE GUIDED NEEDLE BIOPSY , SHORT INTERVAL FOLLOW UP 4a – 4b – 5 ……….BIOPSY
- 11. MAIN INDICATIONSMAIN INDICATIONS PALPABLE LUMPS dense tissue area of palpable lump NO CALCIFICATION / SURROUNDING TISSUE GOAL…..FIND SOMETHING BENIGN TO AVOID BIOPSY
- 12. SONOGRAPHY PREVENTSSONOGRAPHY PREVENTS BIOPSYBIOPSY NORMAL OR DEFINATEVELY BENIGN FINDING . HIGH NEGATIVE PREDICTIVE VALUE FOR NEGATIVE MAMMO & NORMAL OR BENIGN ULTRASOUND FINDING OLD COMMON WISDOM …ALL PALPABLE LUMPS NEEDS BIOPSY…NOT TRUE
- 13. NEGATIVE USG REPORTNEGATIVE USG REPORT Palpable lesion …… NOT ACCEPTABL DOCTOR …..NOT FULLY UNDERSTAND THE PROBLEM ALL SONOGRAM IN PALPABLE LUMPS BEING POSITIVE NORMAL TISSUE , CLEARLY BENIGN FINDINGS…………………………CAUSE
- 14. MAMMOGRAPHIC DensitiesMAMMOGRAPHIC Densities No calcification ….. Best for usg Discrete masses ….. Focal asymmetrical densities USG …….. ASYMMETRICAL NORMAL …………...DEFINITELY BENIGN …………..MORE MALIGNANT THAN LOOKING BY MAMO
- 16. SONO FINDINGSSONO FINDINGS NORMAL TISSUE AND ABERRATIONS OF NORMAL DEVELOPMENT AND INVOLUTION ( ANDIs ) Ductal ectasia , fibrocystic changes , Benign proliferative disorder
- 17. Simple cystSimple cyst Cyst…….. Solid Negative predictive value 100% 99 % for sonographic normal study
- 18. Simple CystSimple Cyst anechoic well-marginated round, ovoid, or lobulated solitary or multiple well-defined posterior wall acoustic enhancement
- 19. Simple cystSimple cyst Strict criteria for simple cyst……….. No biopsy , aspiration or follow up..
- 20. MAIN INDICATIONSMAIN INDICATIONS GOAL……Malignant lesion obscured by surrounding tissue ABNORMALITY PALPATED WHILE SCANNING AGGRASIVELY SCANNING DETECT CARCINOMAS MISSED BY MAMMO
- 21. Solid noduleSolid nodule Automatic indication for biopsy ?…….
- 22. Solid noduleSolid nodule SOLID NODULE
- 23. COMPLEX COMPLICATEDCOMPLEX COMPLICATED CYSTSCYSTS THICK WALL , THICK SEPTATIONS ,MURAL NODULES Debri …………….complicated
- 24. COMPLEX COMPLICATEDCOMPLEX COMPLICATED CYSTSCYSTS MOST COMPLEX CYSTS FALL WITH IN BROAD SPECTRUM OF FIBROCYSTIC CHANGES …. MALIGNANT CYSTS ….. RARE COMPLEX / COMPLICATED CYSTS……..NO FLUID CYTOLOGY / US GUIDED BIOPSY
- 25. Breast Cancer EvaluationBreast Cancer Evaluation PRIMARY SIGNS DOMINANT MASS DENSITY MICROCALCIFICATION ARCHITACTURE DISTORTION INTERVAL CHANGES
- 26. Breast Cancer EvaluationBreast Cancer Evaluation SECONDARY SIGNS ASYMMETRIC THICKENING ASYMMETRIC DUCTS SKIN CHANGES NIPPLE / AREOLAR ABNORMALITIES ABNORMAL VEINS AXILLARY NODES
- 27. INFECTION / ABSCESSINFECTION / ABSCESS MASTITES ……. ABSCESS ABSCESS………… ASPIRATE//DRAIN APPEARANCE …….. VARY FEVER , PAIN ,TENDERNESS , INCREASE WHITE CELL COUNT
- 29. Duct EctasiaDuct Ectasia.. VARIABLE APPERANCE ELONGATED FILLED WITH FLUID TUBULAR APPERANCE
- 30. FibroadenomaFibroadenoma.. ESTROGEN INDUCED TUMOUR . 3 rd most common breast lesion . Most common benign lesion of child bearing age . Firm ,smooth , oval , well marginated and freely mobile Rarely tender or painful Can calcify
- 32. Fibrocystic ChangesFibrocystic Changes.. 72 % of screening population over 55 Round to ovoid cysts with smooth margins , lobulated or multilocular
- 33. CONCLUSIONCONCLUSION USG HAS DEFINATE ROLE PROVIDING ADDITIONAL INFORMATION WITH OR AS AN ALTERNATIVE TO BIOPSY AS A SECONDARY SCREENING MODALITY