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Flashcards in Breast Powerpoint Deck (46)
1

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

2

Main purpose of breast evaluation is the

detection and diagnosis of breast cancer in its early and curable stages

3

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

4

Regular clinical breast exams

by a physician every three years until age 40 then yearly

Screening mammography begins at age 40

5

Ultrasound of the breast is

safer and more accurate in young dense breast

6

Ultrasound can differentiate

solid masses from fluid filled cysts

can visualize tissue adjacent to implants or other structures that limit mammography

7

Interventional breast procedures

Cyst aspirations can be performed

to assess the lesion as a complex cyst or mass

8

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)

9

Interventional breast procedures

Needle localization

preoperative wire localization and injection of radioactive tracer for sentinel node identification

10

Interventional breast procedures

The key to needle visualization is

to keep the needle as to the transducer face as possible

11

Interventional breast procedures

Main hazard is

piercing of the chest wall

12

Pathology -benign

Cyst

clinical signs- discomfort, palpable lump, mobility

smooth walls, anechoic, posterior enhancement

13

Pathology -benign

Complicated cyst

clinical signs- may be related to inflammation or hemorrhage within a cyst

14

Pathology -benign

Sonographic findings

wall thickening or irregularities, septations, internal echos

15

Solid mass- benign

Fibroadenoma

Most common breast tumor
Primarily in young women
Growth stimulated by estrogen

16

Solid mass- benign

Fibroadenoma
Clinical Findings

Firm, rubbery, freely mobile
Slow growing

17

Solid mass- benign

Fibroadenoma
Sonographic Appearance

Smooth, rounded margins
Low-level homogeneous internal echos
Possible posterior acoustic enhancement
Typically hypoechoic

18

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

19

Lipoma- fatty tumor-benign

Sonographic Findings

Typically smooth walls
Hypoechoic similar to breast fat
Posterior acoustic enhancement
Easily compressible

20

Fat Necrosis- benign

Caused by trauma, surgery, radiation treatment, mastitis
Spherical nodule, superficial under layer of calcified necrosis

21

Fat Necrosis- benign

Sonographic Findings

Irregular
Complex low-level echos
May mimic malignant mass
Acoustic shadowing may or may not be present

22

Abscess-benign

Pain
Swelling
Febrile
Enlarged axillary nodes

23

Abscess-benign

Complex
Diffuse increased echogenicity of the breast (if mastitis)
Hyperemia with color and or/ power Doppler

24

Papillomas -benign

arise from lining of breast ducts, retroareolar area most common
Bloody discharge from single duct

25

Papillomas -benign

Sonographic Findings

Tiny papilloma may not be detected
May cause dilatation of a single duct

26

Papillomas -benign

Intracystic papillomas

soft tissue mass growing into lumen of cystic lesion

27

Sebaceous cysts-benign

obstruction of sebaceous gland or hair follicle within dermal layer of skin

28

Sebaceous cysts-benign

Sonographic Findings

Rounded, well defined mass with low to medium level echogenicity
Wall calcification possible

29

Phyllodes- benign/malignant

borderline or transitional form between benign and malignant tumor
Can grow quite large
Develop in women between ages 40-60

30

Phyllodes- benign/malignant

Sonographic Findings

Well-defined, lobulated solid mass with possible internal cystic spaces

31

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

32

Ductal carcinoma in-situ

most common non-invasive carcinoma
Asymptomatic, palpable mass, nipple discharge

33

Ductal carcinoma in-situ

Mammography findings

microcalcifications

34

Ductal carcinoma in-situ

Sonographic findings

intraductal mass
microcalcifications
irregular ductal dilatation
architectural distortion

35

Lobular carcinoma in-situ (LCIS)

generally affects premenopausal women
distinct tumor not a feature

36

Lobular carcinoma in-situ (LCIS)

Sonographic Appearance

bilateral, multicentric
mimics fibrocystic disease

37

Invasive ductal carcinoma-IDC

Most common malignancy
Hard fixed mass
Skin dimpling or skin/nipple retraction

38

Invasive ductal carcinoma-IDC

Mammography findings

Asymmetric
Radiopaque speculated mass
Microcalcifications
Thickened and retracted Cooper’s ligament

39

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

40

Invasive lobular carcinoma-(ILC)

Mammography can underestimate the extent

41

Invasive lobular carcinoma-(ILC)

Sonographic Findings

Possible speculated mass mimicking invasive ductal carcinoma
Architectural distortion

42

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

43

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

44

Colloid/Mucinous

Sonographic Findings

Well-defined margins
Hypoechoic or isoechoic to fat
Homogeneous
Possible microlobulations

45

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

46

Breast implants

Can be challenging to scan
Can be even more challenging to biopsy