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Breast lesion by ultrasound
Breast lesion by ultrasound
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Ultrasound breast mass

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Breast mass is a major concern. Aim of this study is to understand the tissue character of any breast mass, if it is solid then to decide about further strategy for regular follow up and or biopsy

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Ultrasound breast mass

  1. 1. Dr REKHA KHARE MD. RADIOLOGY U/S characterisation of breast mass
  2. 2. Lump in Breast A lump in the breast is a cause of great concern. High frequency, high-resolution USG helps in its evaluation. This is exemplified in women with dense breast tissue where USG is useful in detecting small breast cancers that are not seen on mammography The American College of Radiology has also brought out a BIRADS-US classification system for categorizing focal breast lesion
  3. 3. Breast cancer Breast cancer is among the most common causes of cancer deaths today, coming fifth after lung, stomach, liver and colon cancers.  Refinement of high-frequency technology, particularly with 7.5–13 MHz probes, has brought out a totally new facet in USG breast imaging
  4. 4. Ultrasound for breast mass Harmonic imaging and real-time compounding has been shown to improve image resolution and lesion characterization.  More recently, USG elastography seems to be quite promising. 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 USG is the relative difference in the density and acoustic impedance of the lesion, respectively, as compared to the surrounding breast tissue. This is exemplified in women with dense breast tissue, where USG is useful in detecting small breast cancers that are not detected on mammography
  5. 5. Indication of breast ultrasound
  6. 6. Whatever is the indication Goal of breast u/s is clear
  7. 7. Normal breast parenchymal patterns In the young non-lactating breast, the parenchyma is primarily composed of fibro glandular 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
  8. 8. Normal breast parenchyma
  9. 9. U/S in lactating breast
  10. 10. Abnormal breast parenchymal pattern Simple cyst Complex cyst Chronic abscess Galactocoel Fibrocystic disease Duct ectasia Fibroadenoma Cystosarcoma phyllodes Lipoma
  11. 11. Simple Cyst Breast cysts are the commonest cause of breast lumps in women between 35 and 50 years of age.  A cyst occurs when fluid accumulates due to obstruction of the extra lobular terminal ducts, either due to fibrosis or because of intra ductal epithelial proliferation.  A cyst is seen on USG as a well-defined, round or oval, single or multiple anechoic structure with a thin wall .
  12. 12. Cyst on U/S
  13. 13. Cyst on U/S and mammogram
  14. 14. Complex 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
  15. 15. Chronic abscess of the breast 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.  An abscess may show an ill-defined or a well-defined outline. It may be anechoic or may reveal low-level internal echoes and posterior enhancement
  16. 16. Abscess on U/S
  17. 17. Galactocoel lacteal cyst or milk cyst I t is a retention cyst containing milk or a milky substance that is usually located in the mammary gland It is caused by a protein plug that blocks off the outlet It is seen in lactating women on cessation of lactation Patient typically presents with a painless breast lump occuring over weeks to month
  18. 18. Galactocoel internal contents moving with change in position of breast
  19. 19. Fibrocystic disease This condition is referred to by many different names: fibrocystic disease, fibrocystic change, cystic disease, chronic cystic mastitis or mammary dysplasia.  About half of these breast masses are usually classified as indeterminate and will eventually require a biopsy.
  20. 20. Fibrocystic disease on U/S extremely variable 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 . Discrete single cysts or clusters of small cysts may be seen in some  Focal fibrocystic changes may appear as solid masses or thin- walled cysts.
  21. 21. Fibrocystic disease on U/S
  22. 22. Duct ectasia This lesion has a variable appearance. Typically, duct ectasia may appear as a single or multiple tubular structure filled with fluid  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 identified
  23. 23. Ductal Ectasia on U/S
  24. 24. Fibroadenoma 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 ( breast mouse) on palpation.  It is rarely tender or painful. The size is usually under 5 cm, though larger fibroadenomas are known. Fibroadenomas are multiple in 10–20% and bilateral in 4% of cases. Calcifications may occur.
  25. 25. Fibroadenoma on U/S A well-defined lesion. A capsule can usually be identified. The echotexture is usually homogenous and hypoechoic as compared to the breast parenchyma, and there may be low-level internal echoes  Typically, the transverse diameter is greater than the antero- posterior diameter
  26. 26. Fibroadenoma on U/S and Mammography
  27. 27. Cystosarcoma phyllodes 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 echo texture, sometimes with variable cystic areas.
  28. 28. C.Phylloides on U/S
  29. 29. Lipoma in breast parenchyma 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.
  30. 30. Lipoma on U/S and Mammography  A thin capsulated echo genic mass with a stippled or lamellar appearance
  31. 31. Breast ultrasound criteria for benign lesions Smooth and well circumscribed Hyper echoic, iso echoic or mildly hypo echoic Thin echogenic capsule Ellipsoid shape, with the maximum diameter being in the transverse plane Three or fewer gentle lobulations Absence of any malignant findings
  32. 32. Breast ultrasound criteria for malignant lesion Malignant lesions are commonly hypo echoic nodular lesions with ill- defined borders, which is ‘taller than broader’ and has spiculated margins, posterior acoustic shadowing and micro calcifications  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 to be very efficacious
  33. 33. Malignant breast mass on U/S
  34. 34. Benign versus malignant
  35. 35. Gynecomastia enlarged male breast tissue due to hormonal imbalance It could be uni or bilateral Oestrogen and Testosterone are not adequately balance
  36. 36. Discussion 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 a low risk of being malignant that the option of short-interval follow-up can be offered as a viable alternative to biopsy.
  37. 37. Combined studies Combined studies, which included USG and mammography, have demonstrated nearly 100% negative predictive value for palpable breast lesions, when both are used together. In a study based on characterization of breast masses according to BIRADS-US criteria, people have found no statistical differences between fine-needle aspiration cytology and USG with regard to sensitivity and Negative Predictive value (P > 0.05). It is also found USG characterization of breast lesions using BIRADS- US criteria to be highly accurate.
  38. 38. Have a nice time Dr Rekha Khare Thank you

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