Breast Discharge: Ultrasound and Doppler Evaluation - NCI

More documents

Recommendations

Info

Breast Discharge: Ultrasound & Doppler Evaluation 267 (A) (B) Fig. (7): 35 years old female with long history of breast discharge &developed uniorificial bleeding. A- A small mass with ill defined outline is seen with proximal ductal dilatation. B- On colour Doppler a small vascular stalk is seen. Pathology was florid ductal hyperplasia with focal atypia. (A) (B) (C) (D) Fig. (8): Forty years old female with right uniorficial sero-sanginous discharge. A- Mammogram mediolateral view revealed retroarelar rather well circumscribed macro-lobulated mass(arrow). B- Radial US image showed an irregular intraductal mass (arrows) & microcalcifications (arrow head). C- On colour Doppler non tapering vascular stalk is seen. D- Ductoscopy image showed irregular intraductal mass.
268 Soha T. Hamed, et al. (A) (B) Fig. (9): Forty years old female with uniorificial discharge. A- Galactography revealed two small intraductal filling defects (arrow). B- US revealed multiple echogenic rounded lesions separable from the wall, no flow inside. DISCUSSION Nipple discharge disorders is a field in which there has been both increasing awareness on the part of patients and advances in management [4]. In this study in five cases the only finding seen in galactography was intraductal filling defects. In dedicated study done by cho and his colleagues ,they stated that in order to thoroughly and accurately evaluate patients exhibiting pathologic nipple discharges, it is important to perform ductography and not to miss the subtle but suspicious ductographic findings associated with breast cancer. Diffusely spreading intraductal cancers, with or without focal invasions, are often found to be negative by mammography (especially in absence of microcalcifications) and sonography. In such cases, ductography constitutes the best imaging method, as it has proven effective in the determination of the nature and extent of such lesions and can facilitate appropriate surgical management [5]. We agree with other radiologists who maintain that ductography is prohibitively timeconsuming and that it can be replaced, at least in part, by sonography. Intraductal papillary lesions are sometimes visualized as isoechoic or hyperechoic masses in dilated ducts on sonography and can often be biopsied under sonographic-guidance [6-8]. The quality of breast US is closely related to the performance of the equipment used for the examination and the skill of the examiner. Linear-array, broad-bandwidth transducers with maximum frequencies of 10-13MHz and a center frequency of at least 7 or 7.5MHz are required to depict Ductal carcinoma in situ (DCIS). The adjustment of focal zones, system gain and time gain compensation setting is also important. US should be performed in radial and anti-radial planes as well as longitudinal and transverse planes. In patients with DCIS, radial US is particularly useful for depicting intraductal masses and evaluating the ductal extent of disease, whereas anti-radial US is more helpful for evaluating the surface characteristics of the mass [9]. We add to perfect US technique for assessment of retroareolar area, excessive gel and gentle pressure to see mass inside the duct. Cancer risk from nipple discharge is reported to be anywhere from 1.3% to 47% [10]. The incidence of malignancy in this study was 5.6% in addition to 2.8% precancerous condition likely hyperplasia and atypia. In this study, masses of intraductal carcinoma are relatively hypoechoic compared to benign cases, this coincides with those who reported that ultrasound appearance of non-screening detected intraductal carcinoma is relatively isoechoic in comparison with invasive carcinoma [10], regarding shape; oval shaped masses proved in this study to be papillomas but assessment of margins, was not a point of differentiation, as in two cases of atypia which showed macro-lobulated outline and in two cases of
Page 1 and 2: Journal of the Egyptian Nat. Cancer
Page 3 and 4: 264 RESULTS One hundred and seven p
Page 5: 266 Soha T. Hamed, et al. (A) (B) F
Page 9: 270 Soha T. Hamed, et al. 11- Chen

Breast Discharge: Ultrasound and Doppler Evaluation - NCI

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?