Breast Cancer - Arab Medical Association Against Cancer

Breast Imaging 58Figure 5.2:Type I Microcalcifications (rim-like and tea-cup calcifications) are always associated with benignlesions.The type V correponds to intraductal linear or branching microcalcifications and is associatedwith carcinoma in more than 90% of cases. Histologically, they represent intraductal calcifications ofnecrosis. The other types of microcalcifications are associated with variable risk of carcinoma.Another important criterion is the shape of the cluster as described by Lanyi: linear, triangular orientedtowards the nipple or angular outline are suspect of cancer. Associated signs can be useful likemacrocalcifications, skin abnormalities, nipple retraction.Figure:ULTRASONOGRAPHYUltrasound is an important complementary imaging technique to physical examination andmammography. Mammography will always be first acquired for breast diagnosis. The only exceptioncan sometimes be the case of a young woman with no past history, whose prior ultrasonography showsa palpable cyst or a mass typical of fibroadenoma. But one must always keep in mind the possibility ofbreast cancer also in very young women.High frequency linear array transducers must be used (from 7 to 14 MHz) to correctly explore thissuperficial organ. New sonography units are performing with new software like Spatial or Frequencycompound, Doppler imaging and Harmonic Imaging and Elastography . The examination is performedwith the patient in supine position, sometimes slightly oblique to permit the lateral part of the breast tobe scanned with the arm raised. The major indications of breast ultrasound are the differenciationbetween cyst and solid mass, the exploration of a palpable abnormality not clearly visible onmammogram (dense breast, protheses, mammographic opacity seen on only one incidence) or whenthe lesion cannot be radiographed (axillary or submammary locations). Guided aspiration , biopsy, orneedle localization can be performed under ultrasound guidance.Diagnosis in UltrasonographyUltrasound is essential for diagnosis of masses. It enables to caracterize a cyst as simple, complicatedor complex (FIG 4). When this mass is not a cyst, Ultrasound permits to evaluate the degree ofsuspicion with description of shape, margins, orientation, boundary, internal echo pattern and posterior