Diagnostic ultrasound ( PDFDrive )

CHAPTER
21
The Breast
Jordana Phillips, Rashmi J. Mehta, and A. Thomas Stavros
SUMMARY OF KEY POINTS
• Breast ultrasound plays a key role in supplemental breast
cancer screening, diagnostic imaging, and interventional
breast procedures.
• All images should be annotated with the following: the
side (left or right), clock face position, distance from the
nipple in centimeters, and transducer orientation. All
lesions should be scanned and measured in two
orthogonal planes to assess the size, surface, internal
characteristics, and shape.
• A negative whole-breast screening ultrasound examination
should include a minimum of ive images of each breast,
including one image in one plane of each quadrant of the
breast, typically at the same distance from the nipple, and
one image of the retroareolar breast.
• For diagnostic ultrasound examinations, it is necessary to
document that the area in question was imaged, even if
no abnormality is seen. If the area is palpable, make sure
to palpate the area and place the probe immediately over
this location.
• The Breast Imaging Reporting and Data System
(BI-RADS) is a required standardized lexicon for
describing and classifying indings and their probability of
malignancy.
• Suspicious indings include irregular shape; indistinct,
speculated, angular, or microlobulated margins; orientation
that is not parallel; acoustic shadowing; hypoechoic
echotexture; and calciications.
• For mammographic-sonographic correlation, it is important
to conirm that the size, shape, location, and surrounding
tissue density of the mammographic and sonographic
indings are the same.
• Tools that can aid diagnosis include Doppler imaging and
elastography. Three-dimensional imaging and contrastenhanced
ultrasound are currently being studied.
CHAPTER OUTLINE
APPLICATIONS OF BREAST
ULTRASOUND
BREAST ANATOMY AND
PHYSIOLOGY
SONOGRAPHIC EQUIPMENT
SONOGRAPHIC TECHNIQUE
Patient Position
Annotation
Documentation of Lesions
Split-Screen Imaging
Special Breast Techniques
Doppler Sonography
Elastography
Three-Dimensional Ultrasound
Contrast-Enhanced Ultrasound
REPORTING
SONOGRAPHIC FINDINGS
Normal Tissues and Variations
Cysts and Cystic Masses
Simple Cysts
Complicated Cysts
Complex Cystic and Solid Masses
Solid Masses
Suspicious Findings
Indistinct Margins
Spiculation or Thick Echogenic Rim
Angular Margins
Microlobulations
Not Parallel (Not Taller-Than-Wide)
Orientation
Duct Extension
Acoustic Shadowing
Hypoechogenicity
Calciications
Associated Features
Benign Findings
Hyperechoic Tissue
Parallel (Wider-Than-Tall)
Orientation
Thin Echogenic Capsule
DIAGNOSTIC ULTRASOUND
INDICATIONS
Symptomatic Breast
Breast Pain
Palpable Abnormality
Nipple Discharge
Mammographic Findings
Size Correlation
Shape Correlation
Location or Position Correlation
Surrounding Tissue Density
Correlation
Sonographic-Mammographic
Conirmation
NICHE APPLICATIONS FOR BREAST
ULTRASOUND
Infection
Implants
Breast Cancer Staging
Sonographic–Magnetic Resonance
Imaging Correlation
ULTRASOUND-GUIDED
INTERVENTION
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