Diagnostic ultrasound ( PDFDrive )

CHAPTER 21 The Breast 765
Straight AP
Peripheral comp
Probe
2
Probe
1
A
RT 6 SA RAD
B
Rolled nipple
Two-handed
compression
3
1 2
3
Probe
RT 6 SA RAD
2
Probe
1
FIG. 21.7 Maneuvers for Demonstrating Subareolar and Intranipple Mammary Ducts. (A) Left image, The subareolar ducts are dificult
to assess from a straight anterior approach because shadowing arises from the nipple and areola and the tissue planes of the nipple are parallel
to the ultrasound beam. Right image, Peripheral compression technique. With vigorous compression on the peripheral end of the transducer and
by sliding it over the nipple to push the nipple to the side, shadowing can be minimized, and the angle of incidence of the beam with the subareolar
ducts can be improved. Lesions that lie in the immediate subareolar region can often be demonstrated. (B) Left image, Rolled nipple technique is
the best way to demonstrate the ducts within the nipple and whether a lesion extends into the nipple from the subareolar ducts. Right image,
Two-handed compression technique further improves the angle of incidence with the subareolar ducts and helps assess the compressibility of the
ducts. This can help to distinguish echogenic, inspissated secretions from intraductal papillary lesions and determine whether the lesion (arrows)
has penetrated through the duct wall (arrowheads). The rolled nipple technique shows that this malignant intraductal papillary lesion does not
extend into the intranipple segment of the duct, but the two-handed compression maneuver shows that it has invaded through the posterior duct
wall and is forming angles within the periductal tissues.