Diagnostic ultrasound ( PDFDrive )

CHAPTER 21 The Breast 811
FIG. 21.78 Contralateral Invasive Carcinoma Detected on Magnetic
Resonance Imaging (MRI) and Veriied on “Second-Look” Ultrasound.
(A) Targeted diagnostic sonogram of a high-grade invasive
carcinoma in upper right breast that manifested as a palpable lump.
Ultrasound-guided biopsy showed high-grade invasive carcinoma. (B)
Staging MRI showed right breast carcinoma and an enhancing mass
inferiorly in the contralateral left breast. (C) Second-look ultrasound
showed irregular mass corresponding to the left breast lesion on MRI.
Ultrasound-guided biopsy showed synchronous high-grade invasive duct
carcinoma.
sot, subtle indings. In the diagnostic group, we weight sot and
hard indings almost equally, and in the MRI correlation group,
we weight sot indings heavily (Fig. 21.79).
A
RT
B
C
Left breast 5 N8 AR
MRI correlation
LT
ULTRASOUND-GUIDED
INTERVENTION
he use of sonography for guiding interventional procedures is
almost unlimited. Any type of interventional procedure for a
lesion that is visible with sonography can be guided by sonography.
Ultrasound can be used to guide cyst aspiration (Fig. 21.80),
needle localization for surgical biopsy with specimen sonography
(Fig. 21.81), sentinel node injection, sentinel node localization,
abscess drainage, percutaneous ductography, foreign body removal
(broken localization wires), percutaneous removal, and biopsy
using ine needles, spring-loaded needles (Fig. 21.82), and vacuum
assistance (Fig. 21.83). Sonography can be used to locate and
orient the lumpectomy cavity for booster doses of external
radiation, to guide placement of brachytherapy needles, and to
place partial-breast irradiation balloons. It can also be used to
guide lesion ablation using laser, radiofrequency, and cryotherapy.
Sonographic guidance is usually quicker, more precise, and less
expensive than mammographic, stereotaxic, or MRI guidance.
Ultrasound guidance is truly a real-time procedure, whereas
stereotaxic and MRI guidance are not.
When targeting a mass for histologic sampling, biopsy is the
most preferred approach, and a 14-gauge biopsy device is suficient.
Diferent types of biopsy devices exist that have diferent
mechanisms of action. Some function by having the biopsy device
sample the breast tissue when it is ired in the breast (see Fig.
21.82; Video 21.5). hese biopsy devices are associated with a
throw of approximately 2 cm when ired. Others allow the 2-cm
throw to occur outside of the patient’s breast, and perform the
actual sampling only while in the breast tissue. his is helpful
for areas that are deep within the breast and there is concern
for injuring the chest wall while iring the biopsy device. his
also can be helpful if choosing to sample an axillary lymph node
using a biopsy device because there is increased probability of
injuring adjacent blood vessels and causing hematoma with a
device that ires within the breast. Another form of biopsy device
uses vacuum assistance wherein no iring is involved. he biopsy
device is placed beneath the target. he vacuum then sucks the
targeted area into the aperture and removes it (Fig. 21.83). his
type of biopsy device does not need to be removed from the
breast ater each sample, and therefore there is less risk of losing