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126 Cards in this Set
- Front
- Back
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What is breast ultrasound primarily used for; screening or diagnosis
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diagnosis (screening is becoming more popular)
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What are the 3 zones of the breast
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premammary zone
mammary zone retromammary zone |
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What is contained in the premammary zone (AKA subcutaneous zone)
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SQ fat
suspensory ligaments blood vessels skin pathology |
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What is contained in the mammary zone
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ducts
fat fibrous tissue breast pathology suspensory ligaments |
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What is contained in the mammary zone
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fat
suspensory ligaments (coopers ligaments) superficial perctoralis some breast pathology |
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What is the appearance of skin on US
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hyperechoic
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What is the appearance of fat in the breast
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hypoechoic (hyperechoic everywhere else)
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If a breast is very dense what is the appearance on US
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very hyperechoic
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Does having dense breast help with ultrasound
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yes, the opposite of mammography...having dense breast makes the hypoechoic lesions pop out
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What is the appearance of the fat in a LN
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it is hyperechoic (exception of the breast)
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Describe the findings of a LN on US
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oval
circumscribed hilum hyperechoic (fat) cortex hypoechoic may have increased through transmission |
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What is the doppler findings of a LN
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the hilum may have increased flow
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What is the appropiate position when performning a breast ultrasound
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ipsilateral are underhead
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What type of transducer is used for breast US
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linear high resolution (7.0mhz)
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What is a standoff pad used for
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if a lesion is in the skin a stand off pad allows the focal zone to be elevated for better evaluation
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What are the two ways to scan the breast
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transverse and longitudinal
radial and antiradial (clockwise and counterclockwise) |
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How is doppler helpful in breast US
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determines solid vs cystic
finds hyperemia in infected cyst wall will find hilar flow in a LN |
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Why is duplex doppler useful
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will help to determine if there is true flow vs noise
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Can a cancer look like a cyst
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yes that is why it is important to use doppler
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What is a pitfall when using doppler to determine if there is flow
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if you compress too hard you can eliminate flow that is actually there
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In a fatty breast (hypoechoic) is it sometimes difficult to dicern hypoechoic lesions
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yes
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Besides regular ole doppler what is another technique for determing if a lesion is a mass
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power doppler fremitus
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How does power doppler fremitus work
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pt hum or say 'eee' then normal tissue will vibrate and distiguish from true solid mass.
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Does the lesion fill in on power doppler or the normal tissue
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the normal tissue will fill in and appear as orange the true lesion will not
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Generally speaking for cancers what is the RI centrally and peripherally
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high RI centrally
low RI peripherally |
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If you are having difficulty determining if a lesion is solid or not can you compress it to see if it is a true lesion
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yes, fat will compress 30% while a solid lesion will not
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What is elastography
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this is a new technique which measures the differences in elasticity of tissue
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What must be annotated on all images of US
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side (right vs left)
clock face position distance from the nipple scan plan orientation (trans/long vs rad antirad) depth of the lesion (optional) |
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What are the three descriptors for depth
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anterior
middle deep |
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Hoiw is the distance from the nipple annotated
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inner third
middle third outer third |
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How is depth annotated in some institutions
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A (anterior third)
B (middle third) C (deep third) |
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What is the lexicon for describing masses of a breast on US
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shape
orientation margin lesion boundary echo pattern posterior acoustic features surrounding tissue |
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What is the Birads assessment categories
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0 needs additional work up
1 negative 2 benign 3 probably benign 4 suspicious 5 highly suggestive 6 known |
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What percent chance of breast cancer is there if a pt is birads 3, 4 or 5
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<2%
3-94% >95% |
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What is the follow up for birads 3
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6 month
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What is the time interval fu for a birads 3
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6 month
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What is the time interval fu for birads 1 and 2
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1 year
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When is US the first line technique for analyzing the breast
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Palpable masses:
women less than 30 lactating pregnant |
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What are 3 secondary reasons why breast US is used
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Further eval of mammographic findings
evaluation of breast implants Guidance of interventional procedures |
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What are some other indications for breast imaging that are beginning to come in vogue
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Second look US following MR
Suspected breast mets with unknown mets Evaluate response to therapy and extent of disease Whole breast US screening for occult cancer |
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What are 2 reasons why breast US is the 1st line modality for women under 30y
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No radiation (younger are more sensitive to radiation)
Dense breast limit mammographic evaluation |
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When is mammogram needed in a women less than 30
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if no US correlate is found to a palpable leesion
A suspicous lesion is found on US and this needs further work up |
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Besides women under 30 y when is breast US a first line modality
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pregnant and lactating women
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If a women under 30 gets a mammogram and biopsy reveals a malignant lesion what is the next step
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mammography for further evalution of extent of disease
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What are the US characteristics of a breast cyst
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anechoic
round or oval sharply marginated thin edge shadow artifact posterior acoustic enhancement negative doppler |
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What are the findings of posterior acoustic enhancement
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hyperechoic back wall
increased through transmission |
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What is the cause of dilated terminal ductal lobular unit
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fibrocystic change
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Is a dilated TDLU benign
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yes
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Describe a dilated TDLU
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cluster of 2-3 mm cyst with thin intervening septations
no discrete solid part |
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What is a cluster of microcyst most likely gonna be
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dilated TDLU (benign)
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What are 2 examples of skin cyst
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sebaceous or epidermal inclusion cyst
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Where are both sebaceous and epidermal inclusion cyst located
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dermis or subdermal
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Describe a sebaceous cyst
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hypoechoic
gland neck |
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Describe a epidermal inclusion cyst
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heterogeneous
concentric echogenic layers |
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Can a hair follicle be seen sometimes with a sebaceous cyst
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yes
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Is there color flow in sebaceous and epidermal inclusion cyst
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no
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Where is the doppler flow in a LN
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hilar region
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What are some lesions that are complicated cyst
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Fibrocystic change
galactoceles lipid cyst |
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What are the findings of complicated cyst
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internal echoes
ring down artifact |
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Do complicated cyst sometimes have uniform thick walled cyst, fluid fluid leveles,
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yes
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Can a complex cyst have circumferential wall calcifications
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yes
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What type of lesion typically has circumferential wall calcifications
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oil cyst
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What is a complex mass
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cystic lesion with some solid components
eccentric wall thickening mural nodules thick septations fibrovascular stalk |
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What type of neoplasms are complex masses most of the time
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papillary neoplasm
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Do complex cyst all get biopsied
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yes
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Can high grade invasive ductal cancer , medullary and lymphoma be very hypoechoic
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yes
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What are techniques to determine if something is solid or cystic besides doppler
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compress
change pt position and levels or echogenic material will change position |
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If something is a simple cyst or a skin cyst what is the birads classification
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2
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If soemtheing is a complicated cyst or has clustered microcyst what is the birads classification
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2 or 3
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If something is a complex mass what is the birads level
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4
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If you are sampling percutaneously what must be left
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clip marker (otherwise must undergo excision)
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What do must radiologist call clustered microcyst
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birads 3
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If you are unable to determine if something is solid or not what is the classification
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birads 3 or 4 (based on other features)
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What is the appearance of solid masses to fat
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hyperechoic to fat
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What is the MC shape of a solid mass
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ellipsoid shape
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What are benign US features of a solid mass
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hyperechoic
ellipsoid 3 or fewer gentle lobulations thin echogenic pseudocapsule abscence of any malignant feature |
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Is being ellipsoid and hyperechoic both benign characteristics of a solid on US
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yes
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Is having 3 or fewer lobulations or a thin ehcogenic pseudocapsule a benign characterisitc
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yes
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If a solid mass is hetergenous and 'ugly looking' and has hyperechoic components is it benign
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yes
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What are the malignant features of ultrasound
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spiculations
taller than wide angular margin shadowing branch pattern markedly hypoechoic calcifications duct extension microlobulations disruption of tissue plane |
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Are spiculations and being taller than wide malignant features on US
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yes
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Are angular margins and shadowing malignant features on US
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yes
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What is taller than wide called on US
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non-parallel
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Are branching and being markedly hypoechoic malignant features on US
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yes
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What malignant features have highest PPV for predicting malignancy
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spiculation
taller than wide (non-parallel |
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Again what are the benign characteristics of margins on US
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circumscribed margins
oval or round midly lobulated |
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What are malignant features of margins are
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spiculated
microlobulated margins irregular |
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What is the most important thing to consider when determing if a solid mass appears malignant
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the margins
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What did studies show that would happen to the NPV of predicting tumors if US was added
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the NPV increases (can safely follow it)
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When is it safe to follow birads 3
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if it is mammographically and sonographically benign appearing
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Can you call a new mass a birads 3
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no (should be biopsied)
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What happens if you birads something 3 by mammography and cant see it on US
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-you know its not a cyst (bc you would see it)
-if it is well circumscribed, not new or growing, no suspicious features then can still call it birads 3 -if new or any suspicious features than birads 4 or 5 |
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Are asymmetries seen on mammography ever evaluated by US
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yes
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What are 5 mammographic findings that can be analyzed by US
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asymmetry
focal asymmetry architectural distortion calcifications dilated ducts |
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Why do you analyze questionable mammographic features
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determine if there is an US correlate
determine if it has benign or malignant features on US determine if it is amenable to US guided procedure |
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What is a scenario of an asymmetry that might require evaluation by US
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asymmetry is seen in one view but not the other
roll views doesnt eliminate it then go to US |
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Is architectual distortion analyzed using US
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yes
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Why would you US a highly suspicious pattern of calcification such as fine pleomorphic
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not for diagnosis, but only to see if it is amenable to US guided biopsy (no compression is necessary)
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When you do a core biopsy of area of suspicous calcs what should be done to the samples to assure you have an adequate sample
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x ray
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Would you ever US segmental distribution of linear branching calcifications
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yes, these are a 5 but it is helpful if these can be biopsied via US
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Is there any diagnostic value to US malignant appearing calcifications
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yes, actually studies show if microcalcifications are seen on US they are 3 x more likely to be malignant (doesnt usually change managment since you would have biopsied anyways)
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What are some clinical symptoms that suggest malignancy
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palpable lump, ridge, skin thickening, focal non-cyclical pain, nipple discharge (clear or blood..especially from one side)
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What if there are SS to suggest malignancy but the mammogram is normal
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consider US
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What is a suspicious clinical presentation that always warrants US if mammogram is negative
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nipple discharge
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Why is it a good idea to US a palpable ridge if there is no explaination on mammo
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bc this may be a palpable mass or a benign palpable ridge (but the patient will get an explaination)
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What are 3 detectable causes of nipple discharge by US
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duct ectasia
intraducatal mass abscess |
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Can a large abscess be confused with a agressive carcinoma
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yes (may look heterogenous and partly solid)
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What percent of women will have malignancy and present with a palpable lump but have negative US and mammogram
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4% (therefore alway aspirate if suspicious)
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Do saline and silocone implants look the same on US
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yes (when they are intact)
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What is the appearance of breast implants when they are intact
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hypoechoic
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How many echogenic lines do a single and double lumen breast implants have
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single 3 echogenic lines
double 5 echogenic lines |
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What is the MC reason to evaluate breast implants
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palpable lesion
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What is the MC reasons for a palpable lesion of a breast implant
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radial fold
herniation valve |
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What is the MC presentation of a contracture of the breast
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one breast is larger than the other
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What is the appearance of a saline implant rupture
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the echogenic lines of the breast implant will be folded in on eachother
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What is the US findings of an extracapsular silicone rupture
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snow storm (outside of the implant)
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What is the US findings of an intracapsular silicone rupture
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stepladder sign
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When is second look US utilized
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a suspicious lesion is seen on MRI that wasnt initialy seen on US or mammo. Second look is utilized sometimes to reevaluate
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Why is a second look US done after a lesion seen on MR is already deemed suspicious
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bc you want to see if it is amenable to US guided bx
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If a pt has mets that are suspcious for breast cancer and Mamo is negative is US utilized
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yes
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Is US used for evaluating response to therapy
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yes
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If a pt has birads 4,5 and 6 disease by mammo is US still done?
why?3 |
yes,
-evaluate for multifocal and multicentric disease -evalutate for ipsilateral axilla and LAD -assist in tx planning |
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What does a malignant LN look like
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cortical thickening (asymmetric)
abnormal node adjacent to normal increased peripheral flow |
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If there is increased flow in the cortex of the LN is that suspicous
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yes, warrants a biopsy
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When is whole breast ultrasound screening most useful
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dense breast
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What is the benefit and shortfall of US screening
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increased detection of small cancer
increased biopsy (1 in 10) are cancer |
