Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging...
Transcript of Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging...
![Page 1: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/1.jpg)
mrozin,md
BENIGN VS MALIGNANT MASSES IN BREAST
ULTRASOUND
Dr. Mona RozinDirector of Breast Imaging
Assuta Medical Centers
![Page 2: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/2.jpg)
mrozin,md
Goal of Breast Ultrasound
SOLID VS CYSTIC
![Page 3: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/3.jpg)
mrozin,md
Goal of Breast Ultrasound
• Make a more specific diagnosis than clinical and mammographic findingsalone.
• Prevent unnecessary biopsies.• Find cancers missed by mammography.
![Page 4: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/4.jpg)
mrozin,md
Breast cancer is extremely heterogeneous therefore we CANNOT distinguish benign from malignant on the basis of only a single sonographic finding.
Breast cancer varies greatly not only from one mass to another but even WITHIN an individual mass.
![Page 5: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/5.jpg)
mrozin,md
Ultrasound shows morphology and not histology / biology
ONE suspicious finding requires further evaluation -----> that is biopsy and should be given BIRAD 4A up to 5
![Page 6: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/6.jpg)
mrozin,md
BIRADS for U/S
BIRAD 1 – normal
BIRAD 2 – benign finding
BIRAD 3 – probably benign
![Page 7: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/7.jpg)
mrozin,md
BIRADS for U/S
BIRAD 4A – abnormal finding – low suspicion
BIRAD 4B – abnormal finding – intermediate suspicion
BIRAD 4C – abnormal finding – probably malignant
BIRAD 5 – highly suspicious for malignancy
BIRAD 6 – known malignancy
![Page 8: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/8.jpg)
mrozin,md
Spectrum of masses
![Page 9: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/9.jpg)
mrozin,md
Circumscribed vs Spiculated malignant masses – a
spectrum of ultrasound features
I. Desmoplastic vs. inflammatory reaction
II. Cellularity
III. Vascularity
![Page 10: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/10.jpg)
mrozin,md
Desmoplastic Reaction• Host response to tumor – attempt to
wall off the tumor with fibrosis and elastosis to keep it from spreading.
• Develops slowly• Therefore spiculated lesions are
usually slow growing GRADE 1 – 2 tumors
![Page 11: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/11.jpg)
mrozin,md
Inflammatory Response• GRADE 3 tumors may be
circumscribed and grow so fast that desmoplasia has no time to develop.
• These carcinomas incite an inflammatory response with lymphocytes and plasma cells.
![Page 12: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/12.jpg)
mrozin,md
Cellularity
• Circumscribed masses are much more cellular than spiculated masses.
• They have lots of tumor cells, lymph cells and plasma cells – this causes posterior enhancement.
• Spiculated masses have much fewer cells and very hypocellular desmoplasia – this causes posterior shadowing.
![Page 13: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/13.jpg)
mrozin,md
Vascularity
• Circumscribed masses are usually very vascular – lots of cells and divisions require more blood – more angiogenetic factors; inflammatory response also creates hypervascularity.
• Spiculated masses may have same vascularity as normal tissue or benign masses because of the smaller amount of cells and angiogenetic factors.
![Page 14: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/14.jpg)
mrozin,md
![Page 15: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/15.jpg)
mrozin,md
BIRADS for Ultrasound Masses
I. ShapeII. MarginIII. OrientationIV. Lesion boundaryV. Echogenic patternVI. Posterior acoustic featuresVII. Effect on surrounding
parenchymaVIII.Calcifications IX. Vascularity
![Page 16: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/16.jpg)
mrozin,md
Background Breast Pattern
• Homogenous Fatty• Heterogeneous – focally or
diffusely variable• Homogenous Fibroglandular
![Page 17: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/17.jpg)
mrozin,md
Fatty
![Page 18: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/18.jpg)
mrozin,md
Heterogeneous
![Page 19: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/19.jpg)
mrozin,md
Fibroglandular
![Page 20: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/20.jpg)
mrozin,md
I. Shape
• Oval – includes tear drop shape 2-3 macrolobulations may be with thin echogenic capsule
• Round – cysts, mets, IDC (high grade)
• Irregular – NOT round or oval
![Page 21: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/21.jpg)
mrozin,md
Oval
fibroadenoma
DCIS
![Page 22: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/22.jpg)
mrozin,md
Round
cyst
DCIS
![Page 23: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/23.jpg)
mrozin,md
Irregular
IDC
IDC
radial scar
![Page 24: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/24.jpg)
mrozin,md
II. Margin
• Circumscribed – smooth, distinct margin
• Microlobulated – may be the expression of extended lobules filled with DCIS; 80% of all IDC have a component of DCIS
• Indistinct – NO abrupt interface with surrounding tissue
![Page 25: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/25.jpg)
mrozin,md
Circumscribed
![Page 26: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/26.jpg)
mrozin,md
II. Margin
• Circumscribed – smooth, distinct margin
• Microlobulated – may be the expression of extended lobules filled with DCIS; 80% of all IDC have a component of DCIS
• Indistinct – NO abrupt interface with surrounding tissue
![Page 27: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/27.jpg)
mrozin,md
Microlobulated
![Page 28: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/28.jpg)
mrozin,md
![Page 29: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/29.jpg)
mrozin,md
II. Margin
• Circumscribed – smooth, distinct margin
• Microlobulated – may be the expression of extended lobules filled with DCIS; 80% of all IDC have a component of DCIS
• Indistinct – NO abrupt interface with surrounding tissue
![Page 30: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/30.jpg)
mrozin,md
Indistinct
![Page 31: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/31.jpg)
mrozin,md
Margin – cont.• Angular – part of margin has sharp corners;
most accurate of all signs of malignancy;invasion follows path of least resistance – in fat: many angles; in fibrosis: horizontal and then along Cooper’s ligaments
• Spiculated – sharp projecting lines; use U/S MAG views to see surface characteristics This is a spectrum of findings
![Page 32: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/32.jpg)
mrozin,md
Angular
![Page 33: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/33.jpg)
mrozin,md
![Page 34: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/34.jpg)
mrozin,md
Margin – cont.• Angular – part of margin has sharp corners;
most accurate of all signs of malignancy;invasion follows path of least resistance – in fat: many angles; in fibrosis: horizontal and then along Cooper’s ligaments
• Spiculated – sharp projecting lines; use U/S MAG views to see surface characteristics This is a spectrum of findings
![Page 35: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/35.jpg)
mrozin,md
Spiculated
![Page 36: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/36.jpg)
mrozin,md
Mixed
![Page 37: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/37.jpg)
mrozin,md
III. Orientation
• Parallel – wider than tall – long axis parallel to skin
• NOT parallel – taller than wide – long axis perpendicular to skin
includes ROUND masses
![Page 38: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/38.jpg)
mrozin,md
TDLU
![Page 39: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/39.jpg)
mrozin,md
CA
FA
![Page 40: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/40.jpg)
mrozin,md
![Page 41: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/41.jpg)
mrozin,md
![Page 42: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/42.jpg)
mrozin,md
ant.post. terminal
![Page 43: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/43.jpg)
mrozin,md
![Page 44: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/44.jpg)
mrozin,md
Wider than tall !!
ant. lobule
terminal lobulesdistended duct
with invasion
![Page 45: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/45.jpg)
mrozin,md
IV. Lesion Boundary• Abrupt interface – no transition zone
between mass and surrounding tissue
• Echogenic rim – variant of spicules too
small to resolve on U/S; some masses have a very thick echogenic rim with a tiny hypoechogenic nidus – must examine carefully;
peritumoral edema usually occurs btw. mass and skin
![Page 46: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/46.jpg)
mrozin,md
Abrupt Interface
echogenic capsule
FA CA
![Page 47: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/47.jpg)
mrozin,md
IV. Lesion Boundary• Abrupt interface – no transition zone
between mass and surrounding tissue
• Echogenic rim – variant of spicules too
small to resolve on U/S; some masses have a very thick echogenic rim with a tiny hypoechogenic nidus – must examine carefully;
peritumoral edema usually occurs btw. mass and skin
![Page 48: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/48.jpg)
mrozin,md
Echogenic Rim
![Page 49: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/49.jpg)
mrozin,md
Echogenic Rim
Same mass – with & without Sono-CT
![Page 50: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/50.jpg)
mrozin,md
V. Echogenic Pattern
• Hyperechoic – more than fat; very rarely can be angiosarcoma, ILC, lymphoma
• Isoechoic – equal to fat• Hypoechoic – less than fat• Mixed – hyper and hypo; can be
fibrosis, fat necrosis, FA, IDC• Anechoic – absence of internal echoes;
mets, IDC- high grade.
![Page 51: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/51.jpg)
mrozin,md
normal fibrotic tisssue
siliconefat necrosis
![Page 52: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/52.jpg)
mrozin,md
hyper with iso 4 mo later
hyper?
NOT
![Page 53: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/53.jpg)
mrozin,md
V. Echogenic Pattern
• Hyperechoic – more than fat; very rarely can be angiosarcoma, ILC, lymphoma
• Isoechoic – equal to fat• Hypoechoic – less than fat• Mixed – hyper and hypo; can be
fibrosis, fat necrosis, FA, IDC• Anechoic – absence of internal echoes;
mets, IDC- high grade.
![Page 54: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/54.jpg)
mrozin,md
![Page 55: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/55.jpg)
mrozin,md
Mucinous CA
![Page 56: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/56.jpg)
mrozin,md
V. Echogenic Pattern
• Hyperechoic – more than fat; very rarely can be angiosarcoma, ILC, lymphoma
• Isoechoic – equal to fat• Hypoechoic – less than fat• Mixed – hyper and hypo; can be
fibrosis, fat necrosis, FA, IDC• Anechoic – absence of internal echoes;
mets, IDC- high grade.
![Page 57: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/57.jpg)
mrozin,md
IDC
seroma
FA
![Page 58: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/58.jpg)
mrozin,md
V. Echogenic Pattern
• Hyperechoic – more than fat; very rarely can be angiosarcoma, ILC, lymphoma
• Isoechoic – equal to fat• Hypoechoic – less than fat• Mixed – hyper and hypo; can be
fibrosis, fat necrosis, FA, IDC• Anechoic – absence of internal echoes;
mets, IDC- high grade.
![Page 59: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/59.jpg)
mrozin,md
hematoma
phylloides
Intracystic papillary CA
![Page 60: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/60.jpg)
mrozin,md
V. Echogenic Pattern
• Hyperechoic – more than fat; very rarely can be angiosarcoma, ILC, lymphoma
• Isoechoic – equal to fat• Hypoechoic – less than fat• Mixed – hyper and hypo; can be
fibrosis, fat necrosis, FA, IDC• Anechoic – absence of internal echoes;
cysts mets, IDC- high grade.
![Page 61: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/61.jpg)
mrozin,md
cysts
![Page 62: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/62.jpg)
mrozin,md
VI. Posterior Acoustic Features
• None• Enhancement – highly cellular lesions• Shadowing – seen in desmoplasia• Combined Can use this finding to try and predict
GRADE; very small lesions (< 5 mm) may have no transmission because haven’t had time to develop desmoplasia or inflammatory reaction
![Page 63: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/63.jpg)
mrozin,md
Shadowing
![Page 64: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/64.jpg)
mrozin,md
enhancement
normal
CA
cyst
![Page 65: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/65.jpg)
mrozin,md
DO NOT FORGET - May see artifactual shadowing from
steep Cooper’s ligaments – can be removed with compression !
![Page 66: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/66.jpg)
mrozin,md
artifact
compression
![Page 67: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/67.jpg)
mrozin,md
DD of Enhancement
1) IDC – high GRADE2) Mucinous CA3) Medullary CA4) Metaplastic CA5) Papillary CA
6) FA7) Cysts
![Page 68: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/68.jpg)
mrozin,md
DD of Shadowing
1) IDC – low GRADE2) ILC3) Tubular CA
4) Scar5) Fat necrosis6) Radial scar7) Calcified FA8) Calcified oil cysts
![Page 69: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/69.jpg)
mrozin,md
VII. Effect on Surrounding Tissue
• Straightening of Cooper’s ligaments
• Architectural distortion• Skin thickening – normal 2 mm• Skin retraction• Edema – mastitis, radiation Tx,
inflammatory CA, CHF• Ducts – abnormal size, branching
![Page 70: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/70.jpg)
mrozin,md
Architectural distortion
Thickening & straightening of cooper’s ligaments
![Page 71: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/71.jpg)
mrozin,md
VII. Effect on Surrounding Tissue
• Straightening of Cooper’s ligaments
• Architectural distortion• Skin thickening – normal 2 mm• Skin retraction• Edema – mastitis, radiation Tx,
inflammatory CA, CHF• Ducts – abnormal size, branching
![Page 72: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/72.jpg)
mrozin,md
Inflammatory CA
Skin thickening
![Page 73: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/73.jpg)
mrozin,md
Skin retraction in scar with seroma
![Page 74: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/74.jpg)
mrozin,md
VII. Effect on Surrounding Tissue
• Straightening of Cooper’s ligaments
• Architectural distortion• Skin thickening – normal 2 mm• Skin retraction• Edema – mastitis, radiation Tx,
inflammatory CA, CHF• Ducts – abnormal size, branching
![Page 75: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/75.jpg)
mrozin,md
focal edema
Edema with dilated lymphatics
![Page 76: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/76.jpg)
mrozin,md
VII. Effect on Surrounding Tissue
• Straightening of Cooper’s ligaments
• Architectural distortion• Skin thickening – normal 2 mm• Skin retraction• Edema – mastitis, radiation Tx,
inflammatory CA, CHF• Ducts – abnormal size, branching
![Page 77: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/77.jpg)
mrozin,md
![Page 78: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/78.jpg)
mrozin,md
Duct extension
Branch pattern
![Page 79: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/79.jpg)
mrozin,md
IDC
1st lumpectomy with + margin
2nd lumpectomy with + margin
Duct extension
![Page 80: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/80.jpg)
mrozin,md
VIII. Calcifications
• Macrocalcifications • Microcalcifications outside a
mass• Microcalcifications inside a mass
![Page 81: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/81.jpg)
mrozin,md
FAOil cyst
![Page 82: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/82.jpg)
mrozin,md
IDC
DCIS
![Page 83: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/83.jpg)
mrozin,md
IX. Vascularity
• Absent • Present• Adjacent to lesion• In surrounding tissue
![Page 84: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/84.jpg)
mrozin,md
IDC-Grade I
Feeding vessel
![Page 85: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/85.jpg)
mrozin,md
IDC-GradeII
![Page 86: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/86.jpg)
mrozin,md
FA
![Page 87: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/87.jpg)
mrozin,md
FA Cyst
![Page 88: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/88.jpg)
mrozin,md
![Page 89: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/89.jpg)
mrozin,md
![Page 90: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/90.jpg)
mrozin,md
Suspicious for Malignancy
I. Hard spiculations, thick rim angular margins (shadowing)
II. Intermediate hypoechoic microlobulation taller than wide
Stavaros
![Page 91: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/91.jpg)
mrozin,md
III. Soft duct extension branching pattern calcifications
Stavaros
![Page 92: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/92.jpg)
mrozin,md
Most likely benign
• Oval• Circumscribed – echogenic
capsule• Parallel• Abrupt interface• Hyperechogenic
![Page 93: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/93.jpg)
mrozin,md
Algorithm for Sonographic Evaluation
1) Look for malignant findings and if there are any – give BIRADS 4-5 and biopsy
2) If there are NO malignant findings look for benign findings and if there are any give BIRADS 2-3 and suggest follow-up
3) If NO benign findings found – give BIRADS 4A and biopsy
![Page 94: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/94.jpg)
mrozin,md
Sine Qua Non (without which there is nothing) technique, technique, technique
Must always base management on the worst feature present !!!!
![Page 95: Mrozin,md BENIGN VS MALIGNANT MASSES IN BREAST ULTRASOUND Dr. Mona Rozin Director of Breast Imaging Assuta Medical Centers.](https://reader035.fdocuments.in/reader035/viewer/2022081414/551436f55503466d1a8b5308/html5/thumbnails/95.jpg)
mrozin,md