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Surgeon performed ultrasound
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Surgeon performed ultrasound

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  • Breast Ultrasound requires the use of high end equipment utilizing high frequency linear transducers in order to provide superior resolution. These high-end equipment provide many technologies that improve and enhance the IQ enabling easy detection and characterisation of breast lesions and breast tissue changes.
  • Enhanced image uniformity, improved continuity of structures, improved lateral resolution, reduction of speckle

Surgeon performed ultrasound Surgeon performed ultrasound Presentation Transcript

  • Surgeon-Performed Ultrasound Breast and Thyroid Center Chungmoo General hospital Cheonan Korea Jin Woo Ryu, M.D. [email_address]
  • 참고도서
  • Hertz (Hz) = cycles per second Megahertz (MHz) = millions of cycles per second The frequency of a transducer is labeled in Megahertz
  • . The tranduce r contains an element that is made of a piezo-electric(pressure-electric) crystal. When an electric charge is applied to the piezoelectric crystal , the crystal will expand and contract emitting a sound wave.
  • Thicker crystal produces bigger sound waves for more penetration ,Bigger sound waves travel farther , and less the resolution 7.5 MHz 3.5 MHz Thinner crystal produces small sound waves for less penetration, Smaller sound waves travel less , and better the resolution Ultrasound Transducer
  • 7.5MHz 13.5MHz
  • STC: Sensitivity Time Control
  •  
  • Gain - Gain +,
  • Positioning the Patient
  • Keeps Cooper ligament under tension, speeds the examination Probing direction
  •  
  • Nomal anatomy 1.Interobular stroma, connective tissue 4. Ribs 5. Skin 6. Mammary gland 8. Fat 10. Pectoral muscle 13. Pectoral fascia 15. Prepectoral fat
  •  
  • Echogenecity Hyperecho isoecho hypocho
  • Breast Ultrasound lexicon
    • Shape: oval, round, irregular
    • Orientation to skin line : not parallel, parallel
    • Margins: circmscribed,
    • not circumscribed;
    • indistinct, angular, microlobulated,
    • spiculated
    • Lesion boundary: abrupted interface, echogenic halo
    • Echopattern: anechoic, hyperechoic, hypoechoic, complex, isoechoic
    • Posterior acoustic features: no features, enhanced, shadowing(excluding edge shadows), combined.
    • Surrounding tissue: duct(abnormal caliber or arborization), Cooper ligament(straighting or thickening), edema, aechitectural distortion, skin thickening
    • (BIRAD Ultrasound, 1rst edn. American College of Radiology, Reston, 2003)
    A Mass;
  • 1. Interpretation of breast lesions
    • Is it real? ---fat 과의 구별
    • Cyst or solid – 필요시 aspiration
    • Benign or malignant
    • Specific entity?
    • Fibroadenoma,
    • papilloma, phyllodes, hamartoma,
    • Fat necrosis, abscess, granulomatous
    • mastitis, lipoma, radial scar, DCIS,
    • Invasive cancer
  • <reporting system>
    • 1. reason for exam
    • 2. comparison with previous US
    • 3. lesion analysis;
    • size, location, mass type and modifier,
    • associated calcification or findings,
    • how changed if previously present
    • 4. comparison with P/E, MMG, MR
    • 5. summary and BI-RAD code(0-6)
  • 2. Differentiation of benign and malignant lesions
    • 1) Stavros ’ criteria
    • 1. no malignant characteristics
    • 2. Intense homogeneous hyperechogenicity or Thin echogenic pseudocapsule with ellipsoid shape or Thin echogenic pseudocapsule with bi- or tri gentle lobulation
    • Radiology 1995; 196:123
    • Solid breast nodules: use of sonography to distinguish between
    • benign and malignant lesions
  • Characteristic US findings of breast cancer(Jpn) L/T ratio (>1; cancer in 95.5%, FA in 3.3%) Irregular or rough margin( Ca in 55.5%, FA in 30%) Connetive tissue sign(cancer in 55%-77%) Heterogenous internal echoes(Ca in 52%) Thick boundary echoes Echogenic spot(Ca in 30-40%, FA in 10%) Posterior echo attenuation(Ca in38.7%, FA in 8.2%)
      • .
  • Spiculation
  • Taller than Wide 1; Carcinoma arising from 1,anterior lobule, 2, from posterior lobules, 3; from terminal lobules Taller than wide carcinomas are primarily small lesions with maximum diameters less than 1.5 cm
  • Angular margin
    • In some circumscribed malignant, angular margins are the only hard suspicious findings present
  • Connective tissue sign 유방암 조직소견 중 그 변연에서 내부로 파고 들어가는 섬유성 결합조직이 특징이다 . 이것의 초음파 소견을 connective tissue sign 이라고 한다 .
  • Rough and heterogenous internal echoes
  • Thick boundary echoes Inflammmatory infiltates Lymphcystic host response …peritumoral inflammatory echogenic edema
  • Calcification
  • Posterior acoustic shadowing Lt: Mass with calcification Rt: scar … . obliteration of shadowing Cancer: attenuated Cyst: enhanced
  • Benign characteristics
    • Absent malignant findings
    • Intense hyperechogenicity
    • Ellipsoid shape
    • Gentle bi- or trilobulations
    • Thin, echogenic pseudocapsule
  • 2) ACR-BI-RADS US
    • 1. shape ; oval, round, irregular
    • 2. orientation ; parallel, nonparallel
    • 3. margin ; circumscribed, noncircumscribed (indistinct, angular, microlobulated, spiculated)
    • 4. lesion boundary ; abrupt interface, echogenic halo
    • 5. echopattern; anechoic, hyperechoic, complex, hypoechoic, isoechoic
  • 2) ACR-BI-RADS US
    • 6. posterior acoustic features; no, enhancement, shadowing, combined
    • 7. surrounding tissues; ducts, changes in cooper ’ s ligament, edema, architectual distortion, skin thickening, skin retraction/irregularity
    • 8. calcification; macrocalcification,
    • microcalcifications
    • 9. vascularity; present (immediately adjacent at lesion, diffusely increased in surrounding tissue) or no present
  • 3. Benign breast disease
    • Cysts
    • no internal echo, sharp
    • anterior and posterior
    • border, posterior
    • enhancement
    • Cyst with internal echo
    • proteinaceous material
    • cellular debris,
    • hemorrhage,
    • cholesterol crystal,
    • inspissated secretion,
  • 3. Benign breast disease
    • 2. fibroadenoma
    • most common breast mass between 10-30 th
    • Giant fibroadenoma
    • > 6cm sized
    • Pseuodoencapsulated mass with epithelial & stromal component
    • Carcinoma from FA
    • FA 주변에 DCIS or LCIS or within the FA
  • 3. Benign breast disease
    • 3. Fibrocystic change
    • proliferation of fibrous connective tissue, cystic dilatation of ducts, hyperplasia of ductal and lobular cells
    • solid mass, solid and cystic mass, cyst(s), inhomogeneous bulging parenchyma with attenuation of subcutaneous fat, shadowing, calcification
  • 3. Benign breast disease
    • 4. Phyllodes tumor
    • large solid mass,
    • not different from fibroadenoma
    • Fluid-filled cysts or clefts
  • 3. Benign breast disease
    • 5. Adenolipoma
    • (hamartoma)
    • well circumscribed, oval, mixed echoic
    • Variable tissue composition
  • 3. Benign breast disease
    • 6. Papilloma
    • intraductal or
    • intracystic; anechoic rim
    • Pure solid mass
  • 3. Benign breast disease
    • 7. mastitis and abscess
    • Uncomplicated mastitis; normal or area of increased echogenicity
    • Abscess; poorly
    • marginated or well
    • marginated fluid
    • collection of variable
    • echo+surrounding
    • hyperechoic reactive tissue
  • 3. Benign breast disease
    • 8. fat necrosis
    • Hyperechoic mass with occasional small anechoic foci
    • Subcutaneous fat layer
    • Trauma history
  • 3. Benign breast disease
    • 9. intramammary L/N
  • High end equipment
  • Tissue Harmonic Imaging
    • Pulse-subtraction THI, Differential THI
      • Reduction in side lobe artifacts
      • Improved tissue contrast resolution
    Dr. Siti Fatimah, Melaka General Hospital , Malaysia
  • Compounding Technology
    • Aplipure, Aplipure+
  • Compounding Dr. Fischer, Charite University, Berlin Germany Breast tumour
    • Enhanced image uniformity
    • Improved continuity of structures
    • Improved lateral resolution
    • Reduction of speckle
    Aplipure + Aplipure +