Atlas of Full Breast Ultrasonography

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By (author): Aristida Georgescu

This atlas describes and illustrates a novel approach, referred to as full breast ultrasonography (FBU), that represents a challenge to conventional breast imaging diagnosis. The coverage encompasses examination technique, diagnostic criteria, the imaging features of a wide variety of lesions, and role in follow-up. FBU involves anatomic ultrasound scanning based on the ductal echography technique proposed by Michel Teboul, supplemented by Doppler and real-time sonoelastography. The approach offers a variety of advantages. Compared with MRI it has a lower cost, wider availability, better resolution, and improved correlation with anatomy. Compared with mammography it has the benefits of absence of irradiation and pain, applicability in all cases, and better overall accuracy. Furthermore, the standardized technique of acquisition and interpretation means that it is suitable as a screening test, unlike classic ultrasonography. FBU is applicable in ultrasound BI-RADS assessment and is of value in depicting both benign and malignant conditions. It can be recommended as a first-line method of diagnosis and for the follow-up of treated breasts, regardless of the patient’s age, sex, or physical condition.

Atlas of Full Breast Ultrasonography pdf

Atlas of Full Breast Ultrasonography pdf

Content Atlas of Full Breast Ultrasonography pdf free download

1 Breast Doppler Ductal Ultrasonography: Definition, History, and Advantages

1.1 Defi nition and History: Galactography and Ductal Echography . . . . . . . . . . . . . . 1

1.2 The Advantages of the Breast Doppler Ductal Echography . . . . . . . . . . . . . . . . . 3

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

2 Breast Doppler Ductal Echography: Technique of Examination Related to the Breast Lobar Anatomy

2.1 General Technical Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2.2 Ductal Echography: Radial US Technique of Scanning . . . . . . . . . . . . . . . . . . . 12

2.2.1 Patient Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2.2.2 Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

2.2.3 Water-Bag Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2.2.4 Steps of Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

2.3 About 3D and 4D US Technique Related to DE . . . . . . . . . . . . . . . . . . . . . . . . . 15

2.4 Usefulness of the Panoramic Scans: SieScape-Type Technique Versus DE . . . . 19

2.5 Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

3 Breast Development: Aspects of Doppler Ductal Ultrasonography of the Normal Breast

3.1 Breast Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

3.2 Breast Anatomy and Ductal Echography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

3.3 Types of Normal Breast Anatomy on DE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3.3.1 Thelarche (Mammary Bud) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3.3.2 Young Dense Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

3.3.3 Mixed Adult Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

3.3.4 Fatty Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

3.3.5 Lactating Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

4 Sonoelastography in Addition to Doppler Ductal Echography: Full Breast Ultrasonography

4.1 Defi nition of the Sonoelastography: Systems of Acquisition . . . . . . . . . . . . . . . 53

4.2 Accuracy of the SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

4.3 Technique of Sonoelastography: Integration in FBU. . . . . . . . . . . . . . . . . . . . . . 55

4.4 Rendering Sonoelastogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

4.5 Interpretation of the Elastogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

4.5.1 The Elasticity Score Named Upon Ueno/Tsukuba University: Benign

4.5.2 Malignant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

4.6 Role of SE in Nonpalpable Breast Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
5 Full Breast Ultrasonography and the Ultrasound: BI-RADS Assessment . . . . . . 67

5.1 Importance of the Ultrasound BI-RADS Assessment . . . . . . . . . . . . . . . . . . . . . 67

5.2 Ultrasound Diagnostic Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

5.3 Lexicon for Breast Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

5.3.1 Diagnostic Guidelines for Mass Image- Forming Lesions . . . . . . . . . . . . 68

5.3.2 Diagnostic Guidelines for Non-mass Image-Forming Lesions . . . . . . . . 71

5.3.3 Ultrasound BI-RADS Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

6 Full Breast Ultrasonography of the Benign Lesions . . . . . . . . . . . . . . . . . . . . . . . . 75

6.1 Classifi cation of the Masses in Benign, Indeterminate, and Malignant Based on Stavros Criteria .

6.2 Characteristics of the Benign Breast Lesions in FBU . . . . . . . . . . . . . . . . . . . . . 75

6.3 Mammary Cysts and Fibrocystic Dysplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

6.4 Adenosis and Ductal Hyperplasia in FBU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105

6.5 Radial Scars and Complex Sclerosing Lesions . . . . . . . . . . . . . . . . . . . . . . . . . 107

6.6 Fibroadenomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

6.7 Phyllodes Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

6.8 Hamartomas and Lipomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133

6.9 Fat Necrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

6.10 Papillomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142

6.11 Ductal Ectasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150

6.12 Galactoceles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

6.13 Stromal Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

6.14 Breast Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162

6.15 Diseases of the Nipple-Areolar Complex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

6.16 Nonpalpable Solid Breast Masses That Are Partially or Completely Obscured at Mammography

6.17 Pseudomalignant US Lesion Appearances . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

7 Breast Calcifications in Full Breast Ultrasonography . . . . . . . . . . . . . . . . . . . . . . 189

7.1 Breast Calcifi cations in US: Technical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . 189

7.2 Breast Calcifi cations in FBU: Improvements and Limits in Detection and Interpreting

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210

8 Full Breast Ultrasonography of Malignant Lesions . . . . . . . . . . . . . . . . . . . . . . . 211

8.1 Major Risk Factors for Breast Cancer and Breast Cancer Prevention . . . . . . . . 211

8.1.1 Major Risk Factors for Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 211

8.1.2 Control of the Risk Factors of Breast Cancer: Dishormonal Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

8.1.3 Prevention of Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

8.2 Histologic Aspects of Breast Cancer and Correlation with Mammography and Ductal Echography . . . . . . . . . . . . . . . . . . . . . . .

8.2.1 The Large-Format Section in Surgical Pathology: The Best Pathological-Imaging Correlation of Breast Carcinoma . . . . 213 8.2.2 The Main Pathological and Imaging Classifi cations of Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 8.2.3 Multifocal and Multicentric Breast Carcinoma . . . . . . . . . . . . . . . . . . . 215

8.2.4 Size and Extent of Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216
8.3 Breast Cancer and Ultrasound Diagnosis Applying Old and New Criteria . . . . 216

8.4 Particular Clinical–Imaging Aspects of Breast Carcinoma . . . . . . . . . . . . . . . 218

8.4.1 Infl ammatory Breast Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218

8.4.2 DCIS and LCIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219

8.4.3 Diffuse Breast Carcinomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

8.4.4 Carcinomas with Pseudo-Benign Appearance . . . . . . . . . . . . . . . . . . . . 221

8.4.5 Nipple and Retroareolar Carcinomas . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

8.4.6 Breast Cancer with Nephrotic Syndrome . . . . . . . . . . . . . . . . . . . . . . . 222

8.5 Satellite Lymph Node Metastases in Breast Cancer . . . . . . . . . . . . . . . . . . . . . 222

8.5.1 Diagnosis of the Satellite Lymph Node Metastases by Classical Methods and FBU

8.5.2 Differential Diagnosis of Armpit Lumps . . . . . . . . . . . . . . . . . . . . . . . . 223

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286

9 Full Breast Ultrasonography as Follow-Up Examination After a Complex Treatment of Breast Cancer .

9.1 Technique Particularities in Follow-Up Examinations by FBU. . . . . . . . . . . . . 28

9.2 Findings in the FBU Follow-Up Examinations of Breast Cancer . . . . . . . . . . . 290

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331

10 Physiological and Pathological Aspects of Full Breast Ultrasonography in Men and Children

10.1 Male Breast Gynecomastia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333

10.2 Breast Cancer in Man . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349

10.3 Endocrine and Imaging-Pathological Correlations in Gynecomastia . . . . . . . 352

10.4 Pediatric Breast Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353

10.5 Malignancy of the Pediatric and Adolescent Breast . . . . . . . . . . . . . . . . . . . . 361

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

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