1. INTRODUCTION TOINTRODUCTION TO
BREAST SonographyBREAST Sonography
DR : AYYAZ MAHMOOD
 RADIOLOGY SPECIALIST
KFH

2. ROLE OF SONOGRAPHYROLE OF SONOGRAPHY
PRIMARY SCREENING
SECONDARY SCREENING
DIAGNOSIS

3. PRIMARY SCREENINGPRIMARY SCREENING
SECONDARY
SCREENING
KOLB et al
( 2-
STUDIES )
BUCHBERGE
R et al
KAPLAN et al

4. Usg Detected 3Usg Detected 3
CARCINOMAS missed byCARCINOMAS missed by
mamo /1000mamo /1000
NO CALCIFICATION
OBSURED BY SURROUNDING OR
SUPERIMPOSED DENSE TISSUE ON
MAMMO
VALUE OF USG AS SECONDARY
SCREENING

5. DIAGNOSIS….proven &DIAGNOSIS….proven &
approved roleapproved role
 SPECIFIC GOALS
 PREVENT BIOPSIES &SHORT INTERVAL
FOLLOW UP
 GUIDE INTERVENTIONS
 GIVE FEED BACK THAT IMPROVE
CLINICAL & MAMOGRAPHIC SKILLS
 DETECT MALIGNANCIES MISSED BY
MAMMO

6. EQUIPMENTEQUIPMENT
HIGH FREQUENCY TRANSDUCERS
Optimised for near field imaging
ACS , ACR , AIUM
Minimum FREQUENCY 7 MHZ

7. DOCUMENTATIONDOCUMENTATION
 Side
 Clock face position
 Distance from nipple
 Transducer
orientation
 2 orthogonal planes
 SURFACE
 INTERNAL
ARCHITECTURE
 MAXIMUM
DIAMETER

8. BIRADSBIRADS ….(Breast imaging reporting & data system.)….(Breast imaging reporting & data system.)
 Standardizing reporting and data
1 1 , 2 , 3 , 4a , 4b , 5
1 : sonographic normal tissue , mammographic or
clinical abnormalities
2: benign entities ( intramammery lymph nodes
,ectatic ducts , simple cysts , definitely benign
solid nodules as LIPOMA
3: probably benign ….2 % or less chances as
complex cysts ,small intraductal papillomas ,
subset of fibroadenoma .

9. BIRADSBIRADS ….(Breast imaging reporting & data….(Breast imaging reporting & data
system.)system.)
4: suspicious , two categories
 4a…….mildly suspicious 3- 49 %
 4b…….modera suspicious 50- 89 %
5: malignant ….. 90 % or greater

10. MANAGEMENT RULESMANAGEMENT RULES
1 – 2 ……ROUTINE SCREENING &
FOLLOW UP
3 ……….SURGICAL BIOPSY , IMAGE
GUIDED NEEDLE BIOPSY , SHORT
INTERVAL FOLLOW UP
4a – 4b – 5 ……….BIOPSY

11. MAIN INDICATIONSMAIN INDICATIONS
 PALPABLE LUMPS
 dense tissue area of palpable
lump
NO CALCIFICATION /
SURROUNDING TISSUE
GOAL…..FIND SOMETHING
BENIGN TO AVOID BIOPSY

12. SONOGRAPHY PREVENTSSONOGRAPHY PREVENTS
BIOPSYBIOPSY
NORMAL OR DEFINATEVELY
BENIGN FINDING .
HIGH NEGATIVE PREDICTIVE
VALUE FOR NEGATIVE MAMMO &
NORMAL OR BENIGN ULTRASOUND
FINDING
OLD COMMON WISDOM …ALL
PALPABLE LUMPS NEEDS
BIOPSY…NOT TRUE

13. NEGATIVE USG REPORTNEGATIVE USG REPORT
Palpable lesion …… NOT ACCEPTABL
DOCTOR …..NOT FULLY UNDERSTAND
THE PROBLEM
ALL SONOGRAM IN PALPABLE LUMPS
BEING POSITIVE
NORMAL TISSUE , CLEARLY BENIGN
FINDINGS…………………………CAUSE

14. MAMMOGRAPHIC DensitiesMAMMOGRAPHIC Densities
No calcification ….. Best for usg
Discrete masses ….. Focal asymmetrical densities
USG …….. ASYMMETRICAL NORMAL
 …………...DEFINITELY BENIGN
…………..MORE MALIGNANT THAN
LOOKING BY MAMO

15. SONO MAMMOSONO MAMMO
CORRELATIONCORRELATION
SIZE
SHAPE
LOCATION
SURROUNDING TISSUE DENSITY

16. SONO FINDINGSSONO FINDINGS
NORMAL TISSUE AND ABERRATIONS
OF NORMAL DEVELOPMENT AND
INVOLUTION ( ANDIs )
Ductal ectasia , fibrocystic changes ,
Benign proliferative disorder

17. Simple cystSimple cyst
  Cyst…….. Solid
 Negative predictive
value 100%
 99 % for sonographic
normal study

18. Simple CystSimple Cyst
anechoic
well-marginated
round, ovoid, or lobulated
solitary or multiple
well-defined posterior wall
acoustic enhancement

19. Simple cystSimple cyst
Strict criteria for simple cyst………..
No biopsy , aspiration or follow up..

20. MAIN INDICATIONSMAIN INDICATIONS
GOAL……Malignant lesion obscured by
surrounding tissue
ABNORMALITY PALPATED WHILE
SCANNING
AGGRASIVELY SCANNING DETECT
CARCINOMAS MISSED BY MAMMO

21. Solid noduleSolid nodule
Automatic indication for biopsy ?…….

22. Solid noduleSolid nodule
SOLID NODULE

23. COMPLEX COMPLICATEDCOMPLEX COMPLICATED
CYSTSCYSTS
THICK WALL , THICK
SEPTATIONS ,MURAL NODULES
Debri …………….complicated

24. COMPLEX COMPLICATEDCOMPLEX COMPLICATED
CYSTSCYSTS
MOST COMPLEX CYSTS FALL WITH
IN BROAD SPECTRUM OF
FIBROCYSTIC CHANGES ….
MALIGNANT CYSTS ….. RARE
COMPLEX / COMPLICATED
CYSTS……..NO FLUID CYTOLOGY /
US GUIDED BIOPSY

25. Breast Cancer EvaluationBreast Cancer Evaluation
PRIMARY SIGNS
DOMINANT MASS
DENSITY
MICROCALCIFICATION
ARCHITACTURE DISTORTION
INTERVAL CHANGES

26. Breast Cancer EvaluationBreast Cancer Evaluation
SECONDARY SIGNS
ASYMMETRIC THICKENING
ASYMMETRIC DUCTS
SKIN CHANGES
NIPPLE / AREOLAR ABNORMALITIES
ABNORMAL VEINS
AXILLARY NODES

27. INFECTION / ABSCESSINFECTION / ABSCESS
MASTITES ……. ABSCESS
ABSCESS………… ASPIRATE//DRAIN
APPEARANCE …….. VARY
FEVER , PAIN ,TENDERNESS ,
INCREASE WHITE CELL COUNT

29. Duct EctasiaDuct Ectasia..
VARIABLE APPERANCE
ELONGATED FILLED WITH FLUID
TUBULAR APPERANCE

30. FibroadenomaFibroadenoma..
ESTROGEN INDUCED TUMOUR .
3 rd most common breast lesion .
Most common benign lesion of child
bearing age .
Firm ,smooth , oval , well marginated and
freely mobile
Rarely tender or painful
Can calcify

31. FibroadenomaFibroadenoma..


32. Fibrocystic ChangesFibrocystic Changes..
72 % of screening population over 55
Round to ovoid cysts with smooth
margins , lobulated or multilocular

33. CONCLUSIONCONCLUSION
USG HAS DEFINATE ROLE
PROVIDING ADDITIONAL
INFORMATION WITH OR AS AN
ALTERNATIVE TO BIOPSY AS A
SECONDARY SCREENING
MODALITY

34. THANK YOUTHANK YOU