Breast Sonography Vanderbilt University Medical Center-PDF Free Download

breast sonography Vanderbilt University Medical Center
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ACRIN 6666 ACRIN 6666 RESULTS UPDATE, 14 08 Vol 299 No 18. 2809 women with heterogeneously or extremely, dense tissue in at least one quadrant Addition of screening US to screening. Participants classified as high risk based on mammography M US increased. various parameters the diagnostic yield with an average. Examination performed directly by experienced, breast imagers with additional special. of about 4 3 additional cancers per, training for exam criteria 1000 women screened. Median time of exam 19 minutes This increased yield remains constant. Compared Screening mammography alone to at year 3 of the study. screening mammography plus screening breast, sonography later addition of MRI.
ACRIN 6666 RESULTS UPDATE ACRIN 6666 RESULTS UPDATE. Initial PPV for biopsy, After 3 years screening with M US. recommendation based on US alone, adding MRI increased the cancer. was 8 9 compared to 22 6 for, detection rate among g women at. mammography h alone, elevated risk of breast cancer. PPV for US increased in year 3 but, This suggests that M US screening.
remained about half of that for, in the high risk population may be. mammography alone, less effective than M MRI screening. in this population, ACRIN 6666 CONCLUSIONS UNRESOLVED ISSUES. Physician time Reimbursement, Adding screening US to mammography Can results be duplicated with technologist performed. exams and shorter time for exams, in high risk women with dense breast Whole breast US.
tissue PPV, PPV s would, b regarded, d d as unacceptably. Yields an additional average of 4 3 cancers for mammography attendant cost of false positive. per 1000 women screened biopsy recommendations, Probably benign criteria. Substantially increases the number of false Determination of and logistics for follow. positive biopsy recommendations Frequency of screening. Role of US screening vs MRM screening, ACR SBI STATEMENT BOTTOM LINE. The American College of Radiology ACR and Screening breast sonography should be used very. the Society of Breast Imaging SBI feel that the judiciously. results of ACRIN 6666 increase the evidence base Limit to centers that adopt the rigorous ACRIN 6666. for the utility and limitations of screening criteria for training and performance or have similar. ultrasound ACRIN 6666 established standardized experience. technique and interpretive criteria as well as Selected population high risk increased density. experience, i requirements, i t ffor physicians, performing these examinations At centers which Commitment to scan time. follow similar practice US may improve detection Understanding of poor reimbursement. of early breast cancer in women at increased risk Acceptance of poor PPV for biopsy. of breast cancer who are not currently Does not replace mammography. recommended for MRI These results do not, justify the recommendation for screening For now MRM may be more practical and.
ultrasound for the general public or in lieu of or in effective for this patient population. addition to MRI for very high, high risk women, TARGETING OF EXAM ULTRASOUND COORDINATES. Clinical Position should be determined in 3, Palpate If the exam is being performed for a palpable planes. abnormality palpate the finding before placing the. transducer on the patient Radial, Confirm that an US finding corresponds to the palpable This is almost universally done with clock face. finding position, Mammographic Distance from nipple. Predict location based on mammographic position Can be done with distance from the nipple or with. MULD concentric zones from nipple e g RA 1 2 or 3, Predict US coordinates before US performance.
Predict US appearance based on size and relationship of. mammographic abnormality to anatomic landmarks Superficial mid or deep e g A B C. Is it in premammary or retromammary fat is it in the. glandular tissue is it at the junction of identifiable Document finding with images in 2. anatomic structures planes and measurements in 3 planes. SCAN PLANES PATIENT POSITION, To correlate with other modalities begin. Axial or Transverse supine with breast evenly falling on chest. Longitudinal or Sagittal Locate anticipated US coordinates from other. Radial and antiradial imaging studies in this position. duct orientation, M dif patient, i position, ii ffor improved. Alter as needed e g For lesions in the UOQ of the breast role. Look at all of the lesion as well as its patient away from you to thin out the tissue. overlying the area of interest, For palpable lesions modify position as. needed to reproduce palpable finding, GAIN AND TGC FOCAL ZONE AND FRAME RATE. The reference tissue in the breast is fat Appropriately adjust focal zone. Overall gain should be adjusted with fat, medium gray.
As frame rate is less important than, TGC is adjusted for uniform echogenicity. i some other, in th applications, li ti one can, throughout the depth of tissue use wider focal zones without. Hyperechoic implies more echogenic than fat significant compromise. Hypoechoic implies less echogenic than fat, TRANSDUCER MANIPULATION DOPPLER. Reduce edge shadowing, Improve margin assessment Technique. Project area of interest free of overlapping structures Power. e g nipple, g Transducer pressure, Orientation, Relation to adjacent structures.
Solid vs cystic, Follow ducts Only useful if flow identified. Characterization of solid masses, Enhance capsule, Reduce artifactual shadowing you can decrease real Poor predictive value. shadowing too, Enhance flow, SPECIAL CIRCUMSTANCES ARTIFACTS. Superficial Improved resolution and wider dynamic, Gel or standoff range produce significant artifacts in. Deep breast sonography, Lower frequencies, Artifact Tissue harmonics.
Retroareolar Reduces artifactual echoes by detecting harmonic. frequencies and separating them from the fundamental. frequency and associated artifacts, Angle from side and change orientation. Spatial compounding, Two hand technique, Reduces artifactual echoes by generating multiple sound. Fremitus beams across the transducer face, Experiment. HARMONICS HARMONICS, STAVROS STAVROS, SPATIAL COMPOUNDING EMERGING TECHNOLOGY. Elastography, Technique for mapping relative tissue stiffness in.
response to an applied force, Techniques for breast. Vib i sonoelastography, U off externall or, internal sources of vibration respiration heart to. produce tissue deformation, Compression sonoelastography Use of mechanical. compression to produce deformation, Criteria for assessment. No change in size of benign fibroadenoma Malignant mass showing larger on the elastogram. Image Courtesy Philips Image Courtesy Philips, STIFFNESS UNRESOLVED ISSUES.
Lack of established standards for, performance and assessment. Operator dependency and, Inter Intra observer variability. Inter Intra, Role in relation to standard, sonographic assessment criteria. Dark blue depicts the stiffest areas in this image. A Malignant mass B Benign mass, Image Courtesy Philips. Sonographic Breast Anatomy, BOTTOM LINE, Primary application remains Premammary Fat.
investigational Anterior Mammary Fascia, Glandular Tissue. R ti clinical, li i l application, li ti will, Posterior Mammary Fascia. require additional validation with, Cooper s Ligaments. prospective trials Retromammary Fat, ANATOMY ANATOMY. PREMAMMARY FASCIA, PREMAMMARY FAT, GLANDULAR TISSUE.
COOPER S LIGAMENTS, FAT LOBULE, RETROMAMMARY FASCIA. RETROMAMMARY FAT, MUSCLE GLANDULAR TISSUE, LARGE DUCTS SMALL DUCTS TDLU S. EXTRALOBULAR TERMINAL DUCT, FIBROCYSTIC CHANGE FIBROCYSTIC CHANGE. STAVROS TABAR, STAVROS TABAR, SIMPLE CYSTS, CYSTIC MASSES. Circumscribed, Simple Posterior Acoustic, Complicated Enhancement.
Clustered Microcysts, Thin Avascular Septations, SIMPLE CYST MANAGEMENT OF SIMPLE. THIN SMOOTH WALL No further diagnostic evaluation, Iff symptomatic. SOUND TRANSMISSION, If interference with other, evaluation. Significant incidence of recurrence, COMPLICATED CYSTS COMPLICATED CYST. THIN SMOOTH WALL, Circumscribed, Posterior Acoustic INTERNAL ECHOES.
Enhancement, Low Level Internal Echoes, SOUND TRANSMISSION. GALACTOCELE MOVING INTERNAL ECHOES, THIN SMOOTH WALL. INTERNAL ECHOES, SOUND TRANSMISSION, MANAGEMENT OF COMPLEX CYSTIC MASS. COMPLICATED CYSTS, Any mass with both cystic and solid. Correlation with other modalities components, Stable mammographic finding dismiss Mural nodule.
Benign cyst on MRM dismiss Eccentric wall thickening. Si l or different, Single diff ffrom others, h Indistinct margins or involvement of. Aspirate vs follow surrounding structures, Multiple none dominant or different. Depends on setting and risk, Terminology often used for complicated. Symptomatic cysts but implication very different, Aspirate Significant risk of neoplasia. COMPLEX CYSTIC MASS COMPLEX CYSTIC MASS, CLUSTERED MICROCYSTS.
MANAGEMENT OF COMPLEX, CYSTIC MASSES Look for thinly walled hypo. anechoic microcysts, a fibrotic, b ot c component, BIOPSY No malignant features. No significant associated blood, flow especially no vascular. CLUSTERED MICROCYSTS CLUSTERED MICROCYSTS, CLUSTERED MICROCYSTS PITFALL. MICROPAPILLARY DCIS MICROCYSTS VS DCIS, MICROCYSTS VS DCIS MICROCYSTS VS DCIS.
STAVROS STAVROS, MANAGEMENT OF DERMAL ORIGIN, CLUSTERED MICROCYSTS. Multiple vs solitary clusters, Associated suspicious. p findings, Correlation with other modalities, Micropapillary DCIS much less. common than clustered microcysts, DERMAL ORIGIN DERMAL ORIGIN. STAVROS STAVROS, DERMAL ORIGIN INFLAMMED SEBACEOUS CYST.
WHAT TO WORRY ABOUT, MANAGEMENT OF DERMAL, LESIONS Irregular or asymmetrically. thickened walls, Thick or enhancing septations, Solitary or enlarging complicated. BASED ON CLINICAL SETTING, Any complex cystic mass. Clusters of microcysts with, significant solid components flow or. suspicious features, WHAT NOT TO WORRY ABOUT SOLID MASSES.
Multiple benign appearing complicated, cysts and clusters of microcysts Sonographic Features. Make sure they have no malignant, Don t try to follow analogous to multiple Indeterminate. mammographic nodules or calcifications Suspicious, If high risk setting consider MRM. Dermal lesions in uncomplicated, BENIGN FEATURES FIBROADENOMA. Markedly and uniformly hyperechoic, Don t cheat, Ellipsoid shape parallel axis.
THIN ECHOGENIC CAPSULE, Gently lobulated, Thin continuous echogenic. pseudocapsule, Multiple planes angle PARALLEL ORIENTATION. Dermal in uncomplicated setting, Morphologically benign lymph node. FIBROADENOMA INTRAMAMMARY NODE, SYMMETRIC CORTEX, THIN ECHOGENIC CAPSULE. INTRAMAMMARY NODE INDETERMINATE FEATURES, Echogenicity other than markedly.
hyper or hypoechoic, Echotexture, SYMMETRIC CORTEX Normal or enhanced sound. transmission, Pattern of blood flow, MALIGNANT FEATURES INFILTRATING DUCTAL CA. Sonographic spiculation, Taller than wide non, non parallel SPICULATION. Angular margins, Markedly y hypoechoic, Acoustic shadowing. Punctate calcifications HYPOECHOIC, Duct Extension towards the nipple.
Branch pattern away from the nipple SHADOWING, Microlobulation Thick echogenic collar. INFILTRATING DUCTAL CA INFILTRATING DUCTAL CA, NON PARALLEL. ANGULAR MARGINS, ANGULAR MARGINS, DUCTAL CARCINOMA IN SITU INFILTRATING AND IN SITU. DUCTAL CARCINOMA, MICROCALCIFICATIONS, MICROCALCIFICATIONS. INFILTRATING DUCTAL CA INFILTRATING DUCTAL CA, DUCT EXTENSION BRANCH PATTERN.
INDISTINCT MICROLOBULATED MARGINS, INFILTRATING DUCTAL CA INFILTRATING DUCTAL CA. INDISTINCT MICROLOBULATED MARGINS THICK ECHOGENIC COLLAR. INFILTRATING DUCTAL CA INTRADUCTAL PAPILLOMA, THICK ECHOGENIC COLLAR. BREAST SONOGRAPHY John Huff M D less effective than M MRI screening in this population ACRIN 6666 CONCLUSIONS Adding screening US to mammography

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