SONOGRAPHIC+CHARACTERISTICS+-+BREAST+MASSES

SONOGRAPHIC CHARACTERISTICS - BREAST MASSES


 * Margins **
 * Should be investigated carefully
 * Technique called **Fremitus** can be used to identify and confirm margins
 * Fremitus - refers to vibrations produced by phonation and felt through the chest wall during palpation; a technique used in conjunction with power doppler to identifiy the margins of a lesion
 * Have the patient hum
 * Benign lesions usually have smooth, rounded margins
 * Malignancies are aggressive and tend to grow through tissue via **spiculation**
 * Spiculation - finger-like extension of a malignant tumor; usually appears as a small line that radiates outward from the margin of a mass
 * Spiculated margins are the U/S finding with the highest positive predictive value of malignancy
 * Typically alternating hypoechoic and hyperechoic lines


 * Disruption of Breast Architecture **


 * Benign tumors are usually slow growing and do not invade surrounding tissue
 * They tend to grow horizontally within the tissue planes, parallel to the chest wall
 * Large bening lesions may cause compression of adjacent tissue
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Do not confuse this with infiltrating


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant Lesions tend to grow right through the normal breast tissue
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">As masses enlarge they may cause retraction of the nipple or dimpling of the skin as the spiculation pull on the Cooper's Ligaments




 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 140%;">Shape **[[image:bi-rads-4-ultrasound.jpg width="404" height="246" align="right"]]
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Benign
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Rounded or oval shape is usually associated with benign lesions
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Mild undulations in contour
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Larger, rounded lobulation -- not exceeding 3 in number
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Sharp, angular margins are associated with malignancy
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Microlobulations (1-2mm) -- smaller, sharper, numerous


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 140%;">Orientation **

<span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Normal tissue planes of the breast are horizontally oriented
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Benign lesions tend to grow within the normal tissue planes, long axis lying parallel to chest wall
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant lesions are able to grow through the connective tissue and may have a vertical orientation when imaging A/P
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">If a mass measures longer in the A/P dimension than in either sagittal or transverse it is described as "taller than wide"
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Suspicious for malignancy


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 140%;">Internal Echo Pattern **


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Benign
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Isoechoic with breast parenchyma or have echoes equivalent to or brighter than fat


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Hypoechoic
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Weak internal echoes
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Dense posterior shadowing - making lesion difficult to penetrate
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Microcalcifications within mass


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 140%;">Attenuation Effects **


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Benign
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Enhancement beind a lesion - usually indicates fluid
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Shadowing behind a lesion
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Do not confuse with edge shadowing


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif; font-size: 140%;">Mobility, Compressibility, and Vascularity **


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Mobility **
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Benign
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Limited degree of mobility
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">May roll as they are palpated
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Fixed and Rigid


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Compressibility **
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant lesions are normally very hard and noncompressible


 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Vascularity **
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Essential element of study
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Malignant masses will often demonstrate increased vascularity with the lesion
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Often have a feeder vessel -- can be identified with careful evaluation
 * <span style="font-family: 'Palatino Linotype','Book Antiqua',Palatino,serif;">Check with power doppler to determine number of vessels feeding and also look for intratumoral vessels