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The role of ultrasound in breast imaging

The role of ultrasound in breast imaging. Dr Francien Malan Drs Van Wageningen & Vennote 31 October 2007. How does ultrasound work?. High frequency sound wave Crystal probe serves as both transmitter and detector of sound waves Different tissue types

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The role of ultrasound in breast imaging

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  1. The role of ultrasound in breast imaging Dr Francien Malan Drs Van Wageningen & Vennote 31 October 2007

  2. How does ultrasound work? High frequency sound wave Crystal probe serves as both transmitter and detector of sound waves Different tissue types Signal coming back translated into real time black and white picture by computer software

  3. Uses of ultrasound in breast imaging • Palpable masses • Mammographically detected masses • Dense breasts • Young patients • Pregnant/ lactating woman • Breast implants • Guided aspiration/ biopsy/ localisation

  4. Palpable abnormality • Ultrasound especially useful if mammogram shows no obvious abnormality • +/- mammo shows abnormality • Young patients • Benefits of ultrasound

  5. Cystic or solid?

  6. Simple cyst Typical fibroadenoma

  7. cancer

  8. Dense/whitebreasts Fatty/ dark breasts

  9. Dense breasts means a relatively large percentage of fibroglandular tissue and little fat • 50% of patients <30yrs • 1/3 of patients > 50yrs • Can’t “see through” • Ultrasound useful!!!

  10. Young patients (<30/ <35yrs) • Should be first investigation; mammogram only if ultrasound equivocal • Palpable lesions in young woman most commonly cysts or fibroadenomas

  11. Most common problem in lactating woman is mastitis +/ breast abcesses • + US guided drainage of abcess

  12. Implants

  13. Indications the same as for women without implants • Also for evaluation of implant complications such as rupture

  14. Ultrasound guided cyst aspiration/ biopsy • Aspiration of cysts are done when cyst has atypical features, pain relief, relief of anxiety, cosmetic reasons • Biopsy done when after clinical evaluation/ mammography and ultrasound the nature of lesion is still uncertain

  15. What happens? • Outpatient • Sterilised, anaethetised • Needle is guided into cyst under direct ultrasound vision • Cells obtained to path lab for evaluation

  16. Ultrasound guided localisation • Localisation is done prior to surgical resection of lesion to guide surgeon to the lesion, can be done with u/s or mammogram • Inpatient, fasting, sterile conditions, local anaesthetic, localisation needle guided into lesion, wire strapped to arm, patient goes to theatre.

  17. Why ultrasound for localisation? • Lesion visible on ultrasound, not clinically palpable; may or may not be visible on mammogram • Benefits of real time guidance of wire into lesion; 3D perspective; relatively quick;

  18. Why mammogram for localisation? • Microcalcifications • Small lesion deeply seated in large breasts • Area of suspicion on mammogram not visible on ultrasound

  19. Complications • Unsuccessful • Hematoma • Minor discomfort • Infection

  20. Limitations of breast ultrasound • Many cancers are not visible on ultrasound • Microcalcifications • Inderteminate > biopsy

  21. CANNOT REPLACE REGULAR SELF EXAMINATION AND MAMMOGRAPHY AS PRIMARY SCREENING TOOL FOR BREAST CANCER!!!!

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