医学英语教学课件：Breast Ultrasound

BreastUltrasoundIntroductionAnatomyofbreastMethodsofbreastultrasoundUltrasoundappearanceofbreastlesionsBreastinterventionalultrasoundNewtechniquesIntroduction

BreastCancerStatistics

ThemostcommoncancerinwomenThesecondmostcommoncauseofdeathfromcanceramongwomen232,340newcasesofinvasivebreastcancer

39,620breastcancerdeaths

TheprevalencehasbeenrisingfastinChinaAnannualincreaseof3%to4%,morethan1%to2%oftheworldlevelTheincidencerateswerehigherinurbanareathaninruralareaTheincidenceratesinEasternareaandMiddleareaweresimilarandhigherthanthoseinWesternareasBreastSelf-Exam(BSE)

TakingafewminutestodoaBSEaminimumofonceamonthcanmakealifetimeofdifference.Nearly70%ofallbreastcancersarefoundthroughself-examsandwithearlydetectionthe5-yearsurvivalrateis98%.Ifyoufindalump,scheduleanappointmentwithyourdoctorCommonimagingtechniques:MammographyUltrasound

AdvantagesandDisadvantages

Mammography

Advantages:GoodatdetectingDCIS(ductalcarcinomainsitu)

Reliablydetectscalcifications

WidelyavailableLessexpensivethanbreastMRI

UsefulforwomenatanyriskforbreastcancerFastertestthanMRI(10minutesorless)Disadvantages:Doesnotimagewellaroundimplants

Compressionofbreasttissue(somediscomfort)DifficulttoimagedensebreasttissueBreastmustberepositionedfordifferentviewsUltrasoundAdvantages:High-contrastimagesCanimagenonpalpablemasses(lumpsthatyoucan'tfeel)Nocompression,pain-freeNoradiationLessexpensivethanMRIUltrasound-guidedbiopsyDisadvantages:Can'timageareasdeepinsidethebreastRequiresawell-trainedandexperiencedoperatorNotsensitiveformicrocalcifications

CombinationofMammographyandUltrasoundIncreasestheDetectionofEarlyBreastCancer

DiagnosisTreatmentFollow-upUltrasoundHowimportantisultrasound?

ItplaysavitalroleinbreastscreeningAnatomyofBreastGrossAnatomyThebreasttissuetypicallyextendsfromthe2ndribtothe6thor7thrib,andfromthelateralborderofthesternumtothemidaxillarylineEachbreastcontains15-20lobesthateachconsistsofmanylobules.ThelobulesdrainintoasystemofductsBetweentheglandulartissueandducts,thebreastcontainsfattissueandconnectivetissue.MicroscopicAnatomyParenchymaltissueLobarduct,smallerbranchducts,lobulesStromaltissueConnectivetissue,capillaries,lymphocytes,fibroustissue,fatLymphaticdrainage75%:axillarylymphnodes20-25%:

internalmammarylymphnodesSupraclavicularlymphnodesInfradiaphragmaticlymphnodes;abdominalwall;contralateralaxillaryfossa

UltrasoundExaminationMethodsPreparationPositionSupineorlateraldecubitusposition.Theouterbreastquadrantsarebestvisualizedwiththeipsilateralarmextendedoverthehead

Machine：Highfrequencylineararraytransducerwiththefrequencybetween7.5to14MHz

Thebreastcanbescannedlongitudinallyortransversely.Scanningthebreastinaradialdirectionisadvocatedbysomeoperators.Thebreastisthenagainimagedat90°inananti-radialdirection.Ifamassisdiscovered,theradial/antiradialapproachcanhelpfurtheridentifybordersandthepossibilityofductalextension.Sonographicanatomy

SkinSubcutaneousfatlayerMammarylayerRetromammaryfatlayerPectoralmuscleEchogenecityHyperechoic(高回声的）Hypoechoic（低回声的）Isoechoic（等回声的）Anechoic（无回声的）Theskin:hyperechoicThesubcutaneousfat

layer:hypoechoicThemammarylayer

Duct,lobules:hypoechoicFibroustissue:hyperechoicFat:hypoechoicRetromammaryfatlayer:hypoechoicPectoralmuscle:isoechoic

Themammarylayervariesremarkablyinthicknessandechogenicity,dependingonlocationwithinthebreast,aswellasthepatientage,hormonalstatusandinheritedbreastparenchymalpattern.nippleCooperligamentRibmammaaccessoria

axillaryfossa

Diagnosis?UltrasoundAppearanceofBreastCancer

A50-year-oldpatientwithinvasiveductalcarcinoma.Ahypoechoicmasswithirregularshapeandindistinctborderwasobserved.Ultrasoundimageofa65-year-oldpatientwithinvasiveductalcarcinoma.Ahypoechoicmass(about5mm）withirregularshapeandangularmarginswasobserved(arrows).Depressionintheskinofbreastinapatientwithinvasiveductalcarcinoma.Ahypoechoicmasswithirregularshape,speculatedmargins(arrow)andposterioracousticattenuation.Ahypoechoicmasswithtaller-than-wideshape,microlobulationsandmicrocalcifications

Ultrasoundimageofa42–year-oldpatientwithductalcarcinomainsitu(DCIS).ThereisanextensiveareaofmicrocalcificationsinthebreasttissueTwo-dimensionalultrasound:Directsigns:heterogeneoushypoechoicmassirregularshapetallerthanwideindistinctborderangularmarginmicrolobulationmarginspeculatedmarginposterioracousticattenuationmicrocalcificationsIndirectsigns:InfiltrationofCooperligamentEdemaoftheskinlymphnodesenlargementLymphnodesmetastasisaxillarylymphnodessupraclavicularlymphnodes

infraclavicularlymphnodesInfiltrationofthecooperligamentEdemaoftheskinandsubcutaneoustissueColorDopplerflowimaging(CDFI):BloodflowsignalscanbeseeninmostmalignantlesionsPulseWave(PW）:Peaksystolicvelocity(PSV)>20cm/sResistanceindex(RI)>0.70Followupofbreastcancer

subcutaneousfluidify

5yearsafteroperation,cancerrecurrencewasfoundinthechestwall.Metastasistotheinfraclavicularlymphnodes

MetastasistotheliverUltrasoundAppearanceofbenignbreastlesionsFibroadenomaTwo-dimensionalultrasound:•Ovalshape•Smoothdefinedborders•Uniformlylowormedium-levelinternalechoes•Minimalattenuation,ifany•Widerthantall•TwotothreegentlelobulationsAwell-definedhypoechoicmasswithregularshapeinapatientCDFI:NobloodflowsignalsorfewbloodflowsignalsPW:LowPSVandRISimplecysts

Two-dimensionalultrasound:RoundorovalSmoothdefinedbordersAnechoic•PosteriorenhancementCDFI:nobloodflowsignalsTheabsenceofanyinternalechoesandtheposteriorenhancementarecharacteristicsofasimplecystBreastintraductalpapilloma

Threecommonultrasoundcharacteristics:acystwithasolidormixedcystic/solidmuralnoduleanintraductalmassacompletelysolidmasswheretheintraductalnatureofthemasscannotbeappreciatedAcystwithamuralnoduleanintraductallesionpartlyfillingadilatedductColorDopplerandPWareusefultoconfirmthenoduleintheductMastitis

Theearlystage:alocalhypoechoicarea.TheborderisindistinctandtheinternalechoisheterogeneousTheabscessformationstage:echo-freeormixedechowithwell-definedborder.Itisoftensurroundedbythickwall.Theinternalsurfaceofwallisnotsmoothandirregular.EchogenicpuscanbeseenwithintheabscessHypoechoicareawithabundantbloodflowsignalswereobservedinapatientEchogenicpuswasobservedwithinalargeabscessshaperoundorovalirregularborderdistinctindistinctechohomogeneousinhomogeneous

calcificationmacrocalcificationmicrocalcificationposteriorechoenhancementornochangeposteriorattenuationedgeshadowyesnotallandwidewiderthantalltallerthanwidemetastosistoLNnoyesbloodflownotabundant,lowPSVandRIabundant，highPSVandRIDifferentialdiagnosisofbreastlesions

benignmalignantBI-RADS：breastimagingreportinganddatasystem

（乳腺影像报告及数据系统）BI-RADSAssessmentCategories:0:Inconclusive1:Negative2:Benignfinding(s)3:Probablybenign4:Suspiciousabnormality5:Highlysuggestiveofmalignancy6:Knownbiopsy–provenmalignancyBreastinterventionalultrasoundFineneedleaspiration(FNA)

Duringafine-needleaspiration,thesurgeonwillputathinneedlethroughtheskinandintothelump.Cellswillbedrawnintotheneedle,andgiventoapathologisttolookatunderamicroscope.

Corebiopsy

AutomatedbiopsygunisusedincorebiopsySimilartoFNA,butacorebiopsyusesalargerneedlebecauseactualbreasttissueisremoved,ratherthanatinysamplingofcells.Asampleofthelumpisremoved,butnottheentirelump.WirelocalizationImpalpablebreastcancersrequiresomeformoflocalisationproce-durepriortobreast-conservingsurgerysothatthesurgeoncanidentifythetumoursite.Themostcommonlyemployedmethodoflocalisationisusingahookwire.Thetechniqueissimilartoperforminganultrasound-guidedbiopsy.Vacuum-assistedbiopsyWhat’s

new?Elastography

anoninvasiveimagingtechniquethatcanbeused

inmedicinetodefinestiffnessofthet