Case 51: Malignant Breast Mass with Axillary Nodal Metastasis || BIRADS 6 || Ultrasound || Doppler

        

Clinical Features:

- A 32 years old female patient came with a right breast lump.

- Histopathology revealed Invasive Ductal Carcinoma.

- She also complained about the right axillary lump.

Ultrasound Features:

Rt Breast

- An irregular, heterogeneously hypoechoic, taller than wide, non-parallel mass causing architectural distortion of the mammary layer with invasion into the premammary layer & compression over the underlying retromammary muscles, is noted at the 9 o'clock position of the right breast just inferolateral to the nipple.

- Color Doppler shows, high internal vascularity with intratumoral moderate impedance flow (RI: 0.75) which goes in favor of malignant nature.

Rt Axilla

- Multiple enlarged lymph nodes are seen at the right axilla with loss of normal hilar echoes.

- Color Doppler shows, high internal vascularity with multiple transcapsular feeding vessels.

- Nodal hilar arteries show, high impedance flow (RI: 0.93) which goes in favor of metastatic nodes.

Remember:

Due to compression over the hilum, the hilar arteries in case of lymph node metastasis show high flow resistance.

Ultrasound Images:

Fig: Rt breast mass with TVS probe.

Fig: Irregular breast mass with increased internal vascularity on Doppler

Fig: Spectral Doppler from intratumoral vessel. Moderate impedance flow (RI: 0.75) is seen which goes in favor of malignant nature.

Fig: Multiple enlarged right axillary lymph nodes with loss of hilar normal echoes

Fig: Nodal increased internal vascularity on Doppler with multiple transcapsular feeding vessels.

Fig: Enlarged lymph nodes with increased internal vascularity on Doppler with multiple transcapsular feeding vessels.

Fig: Nodal hilar arteries show, high impedance flow (RI: 0.93) which goes in favor of metastatic nodes.

YouTube Video Link:

https://youtu.be/Mny7hPaUYRM

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Mammography Basics

 

Mammography

 

Introduction

This technique uses a low-energy X-ray beam to maximize differences in soft-tissue density and demonstrates the internal architecture of the breast.

Compression of the breast, a short exposure time and the use of high-quality screen-film equipment improve image quality. 

Anatomy 

 

Radiological Anatomy

  

 

 Common Views

A. Mediolateral oblique view (MLO)

B. Craniocaudal view (CC)

 

1. Pectoralis muscle

2. Retroglandular fat

3. Glandular breast tissue

4. Nipple

5. Cooper’s ligaments

 

Why Compression Is Used

To decrease the thickness of the breast and make it more uniform.

To bring the breast structures as close to the image receptor (IR) as possible.

To decrease the dose needed and the amount of scattered radiation.

To decrease motion and geometric unsharpness.

To increase contrast by allowing a decrease in exposure factors.

To separate breast structures that may be superimposed.

Physics

X-ray beams with low penetrating characteristics must be used to produce visible images

Because the normal composition of the breast and the usual signs of cancer are in soft tissue with very little difference or physical contrast.

If very high kVp x-rays are used, very little absorption by tissues and consequently the contrast will be very poor.

Usually 25-30kVp is used.

This results in higher exposure.

The imaging receptors necessary for their visibility require a higher exposure than receptors for other radiographic procedures.

Criteria

Low kVp x-ray beam

Minimum filtration of the beam

Small focal point

Fine grain mammographic films

 

Breast Types

 

Fibroglandular Breast (Younger or Pregnancy)

 

 

Fibrofatty Breast (30-50 Years)

  

  Fatty Breast

 

 

Ultrasound

 

Why Ultrasound

Safe – No radiation hazard

Can differentiate between solid and cystic lesion

Real time evaluation

Can check the vascularity

Almost exact identification of location

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BIRADS

  

BIRADS

• All BIRADS related topics will be added here
• You can also visit: acr.org/birads

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