common ultrasound appearance:
- poorly circumscribed, hypoechoic mass.
- height greater than width.
- posterior shadowing
you may also see: punctate, micro-calcifications, tethering of adjacent tissues or the mass crossing tissure boundaries.
elastography is also an emerging technique in assisting suspicion levels.
types of breast cancer
**** breast cancer grading and specific differentiation must involve a series of investigations and not be based on ultrasound alone.
indicates that the cancer is still contained entirely with the tissue of origin and not penetrated tissue boundaries (a histological diagnosis)
- ductal carcinoma in-situ (dcis) – the cancer originated within breast milk ductal epithelium and is still contained by the ductal walls.
- lobular carcinoma in-situ (lcis)–
as the name suggests, the cancer has crossed multiple tussue boundaries, and is no longer contained in the tissue of origin.
- infiltrating ductal carcinoma (idc)
- infiltrating lobular carcinoma (ilc)
there are several grades using the tnm grading
- has better defined margins so has a better prognosis than ductal or lobular. only accounts for approximately 5% of breast cancers.
colloid (or mucinous) carcinoma
- rarer again. arises from mucous secreting cells. also a better prognosis.
- is a form of ductal carcinoma with tubular cells visible on histo-cytology. with increasing early (sub-clinical) screening, tubular carcinomas are being detected with increased frequency.
paget’s disease of the breast
- greater than 97% of patients with pagets diseaes of the nipple have an underlying breast cancer (ref breastcancer.org)
- accordingly, accurate diagnosis is important.
- clinically, the patient may have an eczema-like rash around the nipple/areola and nipple discharge. there may be itching/tingling or hypersensitivity of the nipple.
- as many pagets related breast cancers begin in the ducts behind the nipple, ensure this area is scanned thoroughly with high resolution equipment.
- mammography and breast mri are appropriate investigations in these patients.