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.
carcinoma in-situ
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)–
infiltrating carcinoma
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
medullary carcinoma
- 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.
tubular carcinoma
- 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.