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Re: ULTRASOUND digest 8From: ARNOLD@CSTCC.CC.TN.USMon Dec 1 13:12:00 1997
Janet, yes, it has been documented that an irregular-bordered, solid mass, which has a broader AP dimension than width dimension is more likely to be a breast carcinoma. For those of you who are familiar with mammography, this makes sense. First, the irregular borders coincide with the "spiculations" noted on malignant masses, where the cancerous cells are invading the surrounding tissue. As well, many breast CA's extend towards the skin line, which would account for the broader AP dimension theory. With high-resolution systems, you may also note microcalcifica- tions within the lesion (though shadowing may not coexist, due to the width of the wavelength compared to the relatively small calcifications). Color flow to malignant lesions is generally of lower resistance, but this is often difficult to evaluate in small breast lesions....power angiography can be of assistance here. Dr. Gordon Hixson in Chattanooga, TN uses this as part of his evaluation criteria; the more vascularity that is documented feeding the mass, the more likely the malignancy.... I would caution those first performing breast ultrasound to not minimize its importance....many think it is an easy exam, but there is much to be considered, of which I could not begin to cover here. The most alarming finding which I consistently run across is a "cyst" later found to have been a malignancy, due to improper adjustment of gain factors, and other criteria not being taken into consideration. Obviously, the mobile masses are much more likely to be B9, since mobility suggests a non-invasiveness of surrounding tissues (solid, mobile masses are usually the fibroadenomas). If it seems to be a cyst, watch for other criteria (does it meet ALL cystic criteria); if it seems solid, what is the history (are you certain it's not a bleed?). And if she's got fibrocystic changes all over, let someone else have her! ha ha!!! Happy Scanning! Jody
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