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VIGNAL Philippe MD Paris France
Th Stavros, Denver



Breast
The sonographic solid nodules algorithm
The BIRADS characterization


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--- Arabic
Breast The sonographic solid nodules algorithm The BIRADS characterization
Here some examples

Principe de la classification Birads adaptée à l'échographie des nodules solides du sein
Voici quelques exemples

 


 


 

Click on the image below
Cliquez sur les images en bas

 

 

Video

tumor puncture
Ponction tumorale


(1.03M

Harmonic scan
Harmonique


(1,4M)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With anatomicopathologic section avec la coupe anatomopathologique
Diagnosis :Breast tumor Birads 5 Diagnostic :Tumeur du sein : Birads 5 ____

 


The sonographic solid nodules algorithm
The BIRADS characterization
Ph Vignal Paris
Th Stavros, Denver

Français
cliquez ici

Arabic

The BIRADS categories

* A realistic goal for US : identify a short interval follow up group with low risk of malignancy : BIRADS 3 *

* Not all the solid nodules can be characterized : large overlap in sonographic findings between benign and malignant nodules *

* Use multiple findings because cancer is heterogeneous *

* In a strict algorithm approach *

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BIRADS :
Breast Imaging Reporting And Data System

Only for solid nodules

* BIRADS 2 : certainly benign : lipoma, lymph node___________________

* BIRADS 3 : probably benign ( less than 2% of malignity) : fibroadenoma

* BIRADS 4 : suspicious (a,midly and b, moderetly) ___________________

* BIRADS 5 :malignant: > 90%___________________________________

 

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BIRADS 2

Hyperechoic mass ( lipomas)

Lymph node

Silicon granuloma

 

BIRADS 3
the benign sets

* Elliptical, wider than tall and completely encompassed by a thin echogenic capsule

* Gently lobulated, wider than tall and completely encompassed by a thin echogenic capsule

* A partial capsule is inadequate proof of benignity : special manoeuvers are required

 

 

Gently lobulated, wider than tall completely encompassed by a thin echogenic capsule

 

Elliptical, wider than tall completely encompassed by a thin echogenic capsule

 

 

 

Video
Click on the image below (1.03Mb)


A complete ( long and short axis) thin echogenic capsule must be present.

 


A partial capsule is inadequate proof of benignity

 


Where is the capsule ?

 

 

BIRADS 4 and 5 : the suspicious findings

* Spiculation or thick echogenic halo

* Angular margins

* Microlobulations

* Taller than wide

* Duct ectension

* Branch pattern

* Shadowing

* Calcifications

* Markedly hypoechoic

 

Supicious findings

* Surface characteristics : findings 1-3 Spiculation or thick echogenic halo,angular margins ,microlobulations

* Shape characteristics : findings 4-6: Taller than wide,duct ectension,branch pattern

* Internal characteristics: findings 7-9: Shadowing,calcifications,markedely hypoechoic

 

Another look

1. hard findings ( signs of invasive malignancy) : spiculation or thick echogenic halo,angular margins, shadowing

2.soft findings (signs of intraductal components): microlobulation, duct extension, branch pattern, calcifications

3. hard and soft findings (with both DCIS and invasion) : taller than wide, markedly hypoechoic.

 

Sensitivity specificity

* None of the individual findings have the desired sensitivity of 98% or greater

* A single suspicious finding enables a sensitivity of 99% But most often more than 5 or 6 suspicious findings are present.

* The specificity of soft findings is less than that of hard findings

 

   

Microlobulations Se 71% PPV 40%

   

Angular margins Se 28% PPV 80%
 

 
Markedly hypoechoic Se 48 VPP 41%
 

Branch pattern Se 3.6% PPV 14%
 
   

 

duct extension Se 3.6 PPV 100
 

 

 

 

 



Echogenic halo (h: 35%)

 

Echogenic halo: value of harmonics
Click on (1.4Mb)

 

 
  Spiculations Se 43% PPV 97%

 

   

Taller than wide Se 14 PPV 80%

   

 

Why taller than wide is specific of malignancy ?  
Because the breast vasculature is perpenducular to the skin
   

 

   
Shadowing Se 64% PPV 29%
 

 

 

Attention : false positive

Move the probe …

heeling and toeing in the long axis, rocking In the short axis


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Sensitivity : Stavros study’s
(
1211 nodules)

* Sensitivity : 99.8% 1 FN /287 birads 3

* SPE 32% ( due to soft findings)

* PPV 44% .

* The negative to positive biopsy rate is 1.9 to 1

* Far less than before the use of the sonographic algorithm ( 5 to 1) in 1995

 

Conclusion

* The BIRADS classification must be used in all BUS reports

* To achieve a very high sensitivity without an excess of biopsies

* It helps to communicate with the pathologist.

 

 

________________________________Content VIGNAL _mise en page : GOUBAA____________

 

 


 
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