lecbreastcysticlesionusg23-4-25-251022175400-3676c038.pdf

Breast cystic leasion.it is a subjecyvof radiology .describe through x rays and other modulitues.including ct mr and ultrasound

2. Clinical Imaging of Breast
Mammography
DR. MUHAMMAD JAMIL AKHTAR
Associate Professor, FAHS
University of Lahore

3. Course outline
⚫Introduction Breast imaging
⚫Breast anatomy
⚫Breast Imaging techniques
⚫Breast sonography
⚫Sonographicdiagnosis of breast cystic lesions
⚫Mammography
⚫Clinical application of imaging in breast lesions
⚫Congenital breast lesions
⚫Benign breast lesions
⚫Malignant breast lesions
⚫Miscellaneous breast lesions
⚫Breast & Sentinel node biopsy
Latest and advance development

4. Differential Diagnosis of Cystic
Breast Lesions

5. Breast Cystic Lesions

7. Differential Diagnosis of Cystic Breast
Lesions
⚫Simple cyst
⚫Complicated Cysts
⚫Complex cysts
⚫Others cystic lesions
–Galactocele
–Hematoma
–Fat necrosis or oil cyst
–Mastitis or breast abscess
–Intracystic papilloma
–Necrotizing neoplasm

8. Breast Ultrasound Lexicon Summary of
Terminology
Background echotexture Homogeneous, fat
Homogeneous, fibroglandular
Heterogeneous
Masses Shape: oval, round, irregular
Orientation: parallel, antiparallel
Margin: circumscribed, not circumscribed (indistinct,
angular, microlobulated, spiculated)
Lesion boundary: abrupt interface, echogenic halo
Echo pattern: anechoic, hyperechoic, complex,
hypoechoic, isoechoic
Posterior acoustic features: none, enhancement,
shadowing, combined pattern
Surrounding tissue: ducts, changes in Cooper's
ligaments, edema, architectural distortion, skin
thickening, skin retraction
Vascularity Present or not present, adjacent to lesion, diffusely
increased
Miscellaneous Clustered microcysts, complicated cysts, mass in or
on skin, foreign body, intramammaryor axillary
lymph nodes

9. BI-RADS Assessment Categories
BI-RADS Category Assessment Recommendation
0 Incomplete examination Additional imaging necessary
1 Normal Yearly screening mammography
2 Benign findings Yearly screening mammography
3 Probably benign, < 2% chance of
malignancy
Short-interval follow-up
4 Suspicious abnormality Take appropriate action
4A: low probability 1-3% chance of malignancy Biopsy or surgical excision
4B: intermediate probability3-50% chance of malignancy
4C: high probability 51-94% chance of malignancy
5 Suspicious abnormality, > 95%
chance of malignancy
Take appropriate action, biopsy or
surgical excision
6 Biopsy-proven malignancy Take appropriate action

10. Breast Cysts
⚫Fluid-filled sacs inside the breast
–They are usually benign.
⚫Patient may have one or multiple breast cysts
–A breast cyst often feels like a grape or a water-filled
balloon

11. Breast Cysts Classification
⚫Types I: Simple Cysts:-Anechoic masses with
imperceptible, circumscribed border and acoustic
enhancement
⚫Type II: Clustered Cysts: -Anechoic cysts with no
discrete solid component
⚫Type III: Septated Cysts: Cysts with septa of less
than 0.5 mm in thickness
•Type IV: Complicated Cysts: Cysts having homogeniouslow level echoes that
otherwise meet the criteria of simple cyst including cystic lesion containing
fluid debris levels or floating echogenic debris.
•Type V: Complex Cysts: Cysts with solid and cystic components having thkc
wall/septa greater than 0.5 mm in thickness or nodule with atleast50% cystic
component
•Types VI: Complex solid and cystic masses: Solid masses with eccentric cystic
foci:

12. Simple Breast Cysts
⚫Ultrasound Findings
–Oval or round shape
–Anechoic (no internal echoes)
–Circumscribed margins
–Posterior acoustic enhancement
⚫Mild enhancement may be seen in
Fibroadenomas

13. Acoustic Enhancement
Simple Breast Cysts

14. Simple BraestCysts

15. Clustered microcysticmass

16. SeptatedBreast Cystic Mass

17. SeptatedBreast Cystic Mass
Intracystic papillary carcinoma

18. Complicated Breast Cysts
⚫Complicated cystsare “in between” simple
and complex
–Although they share most of the features of
simple cysts
–They tend to have some debris inside them
However, they don’t have the thick walls or Obvious solid
components that a complex cyst has.

19. Complicated Breast Cysts
Cyst with Debris

20. Debris + Fluid / Fluid Level
Complicated BraestCysts

21. Complicated BraestCysts

22. Complicated BraestCysts

23. Complex Breast Cyst:
–The cyst is called a complex cyst
⚫Cystic and solid mass
⚫Thick walls
⚫Irregular or scalloped borders
⚫Thick septa
⚫Intracystic masses

24. ⚫The majority show posterior acoustic
enhancement due to the cystic component
–The margin may be macro-or microlobulated
–Indistinct, or even irregular
Complex Breast Cyst:

25. Papilloma in Complex Breast Cyst

26. Complex Breast Cyst:

27. Papilloma in Cyst: Doppler
Complex Breast Cyst:

28. Papillomain complex Cyst
Complex Breast Cyst:

29. Complex Breast Cyst:

30. Complex Cysts-IntraductalPapilloma
Complex Breast Cyst:

31. Complex Cyst-Malignant Breast Cyst
Complex Breast Cyst:

32. Malignant Breast Cyst
Complex Breast Cyst:

33. Complex Mass

34. Necrotic neoplasm

36. Fibrocystic breast condition
1.This condition is referred to by many different names: fibrocystic
disease, fibrocystic change, cystic disease, chronic cystic mastitis or
mammary dysphasia.
2.The USG appearance of the breast in this condition is extremely
variable since it depends on the stage and extent of morphological
changes.
3.In the early stages, the USG appearance may be normal, even though
lumps may be palpable on clinical examination.
4.There may be focal areas of thickening of the parenchyma, with or
without patchy increase in echogenicity
5.Discrete single cysts or clusters of small cysts may be seen in some
6.Focal fibrocystic changes may appear as solid masses or thin-walled
cysts.
7.About half of these solid masses are usually classified as indeterminate
and will eventually require a biopsy

37. ⚫The term fibrocystic changes (FCC) indicates a spectrum of
histopathologic benign changes of the female mammary gland
including cysts, fibrosis, apocrine metaplasia, calcifications,
inflammation, epithelial hyperplasia, and sclerosing adenosis
(SA).
⚫FCC is not as a disease but rather a disorder of physiological
development, maturation, and involution
⚫Most common symptom is mastalgia–focal or diffuse,
particularly outer breasts, changes with menstrual cycle, more
commonly in women with high amount of
fibroglandulartissue
⚫More common in premenopausal women, trend to increase
with nulliparity, and later menopause
Fibrocystic breast condition

38. ⚫The terminal ductal lobular unit is normally 1–2 mm in size but can vary from 1 to 8 mm in
size.
⚫Around the time of menopause, the production of new TDLUs decrease along with the
atrophy of lobules and connective tissue surrounding the TDLUs.
⚫They are partially replaced by adipose tissue.
⚫Mammographically this is well demonstrated as fatty breasts in the postmenopausal age
group.
⚫Fibrocystic change (cystic hyperplasia) includes various forms of adenosis and epitheliosis,
cyst formation, fibrosis, and apocrine metaplasia.
⚫The term fibrocystic disease should be avoided as fibrocystic changes are considered to be a
range of normal variation in the process of involution.
–Adenosis
⚫Adenosis is multiplication of acini in a disorderly manner. The lobular pattern is
maintained.
–Fibrosis
⚫Fibrosis develops at a later stage of adenosis.
⚫This is represented in the mammograms as dense breast with a ground glass
appearance that is featureless.
⚫The extensive fibrosis masks the parenchymal changes, thereby making cancer
detection difficult in dense breasts
Fibrocystic breast condition

39. Fibrocystic breast condition

41. Duct ectasia
⚫This lesion has a variable appearance.
⚫Typically, duct ectasia may appear as a single
tubular structure filled with fluid or sometimes
may show multiple such structures as well.
⚫Old cellular debris may appear as echogenic
content.
⚫If the debris fills the lumen, it can be
sometimes mistaken for a solid mass, unless
the tubular shape is picked up

43. Galactocele
⚫Also called lacteal cyst or
–A Milk cyst is a Retention cyst
containing milk or
❄A milky substance that is usually
located in the mammary glands
❄They can occur in women during
or shortly after lactation.

44. ⚫A galactocele forms from the accumulation of milk
distal to an obstruction in the terminal ductal unit.
⚫Typically show a circumscribed oval or round mass.
In the acute setting, a galactocele may appear as a
complicated cyst or anechoic fluid with thin septa
⚫Cystic/multicystic: 50%
⚫Mixed (cystic + solid): 37%
⚫Solid: 13%
–Color Doppler interrogation will show a lack of
blood flow.
Galactocele

45. Galactocele

46. Galactocele

47. Galactocele

48. Galactocele

49. Galactocele

50. Breast Abscess
⚫Patients may present with
–Fever
–Pain
–Tenderness to touch
–Increased WBC count
⚫Most commonly located in the central or subareolar
area.

51. Abscess : Sonography
⚫An abscess may show
–An ill-defined or
–A well-defined outline
–It may be anechoic or
–May reveal low-level internal echoes
⚫And posterior enhancement

52. Breast Abscess (Pain. Fever)

53. Breast Abscess (Complex)

54. Hematoma(Trauma)

55. Hematoma(Trauma)

56. Hematoma(Trauma)

57. Fat Necrosis