Aristida Colan-Georges Atlas of Full Breast Ultrasonography 123 Atlas of Full Breast Ultrasonography Aristida Colan-Georges Atlas of Full Breast Ultrasonography Aristida Colan-Georges Department of Radiology and Imaging Diagnosis County Emergency Clinical Hospital Craiova , Dolj Romania ISBN 978-3-319-31417-4 ISBN 978-3-319-31418-1 (eBook) DOI 10.1007/978-3-319-31418-1 Library of Congress Control Number: 2016945363 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland “The missing link in classical breast imaging: the systematic correspondence with anatomy,” as says Teboul, who renewed the breast US since 1995. Moreover, “It is not possible to assess that a breast has been adequately investigated if its ductal-lobular structures have not been observed.” Michel Teboul “No classic method in routine allows the differentiation of a ductal lesion and a lobular one. Only DUCTAL echography is a technique which offers us, with its remarkable accuracy, the possibility of analysis and comprehension of the ANATOMY and thus of a better approach of the pathological alterations at an early stage. Already used successfully by some European teams, Ductal Echography is a method not operator dependant, it is only anatomical-dependant.” Dominique Amy To my family who believed in my dreams, to my teachers who helped me accomplish them, and to my patients who believed in Life. Contents 1 Breast Doppler Ductal Ultrasonography: Definition, History, and Advantages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Defi nition and History: Galactography and Ductal Echography . . . . . . . . . . . . . . 1 1.2 The Advantages of the Breast Doppler Ductal Echography . . . . . . . . . . . . . . . . . 3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2 Breast Doppler Ductal Echography: Technique of Examination Related to the Breast Lobar Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.1 General Technical Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.2 Ductal Echography: Radial US Technique of Scanning . . . . . . . . . . . . . . . . . . . 12 2.2.1 Patient Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.2.2 Transducers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.2.3 Water-Bag Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.2.4 Steps of Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 2.3 About 3D and 4D US Technique Related to DE . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.4 Usefulness of the Panoramic Scans: SieScape-Type Technique Versus DE . . . . 19 2.5 Reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3 Breast Development: Aspects of Doppler Ductal Ultrasonography of the Normal Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.1 Breast Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.2 Breast Anatomy and Ductal Echography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 3.3 Types of Normal Breast Anatomy on DE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.3.1 Thelarche (Mammary Bud) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.3.2 Young Dense Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.3.3 Mixed Adult Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.3.4 Fatty Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.3.5 Lactating Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 4 Sonoelastography in Addition to Doppler Ductal Echography: Full Breast Ultrasonography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.1 Defi nition of the Sonoelastography: Systems of Acquisition . . . . . . . . . . . . . . . 53 4.2 Accuracy of the SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 4.3 Technique of Sonoelastography: Integration in FBU. . . . . . . . . . . . . . . . . . . . . . 55 4.4 Rendering Sonoelastogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.5 Interpretation of the Elastogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.5.1 The Elasticity Score Named Upon Ueno/Tsukuba University: Benign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 4.5.2 Malignant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.6 Role of SE in Nonpalpable Breast Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 ix