1 Solid Nodules Cindy Rapp BS, RDMS, FAIUM, FSDMS National Sales Manager Canon Medical Disclosure Employee – Canon Medical Pathologic Results Type of CA IDC (81.6%) first, seek malignant findings – if present, classify as malignant – if absent..... then look for benign findings – if present, classify as benign – if absent..... then classify as indeterminate Sonography of Solid Breast Nodules methods (old 750 nodules) Sonography of Solid Breast Nodule surface characteristics scan entire surface of nodule in 2 planes ..… surface characteristics heterogeneous if mixture of benign and malignant surface findings……exclude nodule from benign classification. Breast Cancer is Heterogeneous from nodule to nodule often within a single nodule
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Solid Nodules
Cindy Rapp BS, RDMS, FAIUM, FSDMS
National Sales ManagerCanon Medical
Disclosure
Employee – Canon Medical
Pathologic Results Type of CA
IDC (81.6%)
first, seek malignant findings– if present, classify as malignant– if absent.....
then look for benign findings– if present, classify as benign– if absent.....
then classify as indeterminate
Sonography of Solid Breast Nodulesmethods (old 750 nodules)
Sonography of Solid Breast Nodulesurface characteristics
scan entire surface of nodule in 2 planes ..…surface characteristics heterogeneous
if mixture of benign and malignant surface findings……exclude nodule from benign classification.
Breast Cancer is Heterogeneous
from nodule to nodule often within a single nodule
thick, echogenic halo = unresolved spiculationssame lesion, same examination
Malignant Findingangular margins
“hard finding”
Angular Margins
long trans
CA can be heterogeneous within a single nodule-- even circumscribed carcinomas have some --
angular and/or microlobulated margins.
1) cannot simply look at 2 “random slices” through nodule
2) must scan entire surface and volume of nodule in 2 planes (radial and anti-radial)
3) if mixture of benign and malignant findings, ignore benign findings
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radial
anti- radial
angular margins – heterogeneous within one nodule
A
AB
B
Angular Margins
Angular Margins
paths oflow resistance to
invasion
in bases of
Cooper’s ligaments
Malignant Findingmicrolobulation
“invasive or DCIS”
fingers of invasive tumor intraductal components cancerized lobules
Microlobulationmicrolobulation margins
invasive fingers of tumor
1) angular 2) associated with thick haloTabar
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**
* *
microlobulation marginsDCIS components of tumor
**
*
*
85% of ductal CA is mixed invasive and DCIS1) invasive cords central (I) 2) DCIS peripheral (*)
(I)
microlobulation marginscancerized lobules
Microlobulation Sizerelated to tumor grade
LNG DCISsmall microlobulations
HNG DCISlarge lobulations
Malignant Finding“taller-than-wide”
James Bond Island – Phuket Thailand
Malignant Finding“taller-than-wide”
FAFA CACA
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Wider-than-tall Taller-than-wide
Benign Malignant
theories about why malignant nodules are taller-than-wide
growth across tissue planes lack of rotation of fixed malignant nodules only measuring central nidus incompressibility of malignant nodules reflection of axis of orientation of the TDLU in