Common ultrasound appearance:
- Poorly circumscribed, hypoechoic mass.
- Height greater than width.
- Posterior shadowing
You may also see: punctate, micro-calcifications, tethering of adjacent tissues or the mass crossing tissure boundaries.
Elastography is also an emerging technique in assisting suspicion levels.
Types of Breast Cancer
**** Breast cancer grading and specific differentiation must involve a series of investigations and not be based on ultrasound alone.
Carcinoma in-situ
Indicates that the cancer is still contained entirely with the tissue of origin and not penetrated tissue boundaries (a histological diagnosis)
- Ductal Carcinoma In-Situ (DCIS) – The Cancer originated within breast milk ductal epithelium and is still contained by the ductal walls.
- Lobular Carcinoma In-Situ (LCIS)–
Infiltrating Carcinoma
As the name suggests, the cancer has crossed multiple tussue boundaries, and is no longer contained in the tissue of origin.
- Infiltrating Ductal Carcinoma (IDC)
- Infiltrating Lobular Carcinoma (ILC)
There are several grades using the TNM grading
Medullary Carcinoma
- Has better defined margins so has a better prognosis than ductal or lobular. Only accounts for approximately 5% of breast cancers.
Colloid (or Mucinous) Carcinoma
- Rarer again. Arises from mucous secreting cells. Also a better prognosis.
Tubular Carcinoma
- Is a form of Ductal carcinoma with tubular cells visible on histo-cytology. With increasing early (sub-clinical) screening, tubular carcinomas are being detected with increased frequency.
Paget’s Disease of the breast
- Greater than 97% of patients with Pagets diseaes of the nipple have an underlying breast cancer (REF breastcancer.org)
- Accordingly, accurate diagnosis is important.
- Clinically, the patient may have an eczema-like rash around the nipple/areola and nipple discharge. There may be itching/tingling or hypersensitivity of the nipple.
- As many Pagets related breast cancers begin in the ducts behind the nipple, ensure this area is scanned thoroughly with high resolution equipment.
- Mammography and Breast MRI are appropriate investigations in these patients.