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TABLE OF CONTENTS
Introduction 1
1. Historical Development of Breast Ultrasound, Basic Equipment
Requirements 2
2. Manual Real-Time Examination Technique 4
3. Sonographic Anatomy of the Female Breast 7
Principal Tissue Types and Structures 7
Skin 8
Fat 8
Cooper Ligaments 9
Glandular Region 11
Pectoral Muscle 13
Ribs 13
Nipple Region 14
4. Interpretation of Breast Sonograms 16
Parenchymal Pattern 16
Readability 18
Subareolar Region 18
Focal Sonographic Lesions 19
Extent of Disease 19
Infiltration 19
Percutaneous Procedures 20
Microcalcium Correlates 20
Lymph Node Status 20
Sonographic Diagnosis 21
5. Analytic Criteria for the Interpretation of Focal Sonographic
Lesions 23
Margins 24
Retrotumoral Acoustic Phenomena 25
Internal Echo Pattern 27
Echogenicity 27
Effect of Compression on Shape and Internal Echo Pattern 29
L/T Ratio 31
Appendix: Shadowing Not Associated with Focal Lesions 32
6. Indications for Breast Ultrasound 35
Palpable Breast Mass 35
Radiographically Dense Breasts 83
Mammographically Indeterminate Lesions 97
Preoperative Planning, Tumor Extent, and Multicentricity 128
Pregnancy and Lactation 129
Oncologic Follow-Up 134
Chest Wall Evaluation after Mastectomy 134
Oncologic Follow-Up after Breast-Conserving Surgery 153
Postoperative Follow-Up 167
Ultrasound-Guided Needle Aspiration and Localization 176
Axillary, Supraclavicular, and Infraclavicular Lymph Nodes 181
Microcalcifications in Sonography 189
7. Problems of Differential Diagnosis 205
8. High-Resolution Ultrasound Imaging 228
Illustrative Case Reports 229
Tumor Staging and Multifocality 231
Screening 234
Three-Dimensional Ultrasound Imaging 235
9. Doppler Ultrasound 239
Background 239
Continuous-Wave Doppler 239
Color Doppler 240
Ultrasound Contrast Agents 240
Automated Data Analysis 240
Other Doppler and Flow Imaging Techniques 241
10. Conclusion 245
11. References 246
Subject Index 249
