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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5791_Библиотеки_им_академика_М_И_Перельмана.pdf
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10 Ultrasound Examination of Regional Lymph Nodes
corticomedullary differentiation and color pattern (in 40 % of cases).
Most authors agree that, in many cases, sonography does not allow the ultimate de fi nition of
the nature of the lymph nodes, although it does
detect indirect features that facilitate further diagnostics. US-guided FNAB with cytological
examination is feasible. FNAB increases the sensitivity in diagnosis of axillary lymphadenopathy
up to 96 %; speci fi city, 94 %; and diagnostic
accuracy, 88 %.
10.3 Ultrasound Diagnosis
of Distant Metastases
of Breast Cancer
Remote metastases are observed in 6–56 % of
patients with breast carcinoma. The most often
sites are the peripheral areas of lungs (29–63 %),
pleura, bones (5–31 %), mediastinal lymph nodes
(8 %), liver, brain, ovaries, and neck lymph nodes
(Rozhkova 1993 ; Zabolotskaya 2006 ) . Much
more rarely, it metastasizes in the thyroid gland,
pancreas, retroperitoneal or submandibular lymph
nodes, anterior abdominal wall, and soft tissues
of the extremities (Sinyukova et al. 2007 ) .
Metastases in lungs at an early dissemination
are usually multiple (62–78 % of cases) and bilateral (71 %), while late metastases exhibit multiple affection only in 38 % of cases.
Several imaging modalities, such as X-ray,
CT, MRI, and scintigraphy, are utilized to detect
remote metastases.
However, the imaging of the organs of the
abdominal cavity ( fi rst of all, the liver), pelvis,
retroperitoneal space, thyroid gland, soft tissues,
pleura at the thoracic wall, and super fi cial lymph
nodes is well examined with US (Figs. 10.12 ,
10.13 , and 10.14 ).
The breast itself is much more rarely affected
by metastases of malignant neoplasms of other
locations, for example, melanoma (Fig. 10.15 ),
colorectal, or kidney cancer.
Fig. 10.12 Metastases of
breast carcinoma in the liver.
Sonograms. Gray scale, 3D,
and US elastography
22310.3 Ultrasound Diagnosis of Distant Metastases of Breast Cancer
Fig. 10.12 (continued)
224
10 Ultrasound Examination of Regional Lymph Nodes
Fig. 10.12 (continued)
22510.3 Ultrasound Diagnosis of Distant Metastases of Breast Cancer
Fig. 10.13 Metastases of breast carcinoma in the thyroid gland. Sonograms. CDI, PDI, 3DPD, and shear-wave
elastography
226
10 Ultrasound Examination of Regional Lymph Nodes
Fig. 10.13 (continued)
Fig. 10.14 Metastases of
breast carcinoma in soft
tissues. Sonograms. Gray
scale and PDI
22710.3 Ultrasound Diagnosis of Distant Metastases of Breast Cancer
228
Fig. 10.14 (continued)
10 Ultrasound Examination of Regional Lymph Nodes
Fig. 10.15 Metastases of a
skin melanoma to the breast.
Sonograms. Gray scale,
panoramic scan, 3DPD, and
US elastography
22910.3 Ultrasound Diagnosis of Distant Metastases of Breast Cancer
230
10 Ultrasound Examination of Regional Lymph Nodes
Fig. 10.15 (continued)
Ultrasound Examination After Breast Surgery
1 1
Complex treatment of patients with breast
carcinoma is used in the majority of cases. It
includes local methods for primary tumor (surgery or radiotherapy) and system in fl uence
(chemotherapy, hormone therapy, etc.). Breast
cancer treatment usually begins with surgery.
Preoperative treatment permits to reduce the mass
of the primary tumor and to suppress micrometastases, which are probable in some patients by
the time of diagnosis. Despite a large number of
clinical examinations concerning the ef fi cacy of
various schemes of treatment, there is no uniform
guideline that yields the best results.
The type of surgery is de fi ned by the character
of breast pathology, affected breast volume, and
the degree of invasion into surrounding tissues.
The following types of operations may apply in
different situations:
1. Operations for in fl ammatory processes (acute
or chronic mastitis) – dissection and abscess
drainage
2. Operations for benign and malignant neo-
plasms (e.g., fi broadenoma, breast carcinoma,
nodular type of FBD)
Local tumor destruction •
Partial mastectomy; less than total mastec-•
tomy
Partial mastectomy WITH nipple –
resection
Lumpectomy or excisional biopsy –
Re-excision of the biopsy site for gross –
or microscopic residual disease
Segmental mastectomy (including wedge –
resection, quadrantectomy, tylectomy)
Subcutaneous mastectomy •
Total (simple) mastectomy •
Bilateral mastectomy for a single tumor •
involving both breasts, as for bilateral
in fl ammatory carcinoma
Modi fi ed radical mastectomy •
Radical mastectomy •
Extended radical mastectomy •
Axillary dissection •
3. Plastic surgery
Augmentation mammoplasty including •
breast implants
Breast reduction •
Breast lift (mastopexy) •
Breast reconstruction •
Partial mastectomy removes the gross primary tumor and some of the breast tissue (breastconserving). There may be microscopic residual
tumor.
Radical breast resection removes gland sectors
with the tumor (one-third or one half of breast volume), adjacent fascia of pectoralis major together
with pectoralis minor, and adipose tissues of subclavian, axillary, and subscapular areas at early
stages of cancer.
After the operation, US aims to detect complications caused by clumps of blood or lymphatic
fl uid due to insuf fi cient drainage in early postoperative term. According to Sinyukova and Sholokhov
( 2010 ) , the incidence of seroma is 4 %.
Abundant lymphorrhea results in a fl uid collection within operated tissues. It is sonographically
registered as anechoic areas of various sizes with
indistinct rough borders, located subcutaneously
A.N. Sencha et al., Breast Ultrasound,
DOI 10.1007/978-3-642-36502-7_11, © Springer-Verlag Berlin Heidelberg 2013
231