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How to read the breast B-ultrasound checklist
BI-RADS is a breast imaging report and data system created and recommended by American Radiological Society. At present, the latest classification is the fourth edition, with 7 grades.
Guiding opinions:
Each level has its own image representation:
Grade 0: Other imaging tests are needed for further evaluation or comparison with previous films.
Grade 1: negative. Nothing unusual was found. Grade 2: benign findings.
Grade 3: It may be a benign finding. Suggest short-term follow-up. The possibility of benign discovery is very high.
Grade 4: suspicious abnormality, biopsy should be considered.
Grade 5: highly suspected of malignancy, and appropriate measures should be taken clinically (almost certainly malignant).
Grade 6: It was proved to be malignant by biopsy, and corresponding measures should be taken.
1. Location: left chest or right chest? As long as you know the words "left" and "right", you can understand which side of the breast is wrong.
2. Orientation: In which direction of the breast is the lesion located. At present, there are two commonly used methods. One is more intuitive, such as "up, down, inside and outside". The other is the "clock" method, which corresponds to the position of the clock. For example, 12 points correspond to the upper part, 6 points correspond to the lower part, 2 points on the left breast refer to the upper direction of the left breast, and 2 points on the right breast refer to the upper direction of the right breast. And so on.
3. Size: In the B-ultrasound report, the measurement of nodule size usually includes three radial lines, namely "length * width * height". The simplest description of the size of breast nodules is to take the maximum of the three radial lines of "length, width and height", rather than the product of the three. For example, "Your mass is larger than 2cm, so surgery is recommended", which means that any one of the three diameter lines of this mass exceeds 2cm.
4. Echo: In breast B-ultrasound, there are generally four kinds of echoes in nodules: (1) Strong echo nodules: representing calcification in breast tissue. The calcified lesions that can be found by B-ultrasound are generally large, while some small calcified lesions are sometimes difficult to find by B-ultrasound. At this time, molybdenum target inspection is recommended. There are also benign and malignant calcification. Benign calcified lesions include fibroadenoma similar to calculus, hard and thick calcification, calcium salt deposition left by milk stasis, exudate and necrotic substance of breast inflammation, etc. Malignant calcification is the most common imaging manifestation of malignant tumor cells in breast cancer. (2) Hypoechoic nodules: the most common, representing breast parenchymal nodules, commonly known as "solid" nodules, which need to be judged according to other descriptions. (3) Anechoic nodule: A common cystic nodule representing the breast, namely cyst, is a kind of "liquid" nodule. Vividly speaking, there is a "water bubble" in the breast. Under normal circumstances, cysts do not need surgical treatment. Small cysts can be reviewed and followed up regularly. If the cyst grows up, it may be accompanied by anechoic hypoechoic body surface, that is, mixed echo nodules, indicating that there are parenchymal nodules in the cyst. The most common papilloma in clinic is intraductal papilloma, because it has a certain canceration rate and needs surgical treatment. (4) Weak echo nodule: It is a kind of nodule between low echo and non-echo in B-ultrasound image, which is usually transformed from non-echo nodule, that is, the cyst has a long history and the clarified "blister" has become turbid.
5. Benign tumors have clear boundaries and sometimes capsule can be seen; Regular shape, round or oval. Malignant masses are generally rough and unclear; Irregular in shape, crab-footed. There is also a borderline tumor between benign and malignant, also known as lobulated tumor. As the name implies, the shape of this tumor is lobulated.
6. Blood flow: Breast B-ultrasound is usually color ultrasound, which does not mean that the imaging is color, but can display the blood flow signal of the tumor in the imaging. Benign masses generally have no obvious color blood flow, or a small amount of punctate or striped blood flow. Malignant tumor has rich blood flow signals, sometimes dendritic, and low blood flow resistance index. Then, compared with the objective "ultrasonic description", "ultrasonic prompt" is the subjective conclusion of B-ultrasound doctors. What I have to mention here is the BI-RADS classification. Its full name is: breast image reporting and data system, which is divided into 7 levels. Simply put, BI-RADS classification is the classification of breast lesions by B-ultrasound doctors according to their own specialty and experience. The higher the grade, the greater the possibility of malignant lesions. 1 grade: normal breast. Grade 2: lobular hyperplasia of breast. Grade 3: Benign breast lesions are more likely, and fibroadenoma is the most common. Grade 4: It may be malignant. Also classified as 4a: malignant possibility. Grade 4b: malignant possibility; Grade 4c: malignant possibility. Grade 5: The clinical diagnosis is almost confirmed as malignant lesions. Grade 6: Malignant lesion confirmed by pathology (puncture or surgical biopsy). The seventh grade is special, it is 0 grade, that is to say, it can't be judged only by B-ultrasound images, and it needs to be combined with other examinations (such as molybdenum target, magnetic vibration, etc. ), medical history and clinical physical examination for comprehensive diagnosis.