Breast Contrast-Enhanced Ultrasound

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Good afternoon ladies and gentlemen. First, I'd like to say it's my pleasure to participate in this Breast Care symposium. Thank you for the invitation. As we are now in the guidelines and recommendations for the clinical practice of contrast enhanced ultrasound in Nancy practical applications published in 2017. Contrast enhance our chances for their characterization of breast lesions and Sentinel lymph node identifications are not recommended for clinical use. Cell express contrast enhance our chance of practical in clinical. What could breast contrast enhance, such as South do? They peaked the micro circulation and helped tumor differentiation. Biopsy guidance posts are ready. Follow up. Therapeutic evaluation Sentinel lymph node location and evaluation. I'd like to show several cases to demonstrate the application of breast contrasting her surgery cell in our routine job. Oh, into the relatively breast cancer dense breast scan of Chinese women breast. Ultrasound is the primary screen tool. More and more sub centimeter breast lesions are detected. We should we do with this tiny legends biopsy at the first time or short term. Follow up in this slide we could see two almost identical breast lesions. They are both hyperechoic paragraph B supply in regular shape with angular and microbial 8 marking without posterior change. We perform contrasting high such as salt, to see if we could know more about these regions. Usually we judge the region according to its enhancement patterns. For case one, religion is ice are enhanced and conqueror of the Legion is unclear in the contrasting hands image. It means that the blood supply of the region is the same as surrounding breast tissue. The region could be defined as being nine according to its enhancement pattern. The final pathology is fibrocystic breast disease. For case 2, the Legion is hyper enhanced within regular shape and larger scope, correct crowd light enhancement is observed. It's the typical enhancement pattern of malignant lesions and the final pathology is invasive carcinoma. The micro circulation of breast lesions could be deptt. Clearly, by contrast, enhanced sanctions sound. Thus, the diagnostic specificity of Primo Archer self could be elevated by being combined with breast contrast enhanced ultrasound. In this case, a hypoechoic solid lesion was detected in the outer upper quadrant of the right breast of a 53 year old lady, accompanied by opposite was scheduled before the biopsy contrast enhance ultrasound was performed. Non enhanced PA was observed in the region. It means that local necrosis alkalaj nations exist. Non enhanced part should be avoided in the biopsy procedure in order to get accurate pathology result. Test combined contrast enhanced ultrasound biopsy guidance could be more precisely. In China during to the screening program, more and more women with breast cancer are detected at the early age and have the opportunity to undergo breast conserving surgery routine follow up are very important for them. Any change in the surgical site? My panic then, and the post surgery scar usually mimicry currents and can be differentiate by only people actually salt. In this case, a 16 year old lady who underwent breast conserving surgery two years ago touch a hot mess in the surgery part. The results of previous routine exams were all normal, a hypertonic in regular breast lesion was detected. Breast contrasting hansaka S showed none enhancement in the Legion and Legion was indeed a scar rather than a recurrence. Therefore, breast contrast enhance ultrasound is meaningful for post surgery follow up. Sentinel lymph node location and evaluation is very important for patients prognosis and it's very important for the decision to perform a single link, final dissection or not. In this case, a 46 year old woman with a virus, six breast lesion will undergo a breast conserving surgery, finding though biopsy result of the lymph node detected by two D arch itself with negative. Sentinel detection and evaluation was very important. For Sentinel lymph node locations. Contrast agent was injected into separately into the Paria area. Message the area for 10 to 32nd depending on the image in effect. Subcutaneous lymphatic channels could be visualized. Enhanced linked nodes could be detected by moving the Pearl along the channels. Dural images were used to confirm their architecture, redefined Sentinel lymph node. If the lymphatic channel or lymph node was not detected successfully, one or two additional injection could be performed. In this case, totally two Sentinel lymph nodes were detected in the right axilla. The result was confirmed by my Sling Blue Chaser in the operation. Here is another case. A 42 year old woman with a virus express region would undergo a breast conserving surgery. Fine needle biopsy gets out of the lymph node detected by two D Archer cell was uncertain. Two Sentinel lymph nodes were clearly did. Pete, by contrast, enhance ultrasound. Both of them demonstrate ring enhancement in effort. Tumor cells proliferated in the Sentinel lymph node and infiltrate almost the entire linked note. These sterling finals are considered as positive. By contrast, enhance such as self and it was verified by pathology so contrasting hands Archer cell is a feasible method for Sentinel lymph node identification and the enhancement patterns could infer the status of Sentinel lymph nodes. However, interpretation of breasts contrast enhanced search itself is experience dependent. As the contrast pattern of midnight and malignant breast lesions can overlap and be difficult to dictate English by inexperienced doctors. Additionally, the effective observation time is limited or into the high frequency it, sun conditions and great child contrast media. Even with these challenges in mind, or current experience with breast contrast, enhance ultrasound has demonstrated a great deal of values. We look forward to the future. Thanks for your attention.

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Guidelines & Recommendations SLN location SIN Lesion Differentiation Post-surgery follow up Biopsy guidance What could Breast CEUS do? location location Limitation SLN location 210' The EFSUMB Guidelines and Recommendations for the Clinical Tia 022 041 nsom Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic us 022 us 0 22 • Depict the microcirculation and help tumor differentiation ncoü "S 000 800' DSO 00 .usooo us 0 27 us 027 nsom • Short observation time and inadequate evaluation of lesions located Ticooo s:o.2e Applications: Update 2017 (Long Version) us 0 27 us 000 • Subcutaneous injection of contrast agent at deep in the breast (Sonozoid?) Die EFSUMB-Leitlinien und Empfehlungen für den klinischen Einsatz 3/6/9/12 0'clock position of the areola region des kontrastverstärkten Ultraschalls (CEUS) bei nicht-hepatischen Biopsy guidance • Biopsy guidance Ultrasound Anwendungen: Update 2017 (Langversion) • Post-surgery follow up Post-surgerv follow uo Massage the areola region for 10-20s depending Operator-dependence (Al?) Enhanced on the imaging effect • Therapeutic effective evaluation (including neoadjuvant chemotherapy or RECOMMENDATION 59 RECOMMENDATION 60 ablation of benign tumors) CEUS with intradermal injection of contrast agent to identify CEOS for the characterization of breast lesions is an active re- NO Trace the lymphangion to the first group of lymph the sentinel lymph node is an active research field but at pres- search field but at present cannot be recommended for clini- Differentiation of lesions rich in blood supply ent cannot be recommended for clinical use (LOE 2b, GOR C). ent cannot be recommended for clinical use (LOE 2b. GOR C). nodes Case 1, hypoechoic irregular lesion Case 1, hypoechoic irregular lesion Case 2, cal use (LOE 2b, GOR C). strong consensus (20/0/0, 100 X) A 46-year old woman with a BI-RADS 6 breast lesion would undergo a breast-conserving A 42-year old woman with a BI-RADS 6 breast lesion would undergo a breast- A 42-year old woman with a BI-RADS 6 breast lesion would undergo a breast-conserving A 60-year old lady who underwent breast-conserving surgery 2 years ago felt a hard Strong consensus (20/0/0, 100%0/0) Strong consensus (20/0/0, 100 0/0) A hypoechoic solid lesion was detected in the outer upper quadrant of the SLN location Case 2, hyper-enhanced with irregular shape and larger scope, "crab-claw" like located in the right lesion of a 48- located in the lefht lesion of a 46- mass at the surgery site. The former routine exams were all normal. surgery. Fine-needle biopsy result of the lymph node detected by 2D ultrasound was conserving surgery. Fine-needle biopsy result of the lymph node detected by 2D The non-enhanced part should be avoided in the biopsy procedure. right breast of a 53-year old lady. A core-needle biopsy was scheduled Case 1, iso-enhanced lesion with unclear contour in the CEUS enhancement was observed. Typical enhancement pattern of malignant lesions. negative. SLN detection and evaluation was important for further judgement. year old woman A hypoechoic irregular breast lesion was detected. ultrasound was uncertain. Three SLNs were clearly depicted by CEUS.