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Sonographic Professional Skills And Sonography Of The Breast And Thyroid

Question A: Descriptive Information of Different Breast Cysts

The paper looks into the respective cyst category by using ultrasonography evaluation to determine the appropriate surgical interventions that can yield the desired clinical outcome. Cysts are the most commonly encountered condition of the breast, which is usually asymptomatic, and found incidentally while performing an examination for the ultrasound (Odedina et al., 2018). The classification of cystic lesions needs to be done according to the BIRADS lexicon. According to Athanasiou et al. (2014), ACR2, ACR3, and ACR4 are traditionally benign simple cysts, complicated cysts, and complex cysts, respectively.

They are characterised by being filled by fluid, epithelium with oval and round-shaped structures that occur after obstructed ducts. With a simple cyst, the epithelium can either be apocrine or bland type. The former is a tall, secretory epithelium. Ultrasonography of breast cyst is classified as being simple, complicated, or complex. The appropriate classification is essential given the differences in the management of each type of cyst (Collins, 2018; Malik & Klock, 2018). A simple cyst is termed as the anechoic, round oval, and well-circumscribed. When all the inherent features of the simple cyst are present, they are referred to as being benign and they do not warrant interventions. Aspiration is carried out with the aim of relieving patient from the pain caused by cyst.

Benign condition

Figure 1 Benign condition

A complicated cyst is composed of low-levels echoes internally. The tetracyclic remnants that layer or shift with the changes in patient poisoning. Another unique feature of complicated cyst mass is the characteristic similar internal echoes identical to a circumscribed solid mass (Rahman et al., 2019). As such, these kinds of cysts do not have a thick wall, septa, or other defined solid appearance. It is worthwhile to mention that the probability of developing malignancy among the complicated breast cyst is negligible. It is so because this type of cyst can be managed by interventions that are short-term via follow-up evaluation and aspirations.

Nonetheless, if a complicated cyst mass becomes symptomatic (it is usually rare), new needle aspiration is indicated.

Complicated cyst

Figure 2 Complicated cyst

The complex masses require histological verification and are thus categorised into ACR4 by biopsy or surgical ablation. The aetiology is dynamic and can present itself as either benign or high-risk hematoma, fat fibrocystic mastopathy, papilloma, or abscess (Stein, 2018). In this case, the technique of using biopsy must be utilised in every case, and it is often advisable to insert a coil while performing the procedure. It is important to note that complex breast masses exhibit both echogenic and anechoic components, which are solid and cystic, respectively (Antonio et al., 2019). Indications are usually by biopsy, illustrating that several pathogenic agents may create normal and complex cyst (Dupont et al., 2016).

Complex cystic mass

Figure 3 Complex cystic mass

Imaging evaluation can be conducted via different methods: mammography, ultrasonography, and biopsy. Myriad of patients with complex cystic mass has gone through onset mammography which may help provide explanations for the mass. For lesions that appear benign such as those containing fat at mammography, the oil cyst that may culminate later can warrant avoidance of biopsy. However, the lesions that prove to be malignant at point-of-care using biopsy may provide useful information concerning the extent of the disease at mammography. Hence, the information obtained influences the decision-making process for the preceding surgical management.

Question B: Justifications of the Interventions

The patient’s mammographic and historical evaluation and assessment may obviate the interventions used. For instance, this is done when there is a presence of hematoma bearing complex cyst that might form immediately after needle, surgical biopsy, or trauma. When the hematoma is suspected to be present, ultrasonography is conducted to re-evaluate the results and validate the regression (Honig et al., 2019). After surgery or trauma, fat necrosis may form leading to galactoceles, which appear as complex cysts. Hence, meticulousness is required, so that misdiagnosis made on image evaluation is not made. Therefore, a biopsy is eliminated in a typical clinical environment if the symptomology depicts a benign cyst appearance in the mammogram.

Additionally, when there is the presence of palpable lesions, biopsy accompanied by palpation only is utilised. It is worthwhile to mention that biopsy, in this case, the approach is performed only in circumstances where there is difficulty in accurately directing action to the solid component. Moreover, when there is the presence of fluid aspirations and leakage, a subsequent biopsy is made less accurate.

The approach to using biopsy of cystic mass involves the determination of the trade-off between the need for obtaining sufficient material for conducting differential diagnosis and the need for preserving the procedural approach to the situation. Important to note is that breast lesions provide less challenge when using biopsy compared to other classes of the cystic mass. It is the case because of the hindrance of the cystic structure component that is disrupted while conducting the biopsy procedure.

Malignant lesions are common among people with complex cystic masses, including infiltrating ductal and lobular carcinoma and DCIS. The atypical lesions are abnormal pathologic results in complex cystic mass, which may include but not limited to atypical papilloma and atypical ductal hyperplasia. Atypical ductal hyperplasia has histologic similarities to low-risk DCIS but increasingly limited in this case. The lesion is featuring a small monomorphic cell reproduction with the regular placement of the cells. There is also the formation of microlumen. Atypical papilloma and lobular neoplasia features are both associated with moderate risk for acquiring breast cancer, according to Co, Kwong, & Shek. (2018). As such, lobular neoplasia features the prevalence of monomorphic lobular-shaped cells in situ.

In summary, the complex cystic breast masses are severe ultrasonographic findings that typically warrant a biopsy. Ultrasonography is the recommended method for characterising and informing biopsy of the lesions. One of the common benign causes of complex cystic masses is fibrocystic changes, intracystic papilloma, and fibroadenoma. The atypical finding includes abnormal ductal hyperplasia, atypical papilloma, and lobular neoplasia. Malignant findings include infiltrating ductal and lobular carcinoma. The ultrasonographic-guided percutaneous biopsy is relatively effective for diagnostic applications and guiding the management of the lesions in the cystic masses.

References for Sonographic Professional Skills

Antonio, T. D., Córdoba, G. D., Gallardo, M. D. M. G., Ruiz, G. G., Oyarzábal, J. I., Susacasa, E. P., … & Villa, L. P. (2019). Complex cystic and solid mass. Diagnostic management and anatomopathological correlation. European Congress of Radiology 2019.

Athanasiou, A., Aubert, E., Salomon, A. V., & Tardivon, A. (2014). Complex cystic breast masses in ultrasound examination. Diagnostic and Interventional Imaging, 95(2), 169-179.

Co, M., Kwong, A., & Shek, T. (2018). Factors affecting the under-diagnosis of atypical ductal hyperplasia diagnosed by core needle biopsies–A 10-year retrospective study and review of the literature. International Journal of Surgery, 49, 27-31.

Collins, L. C. (2018). Contemporary classification of breast cancer. Pathology, 50, S8-S9.

Dupont, W. D., Degnim, A. C., Sanders, M. E., Simpson, J. F., & Hartmann, L. C. (2018). Risk factors for breast carcinoma in women with proliferative breast disease. In The Breast (pp. 264-271). Elsevier.

Honig, E. L., Mullen, L. A., Amir, T., Alvin, M. D., Jones, M. K., Ambinder, E. B., ... & Harvey, S. C. (2019). Factors impacting false positive recall in screening mammography. Academic Radiology, 26(11), 1505-1512.

Malik, B. H., & Klock, J. C. (2019). Breast cyst fluid analysis correlations with speed of sound using transmission ultrasound. Academic Radiology, 26(1), 76-85.

Odedina, S. O., Ajayi, I. O., Adeniji-Sofoluwe, A., Morhason-Bello, I. O., Huo, D., Olopade, O. I., & Ojengbede, O. A. (2018). A longitudinal study of the prevalence and characteristics of breast disorders detected by clinical breast examination during pregnancy and six months postpartum in Ibadan, Southwestern Nigeria. BMC Women’s Health, 18(1), 152. Retrieved from https://link.springer.com/article/10.1186/s12905-018-0647-4

Rahman, A. N., Shokouh-Amiri, M., Wiley, E., & Green, L. (2019). Epidermoid Cyst in Male Patient Mimicking a Suspicious Breast Mass and Consequences of Biopsy. Journal of Clinical Imaging Science, 9, 50. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884986/

Stein, M. A. (2018). Complex cystic and solid mass. Breast Imaging, 370. Oxford, UK: Oxford University Press.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Medical Science Assignment Help

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