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(a) (1) Stroma that is densely packed with fibrous connective tissues and surround the lobules and an extralobular duct (isoechoic). (2) Edematous stroma with loosely packed fibrous connective tissues (hyperechoic). Isoechoic structures can be confirmed by ultrasound (US). The difference in acoustic impedance density between (1) and (2) is visualized as the iso- to hyperechoic area. b (1) Stroma surrounding lobules and ducts = isoechoic. (2) Edematous stroma = hyperechoic. Triangle Microcyst = hypoechoic. Dotted line The area where the lobulus crowds = isoechoic. c Comparison of US and the histology an age change. In stroma with loosely packed fibrous connective tissues, the ratio between edematous stroma and fat varies depending on age and other factors, but they are visualized as hyperechoic areas regardless of the ratio. d Lobes of various sizes overlap each other, causing varied appearance of the boundary surfaces. (1) If the lobe in front is smaller, the boundary surface is visible in the shallow area. (2) If the lobes in the front and back are of comparable size or the lobe in front is slightly larger, the boundary surface is widely visible to the terminal area. (3) If the lobe in front is larger and the lobe in back is smaller, the boundary surface is visible in the deep area
Parts of the sheet structures containing small vessels are
observed as very thin structures with a hyperechoic surface that
reflects the ultrasonic waves (Fig. 2d).
The fact that these stromata with densely packed fibrous
connective tissues remain unchanged with age suggests that they
serve as structural support for ducts (Figs. 1d, 2c)
Thus, the stroma is considered to be visualized as hyperechoic
areas regardless of the proportion of fat (Fig. 2c)..
The width and depth may differ depending on the site in the breast
because of the difference in the size of the overlapping lobes
Izumori, Ayumi; Horii, Rie; Akiyama, Futoshi; Iwase, TakujiJournal: Breast Cancer
Issue 1DOI: 10.1007/s12282-011-0313-2Published: 2013-01-11Institution(s):
The Cancer Institute Hospital of the Japanese Foundation for Cancer Research
With the recent advances in modalities for diagnostic imaging of the breast, it is now essential to detect isoechoic masses and small nonmass lesions, to which little attention has so far been paid using ultrasound (US) of the breast. It will be possible with the observation method to understand normal breast structural images and anatomy. We elucidated the detailed histological architecture of the normal breast, information indispensable for diagnostic US of the breast.
Verification of the above hypotheses was carried out using the breasts of 11 patients who underwent total mastectomy at our clinic.
Isoechoic structures with fat are lobules, all ducts, and surrounding stroma that support the ducts; intervening hyperechoic areas are edematous stroma and fat-containing stroma that support the breast. By taking an isoechoic structure that reflects the course of the ducts as the basic structure for observation, the boundary between the lobes can be inferred.
Detection of deviations from the normal structure using the method for interpreting three-dimensional ultrasound images of mammary lobes is a radical new approach for diagnosing breast cancer. This technique is very simple and amenable to standardization once one understands the underlying theory. Furthermore, it is useful as a screening method as well as for easy detection of faint minute lesions that can only be detected by magnetic resonance imaging or second-look targeted US.
This image is from the article titled "Proposal of a novel method for observing the breast by high-resolution ultrasound imaging: understanding the normal breast structure and its application in an observational method for detecting deviations"
(from Breast Cancer), which is copyrighted by The Japanese Breast Cancer Society. For more information on the
copyright for this image, please refer to the full image caption and to the
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