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The ultrasonic appearance of pathology in the male breast
Ultrasound in Med. & Biol., Vol. 2. pp. 43-44. Pergamon Press, 1975. Printed in Great Britain.
CLINICAL
NOTE
THE ULTRASONIC APPEARANCE OF PATHOLOGY IN THE MALE BREAST J. JELLINS, G. KOSSOFF a n d T. S. REEVE* National Acoustic Laboratories, Australian Department of Health, Sydney, Australia
(Received in final form 8 January 1975) Abstract--The ultrasonic appearance of pathological conditions in the male breast is similar to that encountered in the female breast. With grey scale echography, characteristic features associated with a particular condition can be recognized and an estimation made of the extent of the pathological involvement.
Key words: Acoustics, Ultrasonics, Breast, Breast diseases, Breast neoplasm, Ultrasonic scanning, Ultrasonic tomography, Grey Scale techniques.
oscillations about its axis. The 4cm dia. transducer has a resonant frequency of 2 MHz and has a radius of curvature of 10cm. This provides a depth resolution of the order of I nun in the focal region. An electronic focus marker is inserted in the echogram at the region of best focus. Each major division of the graticule on the echogram corresponds to 1.3 cm in the patient. The echogram of the left breast of a male patient aged 72 yr with gynaecomastia is illustrated in Fig. 1. The skin appears as the uppermost boundary in the echogram and the nipple is recognized by its protrusion above the skin line. Generally the echo strength of the areola is less than the echoes from the surrounding skin. Beneath the surface of the skin are regions of low level echoes from the subcutaneous fat. Some of the boundaries lobulating the fat are due to fibrous tissue interfaces. Beneath the nipple is a region of low level echoes. The significance of this is unclear as this region is not present to the same extent in the normal male breast shown in Fig. 2. The pectoral fascia is well outlined due to its favourable inclination to the ultrasonic beam. Posterior are the pectoralis muscles and other retromammary structures. The gynaecomastic tissues are displayed as a 2 cm thick area of evenly distributed strong echoes overlying the pectoral fascia. This dense echo pattern has the same appearance as that occurring in fibroadenosis in the female breast. A localised lesion following a football injury in the left breast of a 24 yr old male is illustrated
INTRODUCTION
Grey scale echography has been found useful in the management of breast disease and by the use of multi-classification criteria, a high success rate has been achieved in the interpretation of echo patterns associated with various breast conditions in the female breast. Male breast disease is more rare and only a few cases have been referred for examination to our clinic. In these, the characteristic features visualized in the female breast (Jellins et al., 1975) have been encountered and are described in this paper. ECHO
PATTERNS
The same method of examination as that used for female patients was employed (Jellins et al., 1971). The patient is examined in a supine position by the open tank method of coupling. A surgical drape is fitted around the breast, with an adhesive providing a water tight seal between the skin and the drape. Occasionally some excessive hair growth is removed to avoid premature triggering by echoes from the hair. A perspex tank supports the drape, which is then filled with water at 30°C. Thus the breast forms the bottom surface of the tank, into which the transducer is lowered. The transducer moves across the patient in a lateral plane, whilst undergoing ___30° * From the Professorial Sub-unit in Surgery of the University of Sydney, Royal North Shore Hospital, Sydney, Australia.
43
44
Clinical Note
Fig. 1. Gynaecomastia.
in Fig. 3. The presence of internal low level echoes within the mass immediately beneath the nipple identifies it as a solid lesion. The boundaries are not smooth and its size is more evident by the transition of the internal echoes from low to high level echoes obtained from the surrounding normal tissues. From this appearance the size of the lesion is estimated to be 1.5 cm dia. Posterior to the lesion is the retromammary fascia and the thick pectoralis muscles. On biopsy this proved to be a fibroadenoma. The echogram shown in Fig. 4 is of a male patient aged 70 with a scirrhous carcinoma 1.3 crn dia. situated just below the nipple. The lesion exhibits two features which are characteristic of a solid malignancy, i.e. the presence of very low level echoes from the contents and jagged appearance of boundaries. On linear scans this malignant lesion did not show excessive attenuation which is commonly seen in scirrhous carcinoma in the female. The echogram also shows slight retraction of the skin medial to the nipple.
Fig. 2.
Normal breast.
Fig. 3.
Fibroadenoma following football injury. CONCLUSION
Because of the infrequent occurrence of male breast disease only three pathological conditions have been examined so far. In these, echo patterns have been obtained with features similar to the characteristic features in conditions of the female breast. Grey scale echography facilitates the recognition of these features and allows an estimate of the extent of pathological involvement.
Acknowledgement--This paper is published with permission of the Director-General of Health.
REFERENCES Jellins, J., Kossoff, G., Reeve, T. S. and Barraclough, B. H. 0975) Ultrasonic grey scale visualization of breast disease. Ultrasound Med. Biol 1, 393-404. Jellins, J., Kossoff, G., Buddy, F. W. and Reeve, T. S. (1971) Ultrasonic visualization of the breast. Med. J. Aust. l, 305-307.
Fig. 4.
Scirrhous carcinoma.
CLINICAL
NOTE
THE ULTRASONIC APPEARANCE OF PATHOLOGY IN THE MALE BREAST J. JELLINS, G. KOSSOFF a n d T. S. REEVE* National Acoustic Laboratories, Australian Department of Health, Sydney, Australia
(Received in final form 8 January 1975) Abstract--The ultrasonic appearance of pathological conditions in the male breast is similar to that encountered in the female breast. With grey scale echography, characteristic features associated with a particular condition can be recognized and an estimation made of the extent of the pathological involvement.
Key words: Acoustics, Ultrasonics, Breast, Breast diseases, Breast neoplasm, Ultrasonic scanning, Ultrasonic tomography, Grey Scale techniques.
oscillations about its axis. The 4cm dia. transducer has a resonant frequency of 2 MHz and has a radius of curvature of 10cm. This provides a depth resolution of the order of I nun in the focal region. An electronic focus marker is inserted in the echogram at the region of best focus. Each major division of the graticule on the echogram corresponds to 1.3 cm in the patient. The echogram of the left breast of a male patient aged 72 yr with gynaecomastia is illustrated in Fig. 1. The skin appears as the uppermost boundary in the echogram and the nipple is recognized by its protrusion above the skin line. Generally the echo strength of the areola is less than the echoes from the surrounding skin. Beneath the surface of the skin are regions of low level echoes from the subcutaneous fat. Some of the boundaries lobulating the fat are due to fibrous tissue interfaces. Beneath the nipple is a region of low level echoes. The significance of this is unclear as this region is not present to the same extent in the normal male breast shown in Fig. 2. The pectoral fascia is well outlined due to its favourable inclination to the ultrasonic beam. Posterior are the pectoralis muscles and other retromammary structures. The gynaecomastic tissues are displayed as a 2 cm thick area of evenly distributed strong echoes overlying the pectoral fascia. This dense echo pattern has the same appearance as that occurring in fibroadenosis in the female breast. A localised lesion following a football injury in the left breast of a 24 yr old male is illustrated
INTRODUCTION
Grey scale echography has been found useful in the management of breast disease and by the use of multi-classification criteria, a high success rate has been achieved in the interpretation of echo patterns associated with various breast conditions in the female breast. Male breast disease is more rare and only a few cases have been referred for examination to our clinic. In these, the characteristic features visualized in the female breast (Jellins et al., 1975) have been encountered and are described in this paper. ECHO
PATTERNS
The same method of examination as that used for female patients was employed (Jellins et al., 1971). The patient is examined in a supine position by the open tank method of coupling. A surgical drape is fitted around the breast, with an adhesive providing a water tight seal between the skin and the drape. Occasionally some excessive hair growth is removed to avoid premature triggering by echoes from the hair. A perspex tank supports the drape, which is then filled with water at 30°C. Thus the breast forms the bottom surface of the tank, into which the transducer is lowered. The transducer moves across the patient in a lateral plane, whilst undergoing ___30° * From the Professorial Sub-unit in Surgery of the University of Sydney, Royal North Shore Hospital, Sydney, Australia.
43
44
Clinical Note
Fig. 1. Gynaecomastia.
in Fig. 3. The presence of internal low level echoes within the mass immediately beneath the nipple identifies it as a solid lesion. The boundaries are not smooth and its size is more evident by the transition of the internal echoes from low to high level echoes obtained from the surrounding normal tissues. From this appearance the size of the lesion is estimated to be 1.5 cm dia. Posterior to the lesion is the retromammary fascia and the thick pectoralis muscles. On biopsy this proved to be a fibroadenoma. The echogram shown in Fig. 4 is of a male patient aged 70 with a scirrhous carcinoma 1.3 crn dia. situated just below the nipple. The lesion exhibits two features which are characteristic of a solid malignancy, i.e. the presence of very low level echoes from the contents and jagged appearance of boundaries. On linear scans this malignant lesion did not show excessive attenuation which is commonly seen in scirrhous carcinoma in the female. The echogram also shows slight retraction of the skin medial to the nipple.
Fig. 2.
Normal breast.
Fig. 3.
Fibroadenoma following football injury. CONCLUSION
Because of the infrequent occurrence of male breast disease only three pathological conditions have been examined so far. In these, echo patterns have been obtained with features similar to the characteristic features in conditions of the female breast. Grey scale echography facilitates the recognition of these features and allows an estimate of the extent of pathological involvement.
Acknowledgement--This paper is published with permission of the Director-General of Health.
REFERENCES Jellins, J., Kossoff, G., Reeve, T. S. and Barraclough, B. H. 0975) Ultrasonic grey scale visualization of breast disease. Ultrasound Med. Biol 1, 393-404. Jellins, J., Kossoff, G., Buddy, F. W. and Reeve, T. S. (1971) Ultrasonic visualization of the breast. Med. J. Aust. l, 305-307.
Fig. 4.
Scirrhous carcinoma.