الفهرس 
Anatomy of the breastOnly 14 pages are availabe for public view
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Abstract
Breast cancer is the second most common cause of cancer deaths and one of the most dreaded diseases of women therefore; distinction between benign and malignant breast masses remains a common problem for pathologists, surgeons, and radiologists. Although many studies showed that sono-mammography is helpful in detection of early breast cancer in patients with breast lumps, sometimes the final diagnosis could be reached and excisional biopsy is required for further confirmation of the diagnosis. Hence, an alternative, less invasive methods of diagnosis are needed to reduce the number of unnecessary biopsies, allay anxiety and depression of the patient, and control costs which is the aim of this work. It was proved that tumor growth is related to angiogenesis and appearance of abnormal vessels and that the degree of neovascularization correlates with the biologic behavior of the tumor so that the measurement of tissue blood flow can help in evaluating breast problems. Thus, a breast imaging modality that shows lesion vascularity -such as Doppler US- may be useful for identification or characterization of malignant breast lesion in which angiophenotype is present and can give a further improvement in the value of ultrasound in breast diseases. In this study, breast anatomy, pathology and clinical presentations of different breast masses, basic physical principles as well as the scanning techniques of color Doppler US all were highlighted and discussed with special attention has been guided towards the newly developed echoenhancing US, their advantages and limitations in an attempt to predict more accurately whether a lesion is benign or malignant. Though color Doppler US shown to be not suitable as a screening method in its present form like mammography or ultrasound imaging, it has proven to be a useful addition to the real time ultrasound examination of the breast in patients with localized pathologic finding that can not only detect neoangiogenesis in a malignant breast lesion differentiating it from benign disease but also can help in avoiding larger vascular structures in interventional procedures, thereby reducing the risk of heamatoma. More important, color Doppler US can advance the differential diagnosis not only of axillary lymph node metastatic involvement but also the detection or exclusion of internal mammary nodal involvement, the region that is not routinely included in lymph-adenectomy, thus can provide an alternative accurate predictors of lymph node metastasis which is very important in selecting those patients who would benefit from nodal dissection and can reduce the subsequent risk of surgical complications. Improved technique and introduction of microbubble contrast agents have been proved to offer greater sensitivity. Color Doppler flow imaging has shown to be potential as an additional and independent functional tool for measuring and predicting the response of breast carcinomas and possibly other tumors to therapy while other conventional methods (clinical examination, mammography and B-mode ultrasound) have limitations in sensitivity and reproducibility. This is particularly important in the follow-up of patients who undergone breast conserving surgery to exclude a recurrence by non-invasive means. If doubt exists, the diagnosis should be established by ultrasound-guided biopsy or by administering an ultrasound contrast agent which has been shown to improve the detection rate of recurrence by enhancing Doppler signals. It has proven that echo-enhanced color power Doppler US is-superior to conventional power Doppler US not only in distinguishing malignant from benign breast masses but also malignant from benign nodal diseases in patients with breast cancers as well as comparison between the vascular pattern of each axillary node and that of the corresponding primary breast cancer in the same patient and may also be helpful in guiding therapy. Improvements in equipment technology, advancements in transducer, and the introduction of microbubble US contrast agents are likely to improve the sensitivity to slow flow in small vessels even more than any of the alternatives and can be expected to further the usefulness of color Doppler US in the breast and with more investigations and confirmations the dramatic evolution of breast cancer diagnosis and management in recent decades will be obtained.