Date post: | 14-Apr-2018 |
Category: |
Documents |
Upload: | natallia-batuwael |
View: | 224 times |
Download: | 0 times |
of 161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
1/161
DIAGNOSTIC IMAGING
NEOPLASMA
Dr. Yanto Budiman, Sp.Rad., M.Kes
Bagian Radiologi FK/RS Atma JayaJakarta
7/29/2019 Kuliah Blok Neoplasma_januari 2011
2/161
Imaging is emerging as an important adjunct to
the clinical assessment of cancer, contributing
to :
Tumor detection,
Characterization,
Staging, Treatment planning and follow-up.
7/29/2019 Kuliah Blok Neoplasma_januari 2011
3/161
Imaging may be requested in the
following situations:
As a routine investigation at the time of presentation fordiagnostic and staging purposes.
To answer a specific clinical question in an individualpatient on cancer treatment.
As a routine investigation on patients being treated withestablished therapy (chemotherapy, radiotherapy).
As a surveillance tool in patients undergoing a watchand wait policy (e.g. testicular cancer).
Screeningas a mechanism to identify clinicallyoccult cancers (e.g. breast cancer)
7/29/2019 Kuliah Blok Neoplasma_januari 2011
4/161
Diagnostic Tools
Rontgen X-ray
USG
CT Scan
MRI
Nuclear Medicine
7/29/2019 Kuliah Blok Neoplasma_januari 2011
5/161
NUCLEAR MEDICINE : Gamma Camera
SPECT
PET Scan
7/29/2019 Kuliah Blok Neoplasma_januari 2011
6/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
7/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
8/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
9/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
10/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
11/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
12/161
Normal Bone Scan
Normal increased uptake in :
Growth plate
Kidney and bladder
7/29/2019 Kuliah Blok Neoplasma_januari 2011
13/161
Bone Metastase
(multiple hot nodule/spot)
7/29/2019 Kuliah Blok Neoplasma_januari 2011
14/161
Soft Tissue neoplasm
7/29/2019 Kuliah Blok Neoplasma_januari 2011
15/161
Key Points
X-rays always first line
Ultrasound best second test
MRI best overall for
Characterisation
Staging & extent
Progress evaluation
7/29/2019 Kuliah Blok Neoplasma_januari 2011
16/161
Role of Imaging
Confirmation
Mass? What mass?
Classification
Normal or variant
Developmental
Benign or non-aggressive
Indeterminate/Suspicious/Malignant
Staging & Extent
Progress and surveillance
7/29/2019 Kuliah Blok Neoplasma_januari 2011
17/161
Algorithm for ST Masses
7/29/2019 Kuliah Blok Neoplasma_januari 2011
18/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
19/161
Soft Tissue Tumours
Most masses are NOT tumours
Cysts, ganglia, bursae
Calcinosis, osteochondromatosis, myositis
Most soft tissue masses are benign
Estimated 100:1 benign:malignant
Risk of malignancy rises with age
7/29/2019 Kuliah Blok Neoplasma_januari 2011
20/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
21/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
22/161
MRI Best for Staging
Global overview of relationships
Lesion characterisation
Lesion extent
Detection of contrast enhancement
Blood supply, tissue necrosis
Suspicious components
7/29/2019 Kuliah Blok Neoplasma_januari 2011
23/161
Benign Masses
Sebaceous cyst
Intramuscular
lipoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
24/161
ST Calcinosis
7/29/2019 Kuliah Blok Neoplasma_januari 2011
25/161
Elbow Ganglion Cyst
Palpable Cystic
Mass
7/29/2019 Kuliah Blok Neoplasma_januari 2011
26/161
MFH
Solid indeterminate mass
7/29/2019 Kuliah Blok Neoplasma_januari 2011
27/161
Soft Tissue Chondrosarcoma
High signal heterogeneous mass with internal septations and
marked rim enhancement (MRI)
7/29/2019 Kuliah Blok Neoplasma_januari 2011
28/161
Conclusions
Imaging is not histology
Clinical evaluation critical
X-rays ALWAYS first
Ultrasound second
MRI next
Imaging classification before surgery
7/29/2019 Kuliah Blok Neoplasma_januari 2011
29/161
Bone Neoplasms
7/29/2019 Kuliah Blok Neoplasma_januari 2011
30/161
Diagnostic Algorithm for Bone Tumours
Bone Lesion X-Ray
Manage
&
Review
Yes
No
Benign?No
Malignant?
MRI or CT
??
Diagnostic
BIOPSY
Staging
Path-Rad Correlation
Variant?
Yes
7/29/2019 Kuliah Blok Neoplasma_januari 2011
31/161
Diagnostic Gamut
Developmental
Dysplastic/dystrophic
Traumatic
Metabolic
Infective
Ischaemic necrosis
Tumour-like conditions
Tumours
7/29/2019 Kuliah Blok Neoplasma_januari 2011
32/161
Why X-Rays?
Mandatory for MSK lesions
New bone formation
Periosteal reaction
Bone expansion & growthLesion boundaries
Host marginal reaction
Patterns of destruction Still the most specific imaging modality for
most bone lesions
7/29/2019 Kuliah Blok Neoplasma_januari 2011
33/161
Age at Diagnosis
Age Tumo urs
111 NNNeeeuuurrrooobbblllaaassstttooommmaaa
111111000 EEEwwwiiinnnggg sssaaarrrcccooommmaaa (((tttuuubbbuuulllaaarrr)))
111000333000 OOOsssttteeeooosssaaarrrcccooommmaaa,,, EEEwwwiiinnnggg (((ffflllaaattt )))
333000
444000 NNNHHHLLL,,, MMMFFFHHH,,, fffiiibbbrrrooosssaaarrrcccooommmaaa,,, GGGCCCTTT,,, pppaaarrrooosssttteeeaaalllooosssttteeeooosssaaarrrcccooommmaaa
444000+++ MMMeeetttaaassstttaaasssiiisss,,, mmmyyyeeelllooommmaaa,,, ccchhhooonnndddrrrooosssaaarrrcccooommmaaa
7/29/2019 Kuliah Blok Neoplasma_januari 2011
34/161
X-Ray Features
Pattern of bone destruction or sclerosis
Internal architecture & density
Expansion, endosteal scalloping
Periosteal reaction & new bone
formation
Soft tissue mass
7/29/2019 Kuliah Blok Neoplasma_januari 2011
35/161
X-ray Aggressive Features
Bone destruction
Geographic
Moth-eaten
Permeative
Interrupted periosteal reaction
7/29/2019 Kuliah Blok Neoplasma_januari 2011
36/161
X-ray Benign Features
Elongated growth pattern
Narrow zone of transition
Sclerotic margin
Dense focal sclerosis
Dense incorporated solid periosteal
reaction
RCC M t t i
7/29/2019 Kuliah Blok Neoplasma_januari 2011
37/161
RCC Metastasis
Ewings Sarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
38/161
Ewing s Sarcoma
Osteosarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
39/161
Osteosarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
40/161
Diaphyseal Aclasia
Nonossifying Fibroma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
41/161
Nonossifying Fibroma
TUMORS AND TUMORLIKE
7/29/2019 Kuliah Blok Neoplasma_januari 2011
42/161
TUMORS AND TUMORLIKE
PROCESSES
1.METASTATIC BONE TUMORS
2.PRIMARY MALIGNANT BONE TUMOR
Multiple myeloma
Osteosarcoma
Ewings Sarcoma
3.PRIMARY QUASIMALIGNANT BONETUMOR
Giant Cell Tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
43/161
4.PRIMARY BENIGN BONE TUMORS
Osteochondroma
Osteoma
Bone island Osteoid osteoma
Simple bone cyst
Aneurysmal bone cyst
Metastatic Bone Tumors
7/29/2019 Kuliah Blok Neoplasma_januari 2011
44/161
Metastatic Bone Tumors
General Consideration
The most common malignant tumors
CNS tumors and basal cell Ca rarely
Life threatening complication
Insidence
70% are metastatic, 30% are primary
In females 70% from breast Ca
In males 60% from prostate Ca
Metastatic.. (contd)
7/29/2019 Kuliah Blok Neoplasma_januari 2011
45/161
Metastatic.. (cont d)
Radiologic Features
Technetium bone scan
80% of all metastase are located in the
central or axial skeleton
- Spine and Pelvis being a most commonAlteration in bone density and architecture
75% osteolytic, moth eaten or permeative
15% osteoblasticPeriosteal respose is rare
Metastatic bone tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
46/161
Metastatic bone tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
47/161
Prostatic Metastases
Multiple myeloma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
48/161
p y
Primary bone tumor
Bone scan are cold
Gross Osteoporosis may be the only early
sign
Punched out lesions
Preservation of pedicles
Multiple Myeloma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
49/161
p y
7/29/2019 Kuliah Blok Neoplasma_januari 2011
50/161
Osteosarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
51/161
Ewings Sarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
52/161
g
Most cases occur in the 1025 age rangeMay mimic infection
Diaphyseal permeative lesion
Femur, tibia and fibulaOnion skinperiosteal response
Most common primary malignant bone
tumor to metastasize to bone
Ewings Sarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
53/161
onion-skin
Ewing s Sarcoma
Osteochondroma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
54/161
Aneurysmal Bone Cyst
7/29/2019 Kuliah Blok Neoplasma_januari 2011
55/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
56/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
57/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
58/161
Respiratory Neoplasm
Pleural tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
59/161
Pleural tumor
Benign
Lipoma
- Fibroma
- Angioma
Malignant
- Mesothelioma
- Sarcoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
60/161
Mesothelioma
* From the endothelial pleural layer
* 2 type: - Nodular : > often
- Diffuse haemorrhagic effusion
Metastase :
From bronchogenic Ca (40%)From Mammae Ca (20%)
From Lymphosarcoma (10%)
Mesothelioma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
61/161
Pulmonary Carcinomaa. Bronchogenic Ca
7/29/2019 Kuliah Blok Neoplasma_januari 2011
62/161
a. Bronchogenic Ca- Most common
- Male > Female- Right > often
- Age : 5060 y.o.
- Related : Smoking, radioactive/industry material,TBC
- Classified into :
a. Central type
b. Perifer nodularc. Pneumonic type
d. Miliary type
BronchogenicCa
7/29/2019 Kuliah Blok Neoplasma_januari 2011
63/161
A Posteroanterior (PA) chest radiograph demonstrates a spiculated
right upper lobe mass.
B Chest CT (lung window) demonstrates a peripheral mass with spiculated
borders
b. Pancoasts tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
64/161
b. Pancoast s tumor
Posterior superior pulmonary sulcus tumor
Posterior costae 1- 3 destruction with
vertebral erosion
Cervicalis symphatis paralysis Horner
syndrome
Pancoasts tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
65/161
3 Alveolar cell ca
7/29/2019 Kuliah Blok Neoplasma_januari 2011
66/161
3. Alveolar cell ca
= Pulmonary adenomatosis
Female = Male
40 years
Ro:
Small nodules on both lung field with large masses
in right pulmonary base
No visible node enlargement but shows nodal
consolidation in perihiler Pleura ussualy not affected
Heart normal
7/29/2019 Kuliah Blok Neoplasma_januari 2011
67/161
4. Hamartoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
68/161
. a a to aOvergrowth of few tissue such as smooth
muscle fibrous cartilage tissue and vascular
Ro :
Round/oval/lobulated shadow with soft
tissue density, well-defined border, diameter
2.59 cm.
Calsification inside : pop corncalcification
Hamartoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
69/161
Metastastic tumor in lung
7/29/2019 Kuliah Blok Neoplasma_januari 2011
70/161
Emboli through pulmonaryartery &bronchial artery
From adjacent organ:
Oesophagus
Thyroid
Mammae
7/29/2019 Kuliah Blok Neoplasma_januari 2011
71/161
Metastase intrapulmonal
7/29/2019 Kuliah Blok Neoplasma_januari 2011
72/161
c. Milliary type
7/29/2019 Kuliah Blok Neoplasma_januari 2011
73/161
Thyroid Ca
Mammae CaSarcoma
Lung Ca
d. Pleural metastase : Pleura effusion
Mammae Ca
MesotheliomaLung Ca
e. Pneumonic type
7/29/2019 Kuliah Blok Neoplasma_januari 2011
74/161
Oesophagus
Lung
Mammae
f. Lymphatic type
Lung
Gaster
Mammae
Pancreas, etc.
Lymphatic type:Coarse reticular shadowing
7/29/2019 Kuliah Blok Neoplasma_januari 2011
75/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
76/161
GIT Diagnostic Tools:
7/29/2019 Kuliah Blok Neoplasma_januari 2011
77/161
Sialografi
Esophagograhi
Maagduodenographi
Colon in loop
Barium Follow Through CT Scan, MRI
7/29/2019 Kuliah Blok Neoplasma_januari 2011
78/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
79/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
80/161
Single Contrast Barium EnemaDouble Contrast Barium Enema
Abdominal Imaging
7/29/2019 Kuliah Blok Neoplasma_januari 2011
81/161
g g
In the hollow organ segments of the GI tract, contrastimaging studies remain the cornerstone in characterizingthe tumor, but lack the ability to stage the tumor, either interms of depth of penetration through the wall or indefining regional nodal involvement.
CT Scan remains the most widely used for axial imaging
Magnetic resonance imaging has shown only limitedadvantage over CT
Ca oesophagus
7/29/2019 Kuliah Blok Neoplasma_januari 2011
82/161
Tumours of the stomach
7/29/2019 Kuliah Blok Neoplasma_januari 2011
83/161
Benign tumours of the stomach:- Adenoma
- Leiomyoma
- Lipoma
- Abberant pancreas- Inflammatory polyps, etc
Location:
- pyloric portion (75%)
- body (20%)
- fundus & cardia (5%)
Radiographic appearances:
7/29/2019 Kuliah Blok Neoplasma_januari 2011
84/161
g p pp
- A sharply circumscribed filling defect
projecting within the lumen
Malignant tumors of the stomach:
Gross morphologic types:- Ulcerative (28%)
- Fungating/polypod (22%)
- Spreading/infiltrating (13%)
- Remainder unclassifiable
Usual histologic pattern: well-differentiated adenoca
7/29/2019 Kuliah Blok Neoplasma_januari 2011
85/161
Usual histologic pattern: well differentiated adenoca
Location: pyloric & prepyloric regions
Radiographic appearances:
1. Irregular filling defect.2. Malignant ulcer within the filling defect.
3. A leather bottle type stomach suggesting scirrhous
ca.
7/29/2019 Kuliah Blok Neoplasma_januari 2011
86/161
Ulcerative gastricadenocarcinoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
87/161
Polypoid gastric
adenocarcinoma.
7/29/2019 Kuliah Blok Neoplasma_januari 2011
88/161
leather bottle type
scirrhous ca.
7/29/2019 Kuliah Blok Neoplasma_januari 2011
89/161
Ulcerating leiomyoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
90/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
91/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
92/161
Spot image of adenocarcinoma of the duodenum presenting
as a classic tight annular apple core lesion in the second part
of the duodenum
Peripapillary adenocarcinoma of duodenum
7/29/2019 Kuliah Blok Neoplasma_januari 2011
93/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
94/161
Ductal adenocarcinoma of the pancreatic head.
unenhanced scan (A), CT shows an enlargement
of the head,within
which a hypodense mass is recognizable after
contrast medium
(B). The tumor looks smaller in the venous phase
due to the peripheral
enhancement (C)
SMALL Bowel :
Benign tumors and malignant tumors,
7/29/2019 Kuliah Blok Neoplasma_januari 2011
95/161
Benign tumours:- Adenoma
- Leiomyoma (the commonest)
Malignant tumours:
- Lymphoma (the commonest)
- Leiomyosarcoma- Carcinoid
- Metastases (malignant melanoma & bronchial ca)
Malignant lymphoma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
96/161
Colorectal tumors
Polyps:
A l l ti
7/29/2019 Kuliah Blok Neoplasma_januari 2011
97/161
- A mucosal elevation
- Radiographic appearance:
* Bowler-hat sign
* En face: target sign
Colorectal cancer:
- The commonest cancers in western Europe & US
- Men = women
- Tumours tend to be right-sided- May be associated urinary tract & gynaecological
malignancy
Colorectal cancer
7/29/2019 Kuliah Blok Neoplasma_januari 2011
98/161
Virtual Endoscopy, using CT Scan
7/29/2019 Kuliah Blok Neoplasma_januari 2011
99/161
Colorectal cancer
Fungating type:
7/29/2019 Kuliah Blok Neoplasma_januari 2011
100/161
u g g ype:
- Medullary carcinoma
- Sites: caecum, ascending colon, rectum
- Complication: bleeding, fistula
Polypoid type:
- Sites: ascending colon usually
- Complication: Intussusception
Annular type:
7/29/2019 Kuliah Blok Neoplasma_januari 2011
101/161
- Mucoid adenocarcinoma, scirrhousfibrocarcinoma
- Sites: sigmoid, descending colon, flexures
- Complication: fistula, obstruction
Radiological appearances:
- Filling defect
- Obstruction
7/29/2019 Kuliah Blok Neoplasma_januari 2011
102/161
Polip colon
7/29/2019 Kuliah Blok Neoplasma_januari 2011
103/161
Liver malignancy
7/29/2019 Kuliah Blok Neoplasma_januari 2011
104/161
CT Scan
USG
7/29/2019 Kuliah Blok Neoplasma_januari 2011
105/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
106/161
Cranial Neoplasm
INTRACRANIAL MASSES
7/29/2019 Kuliah Blok Neoplasma_januari 2011
107/161
1. Radiografic Characteristic of Lesion
a. Intrinsic CT density
b. Contrast enhancement BBB(ring, gyriform, homogenous)
c. Multiple lesions
d. MR appearance
DD/ : Intracranial Mass
(TEACH )
7/29/2019 Kuliah Blok Neoplasma_januari 2011
108/161
( )
Tumor
EdemaAbcess, AVM, aneurysm
Cyst
Hematoma
A. Primary Tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
109/161
1. Glioma
a. Astrocytoma
b. Ependymoma
c. Oligodendrogliomad. Ganglioglioma
2. Meningioma
3. Lymphoma
B. Metastatic Tumor
7/29/2019 Kuliah Blok Neoplasma_januari 2011
110/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
111/161
DIFFERENTIAL DIAGNOSIS BYLOCATION
Diagnosa banding berdasarkan pola
7/29/2019 Kuliah Blok Neoplasma_januari 2011
112/161
Enhancement lesi pada parenkim otakA. Cerebral parenchymal lesion
Ring : - Glioma
- Meta- Abcess
- Resolving hematoma
- Resolving infarctionHomogenous :
- Lymphoma
B.DD/ :
Intraventicular
7/29/2019 Kuliah Blok Neoplasma_januari 2011
113/161
Mass Lesion
Meningioma, Astrocytoma,
Choroid plexus papilloma,
Colloid cyst, Meta,
Ependymoma,
Subependymoma, AVM, Oligo,
Lymphoma
C.DD/: PinealRegion Mass
Germ cell tumor,
7/29/2019 Kuliah Blok Neoplasma_januari 2011
114/161
,
Pineal cell tumor
Germinoma,
Pineoblastoma,
Teratoma, Glial cell
tumor, Dermoid,
Epidermoid,
Choriocarcinoma,Meta
D.DD/Tumor di daerah Juxta Sellar and
Supra Sellar
7/29/2019 Kuliah Blok Neoplasma_januari 2011
115/161
Adenoma
CraniopharyngiomaAneurysm
Meningioma
Uncommon : Meta, Arachnoid
cyst, Glioma
7/29/2019 Kuliah Blok Neoplasma_januari 2011
116/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
117/161
Breast Neoplasm
7/29/2019 Kuliah Blok Neoplasma_januari 2011
118/161
Mamografi
USG
MRI
7/29/2019 Kuliah Blok Neoplasma_januari 2011
119/161
BIRADS Classification &Risk of CA Category 0, 4 & 5
7/29/2019 Kuliah Blok Neoplasma_januari 2011
120/161
Positive findings needing further action (10-80%
chance of cancer)
Category 1 & 2
Benign with
7/29/2019 Kuliah Blok Neoplasma_januari 2011
121/161
p g y
Palpable lesion, atypical FA, complex cyst etc.
Benign biopsy expected = discharge or short-term FU
4BIntermediate suspicion
Lesion with suspicious features
Benign biopsy = close correlation, ?re-biopsy
4CModerate suspicion
Not classic for CA Prominent suspicious features
Benign biopsy not expected = should re-biopsy or excise
BIRADS 3 & ScreeningAssessment BIRADS 3 is refuge for indecision
7/29/2019 Kuliah Blok Neoplasma_januari 2011
122/161
Intended for highly likely to be benign, but I am justmaking sure
Appropriate in setting with no biopsy facilities
Implemented by 6-12 month followup
BIRADS 3 has wide variability of application
Depends on individual level of uncertainty
UK and Australian practice
No place in formal assessment centre
Logistic problems, great anxiety, low yield
Determine if benign (Cat 1, 2) or needs biopsy (Cat 4, 5)
Cat 3 actively discouraged
MAMMOGRAPHY
7/29/2019 Kuliah Blok Neoplasma_januari 2011
123/161
X R d i d h
7/29/2019 Kuliah Blok Neoplasma_januari 2011
124/161
X-Ray dosis rendah Massa < 5 mm
Massa tidak teraba
Tanda keganasan
Check-up post operasi
Tidak invasif
Indikasi:B j l
7/29/2019 Kuliah Blok Neoplasma_januari 2011
125/161
Benjolan
Rasa tidak enak pada mammae
Keluarnya cairan dari puting susu
Kelainan kulit mammae
Cancer Phobia
Post operasi
Skrining
Mengapa Skrining Harus Dilakukan ?
C
i 35 th
7/29/2019 Kuliah Blok Neoplasma_januari 2011
126/161
Ca mammae > usia 35 th
Kapan Skrining Diperlukan?
Usia 35 th Usia 3550 th 2 atau 3 th Usia > 50 th Setiap tahun
7/29/2019 Kuliah Blok Neoplasma_januari 2011
127/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
128/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
129/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
130/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
131/161
Kriter ia Keganasan
7/29/2019 Kuliah Blok Neoplasma_januari 2011
132/161
Tanda Primer:
Lesi Radioopak irreguler
Mikrokalsifikasi
Tanda Sekunder:
P b l & t k i k lit
7/29/2019 Kuliah Blok Neoplasma_januari 2011
133/161
Penebalan & retraksi kulit
Vaskularisasi
Posisi papila & areola berubah
Jar. fibroglandular tidak teratur
Distorsi lemak retromammae
Metastasis KGB aksila
Mammogram
Batas tegasBatas tegas/
Irregular
Densitas lemak?
7/29/2019 Kuliah Blok Neoplasma_januari 2011
134/161
Densitas lemak?
Ya Tidak
Lipoma, fat necrosisHamartoma
Galactocele, LNUSG
Anechoic kompleks
Solid
Kista Hematoma, Papillary
Tumor
Fibroadenoma
Phyllodes tumor
Abscess
Hematoma
Fat necrosis
Scleroing adenosis
Radial scarPost surgical scar
Batas tegas? Ya
Densitas lemak ? Tidak
USG? Anechoic
7/29/2019 Kuliah Blok Neoplasma_januari 2011
135/161
Kista
Fibroadenoma
Batas tegas? Ya
Densitas lemak ? Tidak
7/29/2019 Kuliah Blok Neoplasma_januari 2011
136/161
Densitas lemak ? Tidak
USG? Hipoechoic
7/29/2019 Kuliah Blok Neoplasma_januari 2011
137/161
Vascular calcification
7/29/2019 Kuliah Blok Neoplasma_januari 2011
138/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
139/161
Rim calcification Lucent calcificationDermal calcification
7/29/2019 Kuliah Blok Neoplasma_januari 2011
140/161
Dermal calcification
7/29/2019 Kuliah Blok Neoplasma_januari 2011
141/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
142/161
ULTRASONOGRAPHY
7/29/2019 Kuliah Blok Neoplasma_januari 2011
143/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
144/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
145/161
Gambaran USG lesi payudara
7/29/2019 Kuliah Blok Neoplasma_januari 2011
146/161
Gambaran USG lesi payudara
Tanda pr imer :
Batas Bentuk
Pola ekho
Bayangan retro tumor
Tanda Sekunder
Penebalan kulit
7/29/2019 Kuliah Blok Neoplasma_januari 2011
147/161
e eb u
Perubahan jaringan
Kekakuan Lig. Cooperi
Tes Dinamik
Efek kompresi
Mobilitas
7/29/2019 Kuliah Blok Neoplasma_januari 2011
148/161
Arah scanningUSG payudara
7/29/2019 Kuliah Blok Neoplasma_januari 2011
149/161
TECHNIQUE
7/29/2019 Kuliah Blok Neoplasma_januari 2011
150/161
USG Colour Doppler nilai vaskularisasitumor payudara.
L i
7/29/2019 Kuliah Blok Neoplasma_januari 2011
151/161
Lesi ganas =
feeding vessel
pembuluh darah bagian perifer lesi
tumourvessel
pembuluh darah yang terletak didalam lesi payudara
7/29/2019 Kuliah Blok Neoplasma_januari 2011
152/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
153/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
154/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
155/161
Malignant Lesion
7/29/2019 Kuliah Blok Neoplasma_januari 2011
156/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
157/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
158/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
159/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
160/161
7/29/2019 Kuliah Blok Neoplasma_januari 2011
161/161