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PHN LO畉I ACR BI-RADS速 TRONG SIU M TUY畉N V Bs. NGUY畛N QUANG TR畛NG website: www.vietnamultrasound.vn H畛i ngh畛 Si棚u 但m Ton qu畛c l畉n th畛 nh畉t. Thnh ph畛 Hu畉, 06-07/01/2017 Breast Imaging Reporting And Data System (BI-RADS) H畛 th畛ng d畛 li畛u v b叩o c叩o k畉t qu畉 h狸nh 畉nh tuy畉n v炭 1992, 1993, 1995, 1998, 2003, 2013 American College of Radiology - ACR "People only see what they are prepared to see." Ralph Waldo Emerson
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
T畛NG QUAN ACR BI-RADS速 藤畛c h狸nh thnh 畛: Chu畉n h坦a b叩o c叩o k畉t qu畉. Gi畉m thi畛u nh畉m l畉n trong vi畛c 畛c k畉t qu畉 h狸nh 畉nh tuy畉n v炭 v h藤畛ng x畛 tr鱈. T狸m ti畉ng n坦i chung gi畛a c叩c Bs ch畉n o叩n h狸nh 畉nh, c叩c Bs l但m sng v c叩c Bs ph畉u thu畉t (th畛ng nh畉t h藤畛ng x畛 tr鱈, i畛u tr畛 v theo d探i). ACR BI-RADS速 畉n b畉n l畉n th畛 nh畉t: ch畛 c坦 Nh滴 畉nh. ACR BI-RADS速 畉n b畉n l畉n th畛 nm: Nh滴 畉nh, Si棚u 但m, C畛ng h藤畛ng t畛. 4 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 6 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 7 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
K畛 THU畉T 1. 畉u d嘆 ph畉ng: t畉n s畛 trung t但m t畛i thi畛u l 10 MHz, t畉n s畛 cao nh畉t t畛i thi畛u l 12MHz. 8 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 9 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
K畛 THU畉T 2. Tr藤畛ng nh狸n (FOV): c畉n ph畉i l畉y 畛 s但u v畛a 畛 (m担 v炭, c董 ng畛c; kh担ng l畉y mng ph畛i, ph畛i). 10 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. T藤 th畉 b畛nh nh但n th鱈ch h畛p 藤畛c thay 畛i sao cho m担 v炭 藤畛c tr畉i m畛ng v ph畉ng khi kh畉o s叩t si棚u 但m. hinhanhykhoa.com
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 11 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
K畛 THU畉T 3. V湛ng tr畛ng t但m (focus zone): Khi 叩nh gi叩 m畛t t畛n th藤董ng, focus c畉n 藤畛c 畉t 畛 trung t但m c畛a t畛n th動董ng. N畉u t畉p trung kh畉o s叩t t畛n th藤董ng, 01 focus ho畉c vi focus c坦 th畛 畉t t畉i v湛ng gi畛a c畛a t畛n th動董ng (n畉u s畛 d畛ng > 03 focus, t畛c 畛 khung h狸nh tr棚n gi但y s畉 gi畉m 叩ng k畛, h狸nh 畉nh si棚u 但m s畉 kh担ng c嘆n real- time). 12 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 13 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
K畛 THU畉T 4. Gain en - tr畉ng (2D): N畉u gain ch畛nh qu叩 cao: nang c坦 th畛 l畉m l n畛t 畉c. N畉u gain ch畛nh qu叩 th畉p: n畛t h畛i 但m r畉t k辿m c坦 th畛 l畉m l nang 董n thu畉n. Ch畛nh chu畉n: m担 m畛 d動畛i da c畉n ph畉i x叩m v畛a, kh担ng 動畛c en. 14 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 15 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
K畛 THU畉T 5. S畛 d畛ng 畉u d嘆 c坦 ch湛m tia a h藤畛ng: gi畉m nhi畛u, c畉i thi畛n 畛 ph但n gi畉i c畛a h狸nh. * Mode hi h嘆a m担 (RSNA 2016): c畉i thi畛n 畛 ph但n gi畉i kh担ng gian, 畛 t藤董ng ph畉n c畛a t畛n th藤董ng, gi畉m x畉o 畉nh (x畉o 畉nh ph畉n chi畉u t畛 thnh nang), v狸 th畉 叩nh gi叩 t畛t h董n s畛 thay 畛i h狸nh 畉nh ph鱈a sau t畛n th藤董ng. 16 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. hinhanhykhoa.com
K畛 THU畉T 17 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. Ch湛m tia 董n h動畛ng Ch湛m tia a h動畛ng
K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 18 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
K畛 THU畉T 6. Doppler mu: Kh担ng 竪 辿p: M畉ch m叩u nh畛 b畛 竪 x畉p. T畉n s畛 l畉p l畉i xung th畉p: 500 1000 Hz (0.5 1kHz) (thang v畉n t畛c mu:2 - 5 cm/s). Mode: Doppler nng l藤畛ng nh畉y h董n cho d嘆ng ch畉y ch畉m nh藤ng c滴ng nh畉y h董n v畛i x畉o 畉nh. Gi畉i ph叩p: Doppler nng l藤畛ng c坦 畛nh h藤畛ng. 19 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
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N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t) B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 22 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t) B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 23 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t): 1. C畉u tr炭c h畛i 但m n畛n 畛ng nh畉t m畛. 2. C畉u tr炭c h畛i 但m n畛n 畛ng nh畉t s畛i tuy畉n. 3. C畉u tr炭c h畛i 但m n畛n kh担ng 畛ng nh畉t. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 25 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
B. Kh畛i (mass): 1. H狸nh d叩ng: a. B畉u d畛c; b. Tr嘆n; c. Kh担ng 畛u. THU畉T NG畛 M T畉 SIU M V (2013) Debra M. Ikeda. Breast Imaging The Requisites. 2nd Edition. Elsevier Mosby. 2011 H狸nh d叩ng tr嘆n l h狸nh c畉u, gi畛ng qu畉 banh, 鱈t g畉p nh藤ng c坦 t畉n su畉t 叩c t鱈nh cao (60%100%). Sughra Raza et al. US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management. RadioGraphics 2010; 30:11991213 Intra-ductal papilloma B藤畛u v炭 叩c t鱈nh c坦 h狸nh tr嘆n th藤畛ng g畉p nh畉t l Ung th藤 畛ng tuy畉n x但m l畉n. N坦 l d畉ng hi畉m g畉p c畛a m畛t lo畉i ung th藤 r畉t th藤畛ng g畉p. hinhanhykhoa.com
B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
THU畉T NG畛 M T畉 SIU M V (2013) B動畛u s畛i tuy畉n ph叩t tri畛n t畛 trong 董n v畛 畛ng t畉n ti畛u th湛y, theo h藤畛ng vu担ng g坦c v畛i tr畛c d畛c c畛a 董n v畛 畛ng t畉n ti畛u th湛y (terminal ductolobular unit TDLU). A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. b動畛u s畛i tuy畉n TDLU B. Kh畛i: 2. Chi畛u h藤畛ng: a. Song song; b. Kh担ng song song. Carcinoma ph叩t tri畛n t畛 cu畛ng c畛a 董n v畛 畛ng t畉n ti畛u th湛y TDLU, song song theo h藤畛ng tr畛c d畛c c畛a 董n v畛 畛ng t畉n ti畛u th湛y TDLU. Parallel Not parallel hinhanhykhoa.com
B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
B. Kh畛i: 3. 藤畛ng b畛: a. R探; b. Kh担ng r探 (M畛 nh嘆e; G畉p g坦c; a cung nh畛; T畛a gai). THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
B. Kh畛i: 4. H畛i 但m: a. Tr畛ng; b. K辿m; c. Nang ph畛c t畉p c坦 thnh ph畉n 畉c; d. K辿m; e. 畛ng h畛i 但m; f. Kh担ng 畛ng nh畉t. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Nang ph畛c t畉p c坦 thnh ph畉n 畉c 藤畛c xem l nghi ng畛 v畛a ph但n lo畉i 4B intra-cystic papillary carcinoma. hinhanhykhoa.com
PHN LO畉I BERGS BI-RADS T畛N TH蕩NG D畉NG NANG A.Athanasiou et al. Complex cystic breast masses in ultrasound examination. Diagnostic and Interventional Imaging (2014) 95, 169179. Wendie A. Berg et al. Cystic Breast Masses and the ACRIN 6666 Experience. Radiol Clin North Am. 2010 September ; 48(5): 931987. 36% 叩c t鱈nh 0.42% 叩c t鱈nh BI-RADS 2 BI-RADS 4 Ch湛m nang nh畛 (clustered microcysts) BI-RADS 3 00% 叩c t鱈nh
B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
B. Kh畛i: 5. 畉c t鱈nh ph鱈a sau: a. Kh担ng thay 畛i; b. Tng 但m; c. T畉o b坦ng l藤ng; d. Ki畛u h畛n h畛p. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Vi畛n h畛i 但m dy th藤畛ng k畉t h畛p v畛i h狸nh 畉nh T畉o b坦ng l藤ng.
THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 38 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
C. V担i h坦a: 1. V担i h坦a trong b動畛u. A. Thomas Stavros, 2004. V担i h坦a trong n畛t 畉c (畛 nh畉y, 40%; gi叩 tr畛 ti棚n o叩n d動董ng, 53%). Eun-Kyung Kim et al, 2008. C叩c d畉u hi畛u ch鱈nh c畛a 叩c t鱈nh: 1. H狸nh d叩ng kh担ng 畛u; 2. B畛 t畛a gai; 3. Vi v担i h坦a. 2. V担i h坦a ngoi b藤畛u. 3. V担i h坦a trong 畛ng tuy畉n (畉u d嘆 c坦 畛 ph但n gi畉i cao). THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 40 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
D. H狸nh 畉nh k畉t h畛p: 1. Xo畉n v畉n c畉u tr炭c (ph但n bi畛t v畛i s畉o). 2. Thay 畛i 畛ng tuy畉n (b狸nh th藤畛ng kh畉u k鱈nh nh畛 h董n t畛 n畛n n炭m v炭 so v畛i trong nhu m担). 3. Thay 畛i da: a. Dy da (> 2 mm); b. Co r炭t da (l探m m畉t da). 4. Ph湛. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
5. T藤畛i m叩u: a. Kh担ng t藤畛i m叩u; b. T藤畛i m叩u trong t畛n th藤董ng; c. T藤畛i m叩u r狸a t畛n th藤董ng (kh担ng s畛 d畛ng h狸nh 畉nh t藤畛i m叩u nh藤 ti棚u chu畉n duy nh畉t trong vi畛c 畛c k畉t qu畉. B藤畛u 叩c t鱈nh c坦 th畛 kh担ng giu t藤畛i m叩u. Ng藤畛c l畉i, t畛n th藤董ng lnh t鱈nh c坦 th畛 giu t藤畛i m叩u (papillomas, vi棚m nhi畛m). THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Ki畛u h狸nh lnh t鱈nh Ki畛u h狸nh 叩c t鱈nh hinhanhykhoa.com
THU畉T NG畛 M T畉 SIU M V (2013) RI ch畛 s畛 kh叩ng > 0.83 g畛i 箪 叩c t鱈nh (畛 nh畉y 75%, 畛 chuy棚n bi畛t 97%). PI ch畛 s畛 畉p > 1.6 g畛i 箪 叩c t鱈nh (畛 nh畉y 70%, 畛 chuy棚n bi畛t 98%). Mehri Sirous et al. Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses. Journal of Research in Medical Sciences. February 2015 5. T藤畛i m叩u: ACR ch藤a 藤a ra ti棚u chu畉n cho Doppler xung. * Ti li畛u tham kh畉o.
6. 叩nh gi叩 畛 c畛ng: a. M畛m; b. Trung gian; c. C畛ng (FDA g畉n 但y ch畉p thu畉n 董n v畛 o m/s v kPa 畛 o 畛 c畛ng c畛a t畛n th藤董ng v畛i shear-wave elastography). * ACR ch動a 畛ng thu畉n v畛 gi叩 tr畛 ng動畛ng 畛 叩p d畛ng trong ch畉n o叩n ph但n bi畛t gi畛a b動畛u lnh v b動畛u 叩c. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. C畉n ph畉i nh畉n m畉nh r畉ng c叩c ti棚u chu畉n si棚u 但m 2D nh動 h狸nh d叩ng, 動畛ng b畛, v 畛 h畛i 但m c坦 gi叩 tr畛 ti棚n o叩n 叩c t鱈nh h董n l 畛 c畛ng m畛m c畛a t畛n th藤董ng. hinhanhykhoa.com
Richard G. Barr. Breast Elastography. 2015 by Thieme Medical Publishers, Inc. T坦m t畉t k畉t qu畉 t畛 nh畛ng nghi棚n c畛u 達 藤畛c xu畉t b畉n v畛 n h畛i 畛nh t鱈nh v n h畛i 畛nh l動畛ng k竪m theo l nh畛ng ch畛 s畛 gi炭p ph但n lo畉i Breast ImagingReporting and Data system (BI-RADS) 畛 叩nh gi叩 kh畉 nng 叩c t鱈nh c畛a t畛n th藤董ng. - El/B = E/B ratio: t畛 s畛 動畛ng k鱈nh t畛n th動董ng tr棚n n h畛i / 動畛ng k鱈nh t畛n th動董ng tr棚n B mode. - Strain Ratio: t畛 s畛 t畛n th動董ng / m担 m畛. BI-RADS BIRADS 4: - 畛nh t鱈nh: El/B = 1, SR = 2.8 - 4.5. - 畛nh l藤畛ng: 4.5 5.2 m/s; 60 80 kPa. BIRADS 5: - 畛nh t鱈nh: El/B > 1, SR > 4.5. - 畛nh l藤畛ng: > 5.2 m/s; > 80 kPa. *Ti li畛u tham kh畉o. - El/B = 1: Tsukuba score 4. - El/B > 1: Tsukuba score 5.
THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 46 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t: 1. Nang 董n thu畉n. 2. Ch湛m nang nh畛. 3. Nang bi畉n ch畛ng. 4. B藤畛u tr棚n ho畉c trong da. 5. D畛 v畉t bao g畛m t炭i ng畛c. 6. H畉ch trong tuy畉n v炭. 7. H畉ch n叩ch. 8. B畉t th藤畛ng m畉ch m叩u: a. AVMs (d畛 d畉ng 畛ng-t挑nh m畉ch/ gi畉 ph狸nh m畉ch); b畛nh Mondor (huy畉t kh畛i t挑nh m畉ch ng畛c b棚n n担ng). 9. T畛 d畛ch sau ph畉u thu畉t. 10. Ho畉i t畛 m畛. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
1. Ch畛 畛nh. 2. K畛 thu畉t. 3. Thnh ph畉n m担 v炭 (dnh cho t畉m so叩t). 4. M担 t畉 r探 rng (炭ng thu畉t ng畛) nh畛ng b畉t th藤畛ng. 5. So s叩nh v畛i nh畛ng kh叩m nghi畛m tr藤畛c (kh叩m l但m sng, Nh滴 畉nh, C畛ng h藤畛ng t畛). 6. T畛ng h畛p b叩o c叩o. 7. 叩nh gi叩. 8. H藤畛ng x畛 tr鱈. BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
Ph但n lo畉i 0: Kh担ng hon ton. Ph但n lo畉i 1: m t鱈nh (0% 叩c t鱈nh). Ph但n lo畉i 2: Lnh t鱈nh (0% 叩c t鱈nh). Gi畛i h畉n r探, h狸nh b畉u d畛c, h藤畛ng song song, h畛i 但m dy (so v畛i m担 m畛). Nang 董n gi畉n. Ph但n lo畉i 3: Kh畉 nng lnh t鱈nh ( 2% 叩c t鱈nh). Gi畛i h畉n r探, h狸nh b畉u d畛c, h藤畛ng song song, h畛i 但m k辿m (so v畛i m担 m畛). Ch湛m nang nh畛, nang bi畉n ch畛ng, (v畛i h畛i 但m m畉t k鱈nh m畛 畛ng nh畉t, v叩ch ngn m畛ng). BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. BI-RADS 3 (kh畉 nng lnh t鱈nh) Si棚u 但m l畉i vo th畛i i畛m 6, 12, 24 th叩ng sau: - N畉u 畛n 畛nh: kh担ng thay 畛i v畛 k鱈ch th動畛c, h狸nh d叩ng, 動畛ng b畛 v h畛i 但m BIRADS 2 (lnh t鱈nh). - N畉u thay 畛i: k鱈ch th動畛c (tng > 20% 動畛ng k鱈nh sau 6 th叩ng) v /ho畉c thay 畛i c叩c 畉c t鱈nh v畛 h狸nh d叩ng, 動畛ng b畛 ho畉c h畛i 但m BIRADS 4 Ch畉n o叩n t畉 bo. hinhanhykhoa.com
Ph但n lo畉i 4 (4A, 4B, 4C): T畛n th藤董ng nghi ng畛 (2-95% 叩c t鱈nh) Ch畉n o叩n t畉 bo. ACR ch藤a 藤a ra ti棚u chu畉n c畛 th畛. Ph但n lo畉i 5: T畛n th藤董ng r畉t nghi ng畛 ( 95% 叩c t鱈nh) Ch畉n o叩n t畉 bo. ACR ch藤a 藤a ra ti棚u chu畉n c畛 th畛. BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Cho 畉n th畛i i畛m hi畛n t畉i, ch動a c坦 ti棚u chu畉n 畉y 畛 c畛a ACR BI-RADS速 Si棚u 但m t畛 ph但n lo畉i 0 畉n 6!.
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
LM SAO 畛 PHN LO畉I? A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. CC D畉U HI畛U LNH TNH 1. H畛i 但m dy (so v畛i m畛). 2. Chi畛u ngang l畛n h董n chi畛u cao (h藤畛ng song song). 3. B畛 a cung l畛n ( 3 cung). 4. V畛 bao m畛ng, hon ton.
LM SAO 畛 PHN LO畉I? A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. 畛 NH畉Y V GI TR畛 TIN ON D蕩NG V畛I C TNH 1. T畉o b坦ng l藤ng ph鱈a sau (畛 nh畉y, 16%; gi叩 tr畛 ti棚n o叩n d藤董ng, 69%). 2a. B畛 t畛a gai (畛 nh畉y, 36%; gi叩 tr畛 ti棚n o叩n d藤董ng, 87%). 2b. B畛 g畉p g坦c (畛 nh畉y, 90%; gi叩 tr畛 ti棚n o叩n d藤董ng, 59%). 2c. B畛 a cung nh畛 (畛 nh畉y, 92%; gi叩 tr畛 ti棚n o叩n d藤董ng, 50%). 3. Vi畛n h畛i 但m dy (畛 nh畉y, 35%; gi叩 tr畛 ti棚n o叩n d藤董ng, 74%). 4. H畛i 但m r畉t k辿m (畛 nh畉y, 49%; gi叩 tr畛 ti棚n o叩n d藤董ng, 64%. 5. Cao l畛n h董n r畛ng (畛 nh畉y, 48%; gi叩 tr畛 ti棚n o叩n d藤董ng, 74%). - 15 mm: 畛 nh畉y, 63%; gi叩 tr畛 ti棚n o叩n d藤董ng, 82%. - > 15 mm: 畛 nh畉y, 35%; gi叩 tr畛 ti棚n o叩n d藤董ng, 88%. 6a. Lan trn theo 畛ng tuy畉n (畛 nh畉y, 49%; gi叩 tr畛 ti棚n o叩n d藤董ng, 46%). 6b. Lan trn theo ph但n nh叩nh (sen, 44%; gi叩 tr畛 ti棚n o叩n d藤董ng, 60%. 7. V担i h坦a trong t畛n th藤董ng (sen, 40%; gi叩 tr畛 ti棚n o叩n d藤董ng, 53%). hinhanhykhoa.com
LM SAO 畛 PHN LO畉I? D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ti棚n o叩n 叩c t鱈nh c坦 gi叩 tr畛 cao bao g畛m b畛 t畛a gai (86%), h狸nh d叩ng kh担ng 畛u (62%), v h藤畛ng kh担ng song song (69%). D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ti棚n o叩n lnh t鱈nh c坦 gi叩 tr畛 cao bao g畛m gi畛i h畉n r探 (90%), h藤畛ng song song (78%), v h狸nh b畉u d畛c (84%). Andrea S. Hong et al. BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features. AJR 2005;184:12601265. (403 lesions)
LM SAO 畛 PHN LO畉I? Eun-Kyung Kim et al. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008; 190:12091215. (403 cases) Kim et al (2008). D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ch鱈nh c畛a 叩c t鱈nh bao g畛m h狸nh d叩ng kh担ng 畛u, b畛 t畛a gai, v vi v担i h坦a. (4,668 cases, 421 cases failed) Hong et al (2005). D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ti棚n o叩n 叩c t鱈nh c坦 gi叩 tr畛 cao bao g畛m b畛 t畛a gai (86%), h狸nh d叩ng kh担ng 畛u (62%), v h藤畛ng kh担ng song song (69%). hinhanhykhoa.com
LM SAO 畛 PHN LO畉I? Nouf Abdullah et al. Breast Imaging Reporting and Data System Lexicon for US: Interobserver Agreement for Assessment of Breast Masses. Radiology: Volume 252: Number 3September 2009 Vi畛c ph但n lo畉i chi ti畉t 4a, 4b, v 4c l kh担ng kh畉 thi, ph畉n 叩nh vi畛c thi畉u nh畛ng y畉u t畛 r探 rng v kh叩ch quan 畛 h藤畛ng d畉n vi畛c ph但n lo畉i t畛n th藤董ng theo m畛c 畛 nghi ng畛 叩c t鱈nh. (BI-RADS 4: 3% - 94% 叩c t鱈nh!)
LM SAO 畛 PHN LO畉I? Eun-Kyung Kim et al. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008; 190:12091215. D畉u hi畛u ch鱈nh g畛i 箪 叩c t鱈nh: 1. h狸nh d叩ng kh担ng 畛u; 2. b畛 t畛a gai; 3. vi v担i h坦a. D畉u hi畛u ph畛 g畛i 箪 叩c t鱈nh: 1. h狸nh d叩ng tr嘆n; 2. b畛 a cung nh畛, b畛 kh担ng r探 v b畛 g畉p g坦c; 3. h藤畛ng kh担ng song song; 4. h畛i 但m kh担ng 畛ng nh畉t; 5. t畉o b坦ng l藤ng ph鱈a sau; 6. lan trn theo 畛ng tuy畉n. D畉u hi畛u c畛ng th棚m (US lexicon 2013): 1. t藤畛i m叩u trong t畛n th藤董ng v 2. 畛 n h畛i c畛ng. PHN LO畉I Kims BI-RADS SIU M 2008 BI-RADS 1: B狸nh th藤畛ng. BI-RADS 2: T畛n th藤董ng lnh t鱈nh (n畛t h畛i 但m dy, h狸nh b畉u d畛c, h藤畛ng song song, nang 董n gi畉n). BI-RADS 3: Kh畉 nng lnh t鱈nh (n畛t h畛i 但m k辿m, h狸nh b畉u d畛c, h藤畛ng song song, nang bi畉n ch畛ng, ch湛m nang nh畛). BI-RADS 4: 1 d畉u hi畛u nghi ng畛 叩c t鱈nh. BI-RADS 5: 2 d畉u hi畛u ch鱈nh nghi ng畛 叩c t鱈nh. BI-RADS 6: 達 c坦 b畉ng ch畛ng gi畉i ph畉u b畛nh l 叩c t鱈nh. Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
11 January 2017 62 BI-RADS 2 hinhanhykhoa.com
63 BI-RADS 3
64 Microlobulated BI-RADS 4 hinhanhykhoa.com
11 January 2017 65 Thick echogenic halo Not parallel (taller than wide) Irregular shape Spiculated margin BI-RADS 5
11 January 2017 66 Thick echogenic halo Posterior Shadowing Indistinct BI-RADS 5 hinhanhykhoa.com
67 Indistinct Calcifications inside the mass BI-RADS 5
Micro-calcifications inside the lesion? Irregular shape BI-RADS 5 Heterogeneous hinhanhykhoa.com
Strain Elastography: BGR artifact Cyst!
11-Jan-17 70 Peau dorange with nipple retraction inflammatory carcinoma hinhanhykhoa.com
11 January 2017 71 Spiculated margin Microcalcifications Marked hypoechoic Irregular shape Internal vascularity
11 January 2017 72 Thick echogenic halo Not parallel (taller than wide) Angular margin BI-RADS 5 hinhanhykhoa.com
11 January 2017 73 Strain Elastography (+)
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
T畛NG K NH畛NG D畉U HI畛U SIU M G畛I C TNH 1. H狸nh d叩ng (shape): - Kh担ng 畛u (irregular). - Tr嘆n (round). 2. Chi畛u h藤畛ng (orientation): Kh担ng song song (not parallel). 3. 藤畛ng b畛 (margins): - T畛a gai (spiculated). - Kh担ng r探 (indistinct). - G畉p g坦c (angular). - a cung nh畛 (microlobulated). 4. Gi畛i h畉n t畛n th藤董ng: Gi畛i h畉n c坦 vi畛n h畛i 但m dy (echogenic halo). 5. C畉u tr炭c h畛i 但m (echo pattern): - H畛i 但m r畉t k辿m. (marked hypoechoic). - H畛i 但m kh担ng 畛ng nh畉t (heterogeneous). 6. Thay 畛i 但m ph鱈a sau: T畉o b坦ng l藤ng ph鱈a sau (shadowing). 7. V担i h坦a: - V担i h坦a trong b藤畛u (vi v担i h坦a - microcalcifications). - V担i h坦a trong 畛ng tuy畉n (intra-ductal calcifications). 8. Si棚u 但m Doppler: - T藤畛i m叩u trong b藤畛u (internal vascularity). - RI > 0.83, PI > 1.6 (ch藤a 畛ng thu畉n). 9. H畉ch di cn (ch藤a c坦 s畛 担ng thu畉n v畛 ti棚u chu畉n 叩nh gi叩). - 藤畛ng k鱈nh ng畉n > 1 cm. - Dy v畛 h畉ch > 3 mm. - M畉t r畛n h畉ch. -T藤畛i m叩u ngoi r畛n h畉ch. - B畛 a cung. 10. Si棚u 但m n h畛i m担 (ch藤a 畛ng thu畉n v畛 gi叩 tr畛 ng藤畛ng). BI-RADS 4: - 畛nh t鱈nh: E/B = 1, SR = 2.8 - 4.5. - 畛nh l藤畛ng: 4.5 5.2 m/s; 60 80 kPa. BI-RADS 5: - 畛nh t鱈nh: E/B > 1, SR > 4.5. - 畛nh l藤畛ng: > 5.2 m/s; > 80 kPa. PHN LO畉I Kims BI-RADS SIU M 2008 BI-RADS 1: B狸nh th藤畛ng. BI-RADS 2: T畛n th藤董ng lnh t鱈nh (n畛t h畛i 但m dy, h狸nh b畉u d畛c, h藤畛ng song song, nang 董n gi畉n). BI-RADS 3: Kh畉 nng lnh t鱈nh (n畛t h畛i 但m k辿m, h狸nh b畉u d畛c, h藤畛ng song song, nang bi畉n ch畛ng, ch湛m nang nh畛). BI-RADS 4: 1 d畉u hi畛u nghi ng畛 叩c t鱈nh. BI-RADS 5: 2 d畉u hi畛u ch鱈nh nghi ng畛 叩c t鱈nh. BI-RADS 6: 達 c坦 b畉ng ch畛ng gi畉i ph畉u b畛nh l 叩c t鱈nh.
N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
Ch動a c坦 ti棚u chu畉n 畉y 畛 c畛a ACR BI-RADS 速 Si棚u 但m t畛 ph但n lo畉i 0 畉n 6!. Ph但n lo畉i Kims BI-RADS 2008 Si棚u 但m l m畛t ti li畛u tham kh畉o h畛u 鱈ch. - Si棚u 但m 2D v畉n 坦ng vai tr嘆 thi畉t y畉u. - C畉n b畛 sung th棚m b畉ng c叩c d畉u hi畛u th畉y 動畛c tr棚n Si棚u 但m Doppler v Si棚u 但m n h畛i m担 (ch動a c坦 s畛 畛ng thu畉n v畛 gi叩 tr畛 ng動畛ng). 叩nh gi叩 cu畛i c湛ng s畛 d畛ng ph但n lo畉i ACR BI-RADS速 Si棚u 但m ph但n lo畉i t畛 0 畉n 6. K畉T LU畉N Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Debra M. Ikeda. Breast Imaging The Requisites. 2nd Edition. Elsevier Mosby. 2011 Sughra Raza et al. US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management. RadioGraphics 2010; 30:11991213 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. Wendie A. Berg et al. Cystic Breast Masses and the ACRIN 6666 Experience. Radiol Clin North Am. 2010 September ; 48(5): 931987. A.Athanasiou et al. Complex cystic breast masses in ultrasound examination. Diagnostic and Interventional Imaging (2014) 95, 169179. Mehri Sirous et al. Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses. Journal of Research in Medical Sciences. February 2015 Richard G. Barr. Breast Elastography. 2015 by Thieme Medical Publishers, Inc. Andrea S. Hong et al. BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features. AJR 2005;184:12601265. Eun-Kyung Kim et al. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008; 190:12091215. Nouf Abdullah et al. Breast Imaging Reporting and Data System Lexicon for US: Interobserver Agreement for Assessment of Breast Masses. Radiology: Volume 252: Number 3September 2009 TI LI畛U THAM KH畉O hinhanhykhoa.com
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  • 1. PHN LO畉I ACR BI-RADS速 TRONG SIU M TUY畉N V Bs. NGUY畛N QUANG TR畛NG website: www.vietnamultrasound.vn H畛i ngh畛 Si棚u 但m Ton qu畛c l畉n th畛 nh畉t. Thnh ph畛 Hu畉, 06-07/01/2017 Breast Imaging Reporting And Data System (BI-RADS) H畛 th畛ng d畛 li畛u v b叩o c叩o k畉t qu畉 h狸nh 畉nh tuy畉n v炭 1992, 1993, 1995, 1998, 2003, 2013 American College of Radiology - ACR "People only see what they are prepared to see." Ralph Waldo Emerson
  • 2. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
  • 3. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
  • 4. T畛NG QUAN ACR BI-RADS速 藤畛c h狸nh thnh 畛: Chu畉n h坦a b叩o c叩o k畉t qu畉. Gi畉m thi畛u nh畉m l畉n trong vi畛c 畛c k畉t qu畉 h狸nh 畉nh tuy畉n v炭 v h藤畛ng x畛 tr鱈. T狸m ti畉ng n坦i chung gi畛a c叩c Bs ch畉n o叩n h狸nh 畉nh, c叩c Bs l但m sng v c叩c Bs ph畉u thu畉t (th畛ng nh畉t h藤畛ng x畛 tr鱈, i畛u tr畛 v theo d探i). ACR BI-RADS速 畉n b畉n l畉n th畛 nh畉t: ch畛 c坦 Nh滴 畉nh. ACR BI-RADS速 畉n b畉n l畉n th畛 nm: Nh滴 畉nh, Si棚u 但m, C畛ng h藤畛ng t畛. 4 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 5. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
  • 6. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 6 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 7. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 7 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 8. K畛 THU畉T 1. 畉u d嘆 ph畉ng: t畉n s畛 trung t但m t畛i thi畛u l 10 MHz, t畉n s畛 cao nh畉t t畛i thi畛u l 12MHz. 8 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 9. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 9 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 10. K畛 THU畉T 2. Tr藤畛ng nh狸n (FOV): c畉n ph畉i l畉y 畛 s但u v畛a 畛 (m担 v炭, c董 ng畛c; kh担ng l畉y mng ph畛i, ph畛i). 10 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. T藤 th畉 b畛nh nh但n th鱈ch h畛p 藤畛c thay 畛i sao cho m担 v炭 藤畛c tr畉i m畛ng v ph畉ng khi kh畉o s叩t si棚u 但m. hinhanhykhoa.com
  • 11. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 11 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 12. K畛 THU畉T 3. V湛ng tr畛ng t但m (focus zone): Khi 叩nh gi叩 m畛t t畛n th藤董ng, focus c畉n 藤畛c 畉t 畛 trung t但m c畛a t畛n th動董ng. N畉u t畉p trung kh畉o s叩t t畛n th藤董ng, 01 focus ho畉c vi focus c坦 th畛 畉t t畉i v湛ng gi畛a c畛a t畛n th動董ng (n畉u s畛 d畛ng > 03 focus, t畛c 畛 khung h狸nh tr棚n gi但y s畉 gi畉m 叩ng k畛, h狸nh 畉nh si棚u 但m s畉 kh担ng c嘆n real- time). 12 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 13. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 13 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 14. K畛 THU畉T 4. Gain en - tr畉ng (2D): N畉u gain ch畛nh qu叩 cao: nang c坦 th畛 l畉m l n畛t 畉c. N畉u gain ch畛nh qu叩 th畉p: n畛t h畛i 但m r畉t k辿m c坦 th畛 l畉m l nang 董n thu畉n. Ch畛nh chu畉n: m担 m畛 d動畛i da c畉n ph畉i x叩m v畛a, kh担ng 動畛c en. 14 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 15. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 15 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 16. K畛 THU畉T 5. S畛 d畛ng 畉u d嘆 c坦 ch湛m tia a h藤畛ng: gi畉m nhi畛u, c畉i thi畛n 畛 ph但n gi畉i c畛a h狸nh. * Mode hi h嘆a m担 (RSNA 2016): c畉i thi畛n 畛 ph但n gi畉i kh担ng gian, 畛 t藤董ng ph畉n c畛a t畛n th藤董ng, gi畉m x畉o 畉nh (x畉o 畉nh ph畉n chi畉u t畛 thnh nang), v狸 th畉 叩nh gi叩 t畛t h董n s畛 thay 畛i h狸nh 畉nh ph鱈a sau t畛n th藤董ng. 16 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. hinhanhykhoa.com
  • 17. K畛 THU畉T 17 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. Ch湛m tia 董n h動畛ng Ch湛m tia a h動畛ng
  • 18. K畛 THU畉T ACR BI-RADS速 SIU M - 2013: CH畉T L蕩畛NG HNH 畉NH (t畛 畉n b畉n l畉n th畛 5). Khuy畉n c叩o c畛a ACR h動畛ng d畉n th畛c hnh si棚u 但m tuy畉n v炭 (2011). 1. 畉u d嘆. 2. Tr藤畛ng nh狸n. 3. V湛ng tr畛ng t但m. 4. Gain en tr畉ng. 5. Ch湛m tia a h藤畛ng. 6. Doppler mu. 18 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 19. K畛 THU畉T 6. Doppler mu: Kh担ng 竪 辿p: M畉ch m叩u nh畛 b畛 竪 x畉p. T畉n s畛 l畉p l畉i xung th畉p: 500 1000 Hz (0.5 1kHz) (thang v畉n t畛c mu:2 - 5 cm/s). Mode: Doppler nng l藤畛ng nh畉y h董n cho d嘆ng ch畉y ch畉m nh藤ng c滴ng nh畉y h董n v畛i x畉o 畉nh. Gi畉i ph叩p: Doppler nng l藤畛ng c坦 畛nh h藤畛ng. 19 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 21. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
  • 22. THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t) B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 22 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 23. THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t) B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 23 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 24. A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t): 1. C畉u tr炭c h畛i 但m n畛n 畛ng nh畉t m畛. 2. C畉u tr炭c h畛i 但m n畛n 畛ng nh畉t s畛i tuy畉n. 3. C畉u tr炭c h畛i 但m n畛n kh担ng 畛ng nh畉t. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 25. THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 25 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 26. B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 27. B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 28. B. Kh畛i (mass): 1. H狸nh d叩ng: a. B畉u d畛c; b. Tr嘆n; c. Kh担ng 畛u. THU畉T NG畛 M T畉 SIU M V (2013) Debra M. Ikeda. Breast Imaging The Requisites. 2nd Edition. Elsevier Mosby. 2011 H狸nh d叩ng tr嘆n l h狸nh c畉u, gi畛ng qu畉 banh, 鱈t g畉p nh藤ng c坦 t畉n su畉t 叩c t鱈nh cao (60%100%). Sughra Raza et al. US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management. RadioGraphics 2010; 30:11991213 Intra-ductal papilloma B藤畛u v炭 叩c t鱈nh c坦 h狸nh tr嘆n th藤畛ng g畉p nh畉t l Ung th藤 畛ng tuy畉n x但m l畉n. N坦 l d畉ng hi畉m g畉p c畛a m畛t lo畉i ung th藤 r畉t th藤畛ng g畉p. hinhanhykhoa.com
  • 29. B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 30. THU畉T NG畛 M T畉 SIU M V (2013) B動畛u s畛i tuy畉n ph叩t tri畛n t畛 trong 董n v畛 畛ng t畉n ti畛u th湛y, theo h藤畛ng vu担ng g坦c v畛i tr畛c d畛c c畛a 董n v畛 畛ng t畉n ti畛u th湛y (terminal ductolobular unit TDLU). A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. b動畛u s畛i tuy畉n TDLU B. Kh畛i: 2. Chi畛u h藤畛ng: a. Song song; b. Kh担ng song song. Carcinoma ph叩t tri畛n t畛 cu畛ng c畛a 董n v畛 畛ng t畉n ti畛u th湛y TDLU, song song theo h藤畛ng tr畛c d畛c c畛a 董n v畛 畛ng t畉n ti畛u th湛y TDLU. Parallel Not parallel hinhanhykhoa.com
  • 31. B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 32. B. Kh畛i: 3. 藤畛ng b畛: a. R探; b. Kh担ng r探 (M畛 nh嘆e; G畉p g坦c; a cung nh畛; T畛a gai). THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 33. B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 34. B. Kh畛i: 4. H畛i 但m: a. Tr畛ng; b. K辿m; c. Nang ph畛c t畉p c坦 thnh ph畉n 畉c; d. K辿m; e. 畛ng h畛i 但m; f. Kh担ng 畛ng nh畉t. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Nang ph畛c t畉p c坦 thnh ph畉n 畉c 藤畛c xem l nghi ng畛 v畛a ph但n lo畉i 4B intra-cystic papillary carcinoma. hinhanhykhoa.com
  • 35. PHN LO畉I BERGS BI-RADS T畛N TH蕩NG D畉NG NANG A.Athanasiou et al. Complex cystic breast masses in ultrasound examination. Diagnostic and Interventional Imaging (2014) 95, 169179. Wendie A. Berg et al. Cystic Breast Masses and the ACRIN 6666 Experience. Radiol Clin North Am. 2010 September ; 48(5): 931987. 36% 叩c t鱈nh 0.42% 叩c t鱈nh BI-RADS 2 BI-RADS 4 Ch湛m nang nh畛 (clustered microcysts) BI-RADS 3 00% 叩c t鱈nh
  • 36. B. Kh畛i: 1. H狸nh d叩ng. 2. Chi畛u h藤畛ng. 3. 藤畛ng b畛. 4. C畉u tr炭c h畛i 但m. 5. 畉c t鱈nh ph鱈a sau. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 37. B. Kh畛i: 5. 畉c t鱈nh ph鱈a sau: a. Kh担ng thay 畛i; b. Tng 但m; c. T畉o b坦ng l藤ng; d. Ki畛u h畛n h畛p. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Vi畛n h畛i 但m dy th藤畛ng k畉t h畛p v畛i h狸nh 畉nh T畉o b坦ng l藤ng.
  • 38. THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 38 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 39. C. V担i h坦a: 1. V担i h坦a trong b動畛u. A. Thomas Stavros, 2004. V担i h坦a trong n畛t 畉c (畛 nh畉y, 40%; gi叩 tr畛 ti棚n o叩n d動董ng, 53%). Eun-Kyung Kim et al, 2008. C叩c d畉u hi畛u ch鱈nh c畛a 叩c t鱈nh: 1. H狸nh d叩ng kh担ng 畛u; 2. B畛 t畛a gai; 3. Vi v担i h坦a. 2. V担i h坦a ngoi b藤畛u. 3. V担i h坦a trong 畛ng tuy畉n (畉u d嘆 c坦 畛 ph但n gi畉i cao). THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 40. THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 40 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 41. D. H狸nh 畉nh k畉t h畛p: 1. Xo畉n v畉n c畉u tr炭c (ph但n bi畛t v畛i s畉o). 2. Thay 畛i 畛ng tuy畉n (b狸nh th藤畛ng kh畉u k鱈nh nh畛 h董n t畛 n畛n n炭m v炭 so v畛i trong nhu m担). 3. Thay 畛i da: a. Dy da (> 2 mm); b. Co r炭t da (l探m m畉t da). 4. Ph湛. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 42. 5. T藤畛i m叩u: a. Kh担ng t藤畛i m叩u; b. T藤畛i m叩u trong t畛n th藤董ng; c. T藤畛i m叩u r狸a t畛n th藤董ng (kh担ng s畛 d畛ng h狸nh 畉nh t藤畛i m叩u nh藤 ti棚u chu畉n duy nh畉t trong vi畛c 畛c k畉t qu畉. B藤畛u 叩c t鱈nh c坦 th畛 kh担ng giu t藤畛i m叩u. Ng藤畛c l畉i, t畛n th藤董ng lnh t鱈nh c坦 th畛 giu t藤畛i m叩u (papillomas, vi棚m nhi畛m). THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Ki畛u h狸nh lnh t鱈nh Ki畛u h狸nh 叩c t鱈nh hinhanhykhoa.com
  • 43. THU畉T NG畛 M T畉 SIU M V (2013) RI ch畛 s畛 kh叩ng > 0.83 g畛i 箪 叩c t鱈nh (畛 nh畉y 75%, 畛 chuy棚n bi畛t 97%). PI ch畛 s畛 畉p > 1.6 g畛i 箪 叩c t鱈nh (畛 nh畉y 70%, 畛 chuy棚n bi畛t 98%). Mehri Sirous et al. Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses. Journal of Research in Medical Sciences. February 2015 5. T藤畛i m叩u: ACR ch藤a 藤a ra ti棚u chu畉n cho Doppler xung. * Ti li畛u tham kh畉o.
  • 44. 6. 叩nh gi叩 畛 c畛ng: a. M畛m; b. Trung gian; c. C畛ng (FDA g畉n 但y ch畉p thu畉n 董n v畛 o m/s v kPa 畛 o 畛 c畛ng c畛a t畛n th藤董ng v畛i shear-wave elastography). * ACR ch動a 畛ng thu畉n v畛 gi叩 tr畛 ng動畛ng 畛 叩p d畛ng trong ch畉n o叩n ph但n bi畛t gi畛a b動畛u lnh v b動畛u 叩c. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. C畉n ph畉i nh畉n m畉nh r畉ng c叩c ti棚u chu畉n si棚u 但m 2D nh動 h狸nh d叩ng, 動畛ng b畛, v 畛 h畛i 但m c坦 gi叩 tr畛 ti棚n o叩n 叩c t鱈nh h董n l 畛 c畛ng m畛m c畛a t畛n th藤董ng. hinhanhykhoa.com
  • 45. Richard G. Barr. Breast Elastography. 2015 by Thieme Medical Publishers, Inc. T坦m t畉t k畉t qu畉 t畛 nh畛ng nghi棚n c畛u 達 藤畛c xu畉t b畉n v畛 n h畛i 畛nh t鱈nh v n h畛i 畛nh l動畛ng k竪m theo l nh畛ng ch畛 s畛 gi炭p ph但n lo畉i Breast ImagingReporting and Data system (BI-RADS) 畛 叩nh gi叩 kh畉 nng 叩c t鱈nh c畛a t畛n th藤董ng. - El/B = E/B ratio: t畛 s畛 動畛ng k鱈nh t畛n th動董ng tr棚n n h畛i / 動畛ng k鱈nh t畛n th動董ng tr棚n B mode. - Strain Ratio: t畛 s畛 t畛n th動董ng / m担 m畛. BI-RADS BIRADS 4: - 畛nh t鱈nh: El/B = 1, SR = 2.8 - 4.5. - 畛nh l藤畛ng: 4.5 5.2 m/s; 60 80 kPa. BIRADS 5: - 畛nh t鱈nh: El/B > 1, SR > 4.5. - 畛nh l藤畛ng: > 5.2 m/s; > 80 kPa. *Ti li畛u tham kh畉o. - El/B = 1: Tsukuba score 4. - El/B > 1: Tsukuba score 5.
  • 46. THU畉T NG畛 M T畉 SIU M V (2013) Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013) (畉n b畉n l畉n th畛 5). A. Thnh ph畉n m担 (ch畛 d湛ng trong t畉m so叩t). B. Kh畛i C. V担i h坦a D. H狸nh 畉nh k畉t h畛p E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t 46 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 47. E. Nh畛ng tr藤畛ng h畛p 畉c bi畛t: 1. Nang 董n thu畉n. 2. Ch湛m nang nh畛. 3. Nang bi畉n ch畛ng. 4. B藤畛u tr棚n ho畉c trong da. 5. D畛 v畉t bao g畛m t炭i ng畛c. 6. H畉ch trong tuy畉n v炭. 7. H畉ch n叩ch. 8. B畉t th藤畛ng m畉ch m叩u: a. AVMs (d畛 d畉ng 畛ng-t挑nh m畉ch/ gi畉 ph狸nh m畉ch); b畛nh Mondor (huy畉t kh畛i t挑nh m畉ch ng畛c b棚n n担ng). 9. T畛 d畛ch sau ph畉u thu畉t. 10. Ho畉i t畛 m畛. THU畉T NG畛 M T畉 SIU M V (2013) Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 48. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
  • 49. 1. Ch畛 畛nh. 2. K畛 thu畉t. 3. Thnh ph畉n m担 v炭 (dnh cho t畉m so叩t). 4. M担 t畉 r探 rng (炭ng thu畉t ng畛) nh畛ng b畉t th藤畛ng. 5. So s叩nh v畛i nh畛ng kh叩m nghi畛m tr藤畛c (kh叩m l但m sng, Nh滴 畉nh, C畛ng h藤畛ng t畛). 6. T畛ng h畛p b叩o c叩o. 7. 叩nh gi叩. 8. H藤畛ng x畛 tr鱈. BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 50. BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 51. Ph但n lo畉i 0: Kh担ng hon ton. Ph但n lo畉i 1: m t鱈nh (0% 叩c t鱈nh). Ph但n lo畉i 2: Lnh t鱈nh (0% 叩c t鱈nh). Gi畛i h畉n r探, h狸nh b畉u d畛c, h藤畛ng song song, h畛i 但m dy (so v畛i m担 m畛). Nang 董n gi畉n. Ph但n lo畉i 3: Kh畉 nng lnh t鱈nh ( 2% 叩c t鱈nh). Gi畛i h畉n r探, h狸nh b畉u d畛c, h藤畛ng song song, h畛i 但m k辿m (so v畛i m担 m畛). Ch湛m nang nh畛, nang bi畉n ch畛ng, (v畛i h畛i 但m m畉t k鱈nh m畛 畛ng nh畉t, v叩ch ngn m畛ng). BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 52. BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. BI-RADS 3 (kh畉 nng lnh t鱈nh) Si棚u 但m l畉i vo th畛i i畛m 6, 12, 24 th叩ng sau: - N畉u 畛n 畛nh: kh担ng thay 畛i v畛 k鱈ch th動畛c, h狸nh d叩ng, 動畛ng b畛 v h畛i 但m BIRADS 2 (lnh t鱈nh). - N畉u thay 畛i: k鱈ch th動畛c (tng > 20% 動畛ng k鱈nh sau 6 th叩ng) v /ho畉c thay 畛i c叩c 畉c t鱈nh v畛 h狸nh d叩ng, 動畛ng b畛 ho畉c h畛i 但m BIRADS 4 Ch畉n o叩n t畉 bo. hinhanhykhoa.com
  • 53. Ph但n lo畉i 4 (4A, 4B, 4C): T畛n th藤董ng nghi ng畛 (2-95% 叩c t鱈nh) Ch畉n o叩n t畉 bo. ACR ch藤a 藤a ra ti棚u chu畉n c畛 th畛. Ph但n lo畉i 5: T畛n th藤董ng r畉t nghi ng畛 ( 95% 叩c t鱈nh) Ch畉n o叩n t畉 bo. ACR ch藤a 藤a ra ti棚u chu畉n c畛 th畛. BO CO K畉T QU畉 Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Cho 畉n th畛i i畛m hi畛n t畉i, ch動a c坦 ti棚u chu畉n 畉y 畛 c畛a ACR BI-RADS速 Si棚u 但m t畛 ph但n lo畉i 0 畉n 6!.
  • 54. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
  • 55. LM SAO 畛 PHN LO畉I? A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. CC D畉U HI畛U LNH TNH 1. H畛i 但m dy (so v畛i m畛). 2. Chi畛u ngang l畛n h董n chi畛u cao (h藤畛ng song song). 3. B畛 a cung l畛n ( 3 cung). 4. V畛 bao m畛ng, hon ton.
  • 56. LM SAO 畛 PHN LO畉I? A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. 畛 NH畉Y V GI TR畛 TIN ON D蕩NG V畛I C TNH 1. T畉o b坦ng l藤ng ph鱈a sau (畛 nh畉y, 16%; gi叩 tr畛 ti棚n o叩n d藤董ng, 69%). 2a. B畛 t畛a gai (畛 nh畉y, 36%; gi叩 tr畛 ti棚n o叩n d藤董ng, 87%). 2b. B畛 g畉p g坦c (畛 nh畉y, 90%; gi叩 tr畛 ti棚n o叩n d藤董ng, 59%). 2c. B畛 a cung nh畛 (畛 nh畉y, 92%; gi叩 tr畛 ti棚n o叩n d藤董ng, 50%). 3. Vi畛n h畛i 但m dy (畛 nh畉y, 35%; gi叩 tr畛 ti棚n o叩n d藤董ng, 74%). 4. H畛i 但m r畉t k辿m (畛 nh畉y, 49%; gi叩 tr畛 ti棚n o叩n d藤董ng, 64%. 5. Cao l畛n h董n r畛ng (畛 nh畉y, 48%; gi叩 tr畛 ti棚n o叩n d藤董ng, 74%). - 15 mm: 畛 nh畉y, 63%; gi叩 tr畛 ti棚n o叩n d藤董ng, 82%. - > 15 mm: 畛 nh畉y, 35%; gi叩 tr畛 ti棚n o叩n d藤董ng, 88%. 6a. Lan trn theo 畛ng tuy畉n (畛 nh畉y, 49%; gi叩 tr畛 ti棚n o叩n d藤董ng, 46%). 6b. Lan trn theo ph但n nh叩nh (sen, 44%; gi叩 tr畛 ti棚n o叩n d藤董ng, 60%. 7. V担i h坦a trong t畛n th藤董ng (sen, 40%; gi叩 tr畛 ti棚n o叩n d藤董ng, 53%). hinhanhykhoa.com
  • 57. LM SAO 畛 PHN LO畉I? D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ti棚n o叩n 叩c t鱈nh c坦 gi叩 tr畛 cao bao g畛m b畛 t畛a gai (86%), h狸nh d叩ng kh担ng 畛u (62%), v h藤畛ng kh担ng song song (69%). D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ti棚n o叩n lnh t鱈nh c坦 gi叩 tr畛 cao bao g畛m gi畛i h畉n r探 (90%), h藤畛ng song song (78%), v h狸nh b畉u d畛c (84%). Andrea S. Hong et al. BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features. AJR 2005;184:12601265. (403 lesions)
  • 58. LM SAO 畛 PHN LO畉I? Eun-Kyung Kim et al. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008; 190:12091215. (403 cases) Kim et al (2008). D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ch鱈nh c畛a 叩c t鱈nh bao g畛m h狸nh d叩ng kh担ng 畛u, b畛 t畛a gai, v vi v担i h坦a. (4,668 cases, 421 cases failed) Hong et al (2005). D畛a vo thu畉t ng畛 m担 t畉 BI-RADS (2003) nh畛ng d畉u hi畛u ti棚n o叩n 叩c t鱈nh c坦 gi叩 tr畛 cao bao g畛m b畛 t畛a gai (86%), h狸nh d叩ng kh担ng 畛u (62%), v h藤畛ng kh担ng song song (69%). hinhanhykhoa.com
  • 59. LM SAO 畛 PHN LO畉I? Nouf Abdullah et al. Breast Imaging Reporting and Data System Lexicon for US: Interobserver Agreement for Assessment of Breast Masses. Radiology: Volume 252: Number 3September 2009 Vi畛c ph但n lo畉i chi ti畉t 4a, 4b, v 4c l kh担ng kh畉 thi, ph畉n 叩nh vi畛c thi畉u nh畛ng y畉u t畛 r探 rng v kh叩ch quan 畛 h藤畛ng d畉n vi畛c ph但n lo畉i t畛n th藤董ng theo m畛c 畛 nghi ng畛 叩c t鱈nh. (BI-RADS 4: 3% - 94% 叩c t鱈nh!)
  • 60. LM SAO 畛 PHN LO畉I? Eun-Kyung Kim et al. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008; 190:12091215. D畉u hi畛u ch鱈nh g畛i 箪 叩c t鱈nh: 1. h狸nh d叩ng kh担ng 畛u; 2. b畛 t畛a gai; 3. vi v担i h坦a. D畉u hi畛u ph畛 g畛i 箪 叩c t鱈nh: 1. h狸nh d叩ng tr嘆n; 2. b畛 a cung nh畛, b畛 kh担ng r探 v b畛 g畉p g坦c; 3. h藤畛ng kh担ng song song; 4. h畛i 但m kh担ng 畛ng nh畉t; 5. t畉o b坦ng l藤ng ph鱈a sau; 6. lan trn theo 畛ng tuy畉n. D畉u hi畛u c畛ng th棚m (US lexicon 2013): 1. t藤畛i m叩u trong t畛n th藤董ng v 2. 畛 n h畛i c畛ng. PHN LO畉I Kims BI-RADS SIU M 2008 BI-RADS 1: B狸nh th藤畛ng. BI-RADS 2: T畛n th藤董ng lnh t鱈nh (n畛t h畛i 但m dy, h狸nh b畉u d畛c, h藤畛ng song song, nang 董n gi畉n). BI-RADS 3: Kh畉 nng lnh t鱈nh (n畛t h畛i 但m k辿m, h狸nh b畉u d畛c, h藤畛ng song song, nang bi畉n ch畛ng, ch湛m nang nh畛). BI-RADS 4: 1 d畉u hi畛u nghi ng畛 叩c t鱈nh. BI-RADS 5: 2 d畉u hi畛u ch鱈nh nghi ng畛 叩c t鱈nh. BI-RADS 6: 達 c坦 b畉ng ch畛ng gi畉i ph畉u b畛nh l 叩c t鱈nh. Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. hinhanhykhoa.com
  • 61. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n.
  • 62. 11 January 2017 62 BI-RADS 2 hinhanhykhoa.com
  • 65. 11 January 2017 65 Thick echogenic halo Not parallel (taller than wide) Irregular shape Spiculated margin BI-RADS 5
  • 66. 11 January 2017 66 Thick echogenic halo Posterior Shadowing Indistinct BI-RADS 5 hinhanhykhoa.com
  • 68. Micro-calcifications inside the lesion? Irregular shape BI-RADS 5 Heterogeneous hinhanhykhoa.com
  • 69. Strain Elastography: BGR artifact Cyst!
  • 70. 11-Jan-17 70 Peau dorange with nipple retraction inflammatory carcinoma hinhanhykhoa.com
  • 71. 11 January 2017 71 Spiculated margin Microcalcifications Marked hypoechoic Irregular shape Internal vascularity
  • 72. 11 January 2017 72 Thick echogenic halo Not parallel (taller than wide) Angular margin BI-RADS 5 hinhanhykhoa.com
  • 73. 11 January 2017 73 Strain Elastography (+)
  • 74. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
  • 75. T畛NG K NH畛NG D畉U HI畛U SIU M G畛I C TNH 1. H狸nh d叩ng (shape): - Kh担ng 畛u (irregular). - Tr嘆n (round). 2. Chi畛u h藤畛ng (orientation): Kh担ng song song (not parallel). 3. 藤畛ng b畛 (margins): - T畛a gai (spiculated). - Kh担ng r探 (indistinct). - G畉p g坦c (angular). - a cung nh畛 (microlobulated). 4. Gi畛i h畉n t畛n th藤董ng: Gi畛i h畉n c坦 vi畛n h畛i 但m dy (echogenic halo). 5. C畉u tr炭c h畛i 但m (echo pattern): - H畛i 但m r畉t k辿m. (marked hypoechoic). - H畛i 但m kh担ng 畛ng nh畉t (heterogeneous). 6. Thay 畛i 但m ph鱈a sau: T畉o b坦ng l藤ng ph鱈a sau (shadowing). 7. V担i h坦a: - V担i h坦a trong b藤畛u (vi v担i h坦a - microcalcifications). - V担i h坦a trong 畛ng tuy畉n (intra-ductal calcifications). 8. Si棚u 但m Doppler: - T藤畛i m叩u trong b藤畛u (internal vascularity). - RI > 0.83, PI > 1.6 (ch藤a 畛ng thu畉n). 9. H畉ch di cn (ch藤a c坦 s畛 担ng thu畉n v畛 ti棚u chu畉n 叩nh gi叩). - 藤畛ng k鱈nh ng畉n > 1 cm. - Dy v畛 h畉ch > 3 mm. - M畉t r畛n h畉ch. -T藤畛i m叩u ngoi r畛n h畉ch. - B畛 a cung. 10. Si棚u 但m n h畛i m担 (ch藤a 畛ng thu畉n v畛 gi叩 tr畛 ng藤畛ng). BI-RADS 4: - 畛nh t鱈nh: E/B = 1, SR = 2.8 - 4.5. - 畛nh l藤畛ng: 4.5 5.2 m/s; 60 80 kPa. BI-RADS 5: - 畛nh t鱈nh: E/B > 1, SR > 4.5. - 畛nh l藤畛ng: > 5.2 m/s; > 80 kPa. PHN LO畉I Kims BI-RADS SIU M 2008 BI-RADS 1: B狸nh th藤畛ng. BI-RADS 2: T畛n th藤董ng lnh t鱈nh (n畛t h畛i 但m dy, h狸nh b畉u d畛c, h藤畛ng song song, nang 董n gi畉n). BI-RADS 3: Kh畉 nng lnh t鱈nh (n畛t h畛i 但m k辿m, h狸nh b畉u d畛c, h藤畛ng song song, nang bi畉n ch畛ng, ch湛m nang nh畛). BI-RADS 4: 1 d畉u hi畛u nghi ng畛 叩c t鱈nh. BI-RADS 5: 2 d畉u hi畛u ch鱈nh nghi ng畛 叩c t鱈nh. BI-RADS 6: 達 c坦 b畉ng ch畛ng gi畉i ph畉u b畛nh l 叩c t鱈nh.
  • 76. N畛I DUNG T畛ng quan. Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (t畛 畉n b畉n l畉n th畛 4 - 2003). K畛 thu畉t chu畉n (t畛 畉n b畉n l畉n th畛 5 -2013). Thu畉t ng畛 m担 t畉 si棚u 但m v炭 (2013). N畛i dung b叩o c叩o k畉t qu畉. Lm sao 畛 ph但n lo畉i? M畛t s畛 tr藤畛ng h畛p minh h畛a. Nh畛ng g狸 b畉n c畉n nh畛. K畉t lu畉n. hinhanhykhoa.com
  • 77. Ch動a c坦 ti棚u chu畉n 畉y 畛 c畛a ACR BI-RADS 速 Si棚u 但m t畛 ph但n lo畉i 0 畉n 6!. Ph但n lo畉i Kims BI-RADS 2008 Si棚u 但m l m畛t ti li畛u tham kh畉o h畛u 鱈ch. - Si棚u 但m 2D v畉n 坦ng vai tr嘆 thi畉t y畉u. - C畉n b畛 sung th棚m b畉ng c叩c d畉u hi畛u th畉y 動畛c tr棚n Si棚u 但m Doppler v Si棚u 但m n h畛i m担 (ch動a c坦 s畛 畛ng thu畉n v畛 gi叩 tr畛 ng動畛ng). 叩nh gi叩 cu畛i c湛ng s畛 d畛ng ph但n lo畉i ACR BI-RADS速 Si棚u 但m ph但n lo畉i t畛 0 畉n 6. K畉T LU畉N Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013.
  • 78. Carl J. DOrsi, MD et al. ACR BI-RADS速 Atlas Breast Imaging Reporting and Data System. The 5th Edition. 2013. Debra M. Ikeda. Breast Imaging The Requisites. 2nd Edition. Elsevier Mosby. 2011 Sughra Raza et al. US of Breast Masses Categorized as BI-RADS 3, 4, and 5: Pictorial Review of Factors Influencing Clinical Management. RadioGraphics 2010; 30:11991213 A. Thomas Stavros. Breast Ultrasound. 1st Edition. 2004 Lippincott Williams & Wilkins. Wendie A. Berg et al. Cystic Breast Masses and the ACRIN 6666 Experience. Radiol Clin North Am. 2010 September ; 48(5): 931987. A.Athanasiou et al. Complex cystic breast masses in ultrasound examination. Diagnostic and Interventional Imaging (2014) 95, 169179. Mehri Sirous et al. Evaluation of different aspects of power Doppler sonography in differentiating and prognostication of breast masses. Journal of Research in Medical Sciences. February 2015 Richard G. Barr. Breast Elastography. 2015 by Thieme Medical Publishers, Inc. Andrea S. Hong et al. BI-RADS for Sonography: Positive and Negative Predictive Values of Sonographic Features. AJR 2005;184:12601265. Eun-Kyung Kim et al. Clinical Application of the BI-RADS Final Assessment to Breast Sonography in Conjunction with Mammography. AJR 2008; 190:12091215. Nouf Abdullah et al. Breast Imaging Reporting and Data System Lexicon for US: Interobserver Agreement for Assessment of Breast Masses. Radiology: Volume 252: Number 3September 2009 TI LI畛U THAM KH畉O hinhanhykhoa.com
  • 79. Knowledge is a treasure, but practice is the key to it. Lao Tzu