Abstract From February 2014 to November 2014 inclusive, (200) patients presented for breast imaging and of these, (100) formed the study group , All patients in the study group were imaged with breast ultrasound. There was inclusive and exclusive data due to the lack of required information. The appearance of specific types of breast carcinoma has been studied. Although appearances vary greatly, some patterns are typical,, Mucin-containing carcinomas are often circumscribed but may have irregular margins. These lesions may be either hypoechoic or isoechoic relative to subcutaneous fat. Statistical measures of accuracy, sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) were calculated using 2x2 contingency tables. The ultrasound examinations were performed by Toshiba Xario (Toshiba Corporation, Tokyo, Japan) and sono scape . The ultrasound scan was performed in a radial pattern, beginning at the periphery of the breast and moving inward. Each quadrant was scanned with overlap at the 12-, 3-, 6- and 9-o’clock positions followed by three scanning in orthogonal planes to complete the assessment. Imaging of each axilla was deemed an essential part of the ultrasound. Malignant lesions had a mean size of (4.35) mm (SD .37) . most of the patients was from various Sudan states (about 90%), while 10 was from Khartoum city that mean place may considered as risk factor. Age risk factor at the range of classes (40- 49).most of the patients was a housekeeper that mean the job is not considered as a risk factor. V The prevalence of cancer in the screened population was 56% of patients. The statistical measures of accurac, sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) were calculated. Malignant lesions were detected in each patient group at the rate of 43% 89%, 84%, 87% and 86% respectively. In this study, breast ultrasound significantly increases the cancer detection rate and should be considered as an important in the patient with positive imaging findings. Ultrasonography has been playing an increasingly important role in the evaluation of breast cancer as well as evaluation of many abnormalities seen on mammograms. US is also useful in the guidance of biopsies and therapeutic procedures.

Table of contents

Title Page No.

 I االية

Dedication II

Acknowledgment III

Abstract(English) IV

Abstract (Arabic) VI

Table of Contents VIII

List of Tables XII

List of Figure XIII

List of abbreviation XIV

Chapter One

Introduction

1.1.Introduction 1

1.2. Statement of the problem 3

1.3. Objectives of the study 3

1.4.Overview of the study 5

1.5.Breast caner overview 5

1.5.1. Signs and symptoms of breast cancer 5

1.5.2.Diagnosis 6

1.5.3 Background 7

1.5.4 Pathophysiology 8

1.5.5 Etiology 10

1.5.6 Age and gender 10

IX

1.5.7 Family history of breast cancer 10

1.5.8 Reproductive factors and steroid hormones 12

1.5.9 Prior breast health history 15

1.5.10 Lifestyle risk factors 16

1.5.11 Obesity 16

1.5.12 Environmental risk factors 17

1.5.13.Age-related demographics 20

1.5.14.Histopathology 21

1.5.14.Grade 21

1.5.15.Stage 21

1.5.16.Receptor status 22

1.5.17.DNA assays 23

1.5.18.Tumor Size and Staging 23

1.6.Where in the body does breast cancer usually spread? 25

Chapter Two

Section one

Ultrasound characteristic of the lesion

2.1. Breast ultrasound (Theoretical Baground ) 30

2.2.Malignant breast lesions 32

2.3.Ultrasound characteristic of the lesion 32

2.3.1. Shape and margin of the lesion 37

2.3.2.Width-AP dimension ratio 38

2.3.3 Echogenicity 38

2.3.4.Internal Echo pattern 38

X

2.3.5.Shadowing 38

2.3.6.Calcifications 38

2.3.7.Duct Extension 39

Section two:

Literature review

2.4 Anatomy of the breast 40

2.4.1. Anatomy of the breast Vascular Anatomy and

Innervation of the Breast

40

2.4.2. Breast Parenchyma and Support Structures 41

2.4.3. Musculature Related to the Breast 42

2.4.3.1. Pectoralis major 42

2.4.3.2. Seriates anterior 43

2.4.3.3. Rectus abdominis 43

2.4.3.4. External oblique 44

2.4.4 Lymphatic drainage of the breast 44

2.4.5 . Hormones of the breast 46

2.5 Literature studies 47

Chapter three

Material & method

3.1: Introduction 50

3.2. The study design & the study duration 50

3.3. The patient population 51

3.4. Ultrasound imaging method 51

3.5.Statistical analysis 52

XI

Chapter four

Results

4.1 Introduction 54

4.2 Lesions classification &types 54

4.3. Patient age 55

4.4.Lesion sizes 56

4.5.lymph node involvement 57

Chapter five

 Discussion

Discussion 61

Conclusion 65

Recommendations 66

References 67