Shadowing Practice: Breast Ultrasound Normal Vs Abnormal Image Appearances Comparison | BI-RADS Classification USG - Learn English Speaking with YouTube
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hello everyone this is dr sam and today we will study breast ultrasound image appearances here we
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hello everyone this is dr sam and today we will study breast ultrasound image appearances here we
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have the images of normal breast the uppermost layer is the skin this is the hyperechoic
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layer and below that is the subcutaneous zone it is usually hypoechoic as compared to the tissues
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below and the largest region is the mammary zone it usually has mixed echogenicity most
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of the pathologies occur in this zone and this hyperechoic area is the fibro glandular tissue
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these hyperechoic slanted or diagonal lines are cooper ligaments this striated structure
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is the pectoral muscle the retro memory zone lies between the pectoral muscle and the memory zone
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usually it appears smaller because it is compressed due to probe pressure
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and this shadowing over here is due to the rib here we have more images of normal breast
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we can see the three zones and the fibro glandular tissue which is hyperechoic usually the
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retro memory zone is below this fibroglandular tissue but it is not always the case
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breast pathologies can be classified by using a system known as bi-rads
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it stands for breast imaging reporting and data system in total it has seven categories
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in bi-rads 0 we need further images we need more scans such as mammograms or ultrasound scans
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bi-rads 1 is for normal breast tissue where there is no mass or no distortion
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no lesion both these images are by reds one
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a simple cyst will appear as an anechoic structure with posterior enhancement the cyst will be round
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or ovoid with a smooth hyperechoic border it is classified as bi-rads 2 which is benign
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a complicated cyst will have fat fluid levels and internal echoes
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these are fat fluid levels the low density fluid is at the top and the high density fat
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is at the bottom now these cysts may resemble malignant lesions that is why a follow-up is needed examples of complicated cysts include oil cysts and galactocysts
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a fibroadenoma is a benign tumor which will appear as a hypoechoic round or ovoid mass
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it may have a hyperechoic rim known as a pseudo capsule and it has a parallel orientation it is
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wider than tall you can see it is wider instead of being taller this is a sign of benign lesion
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it is classified as bi-rads 2 which is benign however routine screening mammography should be
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done here we have another image of fibroadenoma it has a smooth border it may have calcifications
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you can see the pseudo capsule here and it has a parallel orientation it is wider than tall
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a lipoma will appear as a hyperechoic rounded mass usually hyperechoic rounded masses are benign it
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has a bi-rads score of two despite this appearance routine screening mammography should be done
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hyperechoic masses that are ovoid rounded or well circumscribed are usually benign another benign
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feature is the parallel orientation in which it is wider than tall examples include angio lipoma
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hemangioma hamartoma they usually appear as hyperechoic masses with a hyperechoic border
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here we have an image of intra memory lymph node they have a hypoechoic outer cortex
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this is the cortex and a hyperechoic central mediastinum
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which is hyperechoic usually due to fat they are classified as bi-rads 2
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a neurofibroma is a rare benign tumor
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which appears as a hypoechoic mass with posterior enhancement now it is very tricky because it resembles a cyst so it can be misdiagnosed very easily but it is a rare lesion
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a sebaceous cyst is a complex cyst which is present closer to the skin
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here you can see it is present just below the skin and it is even involving the skin so this superficial location can help us in diagnosing sebaceous cyst it is classified as bi-rads 2
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a simple cyst containing a small hyperechoic calculus
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is usually a milk of calcium cyst these cysts are also benign
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egg shell calcifications are small calcifications which may have shadowing if they are a bit dense
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they have a bi-rads score of two complex cysts are rated as bi-rads 3 because they need a follow-up exam usually thin hyperechoic septations
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are benign but they still need a follow-up so that is why it is rated as bi-rads 3
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clustered microcysts will have a group of cysts clustered together the diameter is less than three millimeters and septations may be present it is rated as bi-rads 3 because follow-up is required
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fat necrosis has a variety of appearances in the acute phase the lesion is new so it may appear as a hyperechoic lesion due to edema fat necrosis
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appearances overlap with malignant lesions so a follow-up is required so it is rated as bi-rads 3
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fat necrosis enters late stage after 1.5 years
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it will have calcified walls which give posterior acoustic shadowing
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now we move on to bi-rads categories which have chance of malignancy bi-rads 4 has 3 sub-categories
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in 4a the chance of malignancy is between 2 to 10 percent b is 10 to 49 and 4c is 50 to 94 percent
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bi-rads 5 has greater than 95 percent chance of malignancy
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and bi-rads 6 is a biopsy proven malignancy usually hypoechoic masses with irregular walls or a speculated appearance are malignant and they have a taller than wide orientation
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here we have a case of lymph node metastasis
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we are comparing it with a non-malignant lymph node the cortex is very thick
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which gives it an abnormally hyperechoic appearance it is usually a sign of malignancy
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intraductal papilloma is not very common its appearance usually involves dilated ducts
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and a well-defined nodule it is rated as bi-rads 4 and biopsy is advised
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intracystic papillary carcinoma consists of a complex cyst with a thick mural based nodule
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this nodule will be attached to the wall it will not move around
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here we have another image of intra-cystic papillary carcinoma this one has a thick isoechoic septation as well these thick isoechoic septations are usually a sign of malignancy as opposed to the
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thin hyperechoic septation which is usually benign and here is a large thick mural nodule
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ductal carcinoma in situ will have hypoechoic masses which will be micro lobulated which means they have these type of outpouchings and there is no enhancement which means it is a solid mass
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in this image the mass involves the ducts so it appears elongated
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usually these hypoechoic masses involving the duct are ductal carcinoma in situ
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invasive ductal carcinoma is the most common form of breast cancer it also has variable appearances
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one of them is a circumscribed mass
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hypoechoic mass with some calcifications which are usually invasive ductal carcinoma
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here we have another case of invasive ductal carcinoma
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we have an ill-defined hypoechoic mass and it has a non-parallel orientation it is taller than wide
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the ap diameter will be more than the horizontal measurement it also has posterior shadowing which is usually a sign of grade 1 invasive ductal carcinoma but it is not always the case
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here we have invasive ductal carcinoma with posterior acoustic enhancement
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this enhancement is usually a sign of a higher grade cancer
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it also has a speculated appearance suggesting a malignant lesion it is rated as bi-rads 4c
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here we have another image of invasive ductal carcinoma
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showing us a circumscribed hyperechoic mass with uniform internal echoes
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it also has posterior enhancement suggesting a high grade cancer you can see that invasive ductal carcinoma has lots of appearances ultimately it is confirmed with biopsy
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mastitis is the inflammation of breast tissue its appearances consists of hyperechoic fat lobules
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and some hypoechoic areas another distinguishing feature is that it has thickened skin here you can see the skin is very thick as compared to the normal image these are the features of mastitis
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duct ectasia involves dilated duct with branching tubular anechoic structures
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with the diameter measuring more than two millimeters
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the normal ducts are somewhat difficult to visualize they usually have mixed echoes
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here we have a case of infected and inflamed cyst has thick isoechoic walls
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and it has dependent debris which means this debris will settle down due to gravity
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this is the gravity dependent side this debris will move in accordance with the patient position
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this debris will move using this feature we can differentiate it from a neural nodule
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another feature is seen on doppler it is the presence of increased blood flow in the thick wall
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a normal breast implant is anechoic with a double layered hyperechoic shell
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and these are the normal breast tissues in an implant rupture we have a step ladder sign
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which are linear horizontal hyperechoic bands representing force of a collapsed shell
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it suggests intracapsular rupture
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a silicone granuloma suggests extra capsular rupture and gives us a snowstorm sign in this we have a hyperechoic circumscribed superficial border
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with dirty posterior shadowing this shadowing is grayish
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thank you so much for watching please subscribe and stay tuned for more imaging videos
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Context & Background
In the video titled "Breast Ultrasound Normal Vs Abnormal Image Appearances Comparison | BI-RADS Classification USG," Dr. Sam provides an insightful overview of breast ultrasound imaging. This includes detailed explanations of normal and abnormal breast tissue appearances, the classifications of various breast conditions, and the BI-RADS (Breast Imaging Reporting and Data System) classification system. This comprehensive study can serve as an excellent learning resource for healthcare professionals as well as those interested in the technical aspects of ultrasound imaging. Additionally, English learners can benefit from engaging with this material to enhance their language skills in a specialized medical context.
Top 5 Phrases for Daily Communication
- Hyperechoic layer: Refers to areas that reflect more ultrasound waves, appearing brighter on the image.
- Benign tumor: A non-cancerous growth that does not threaten health.
- Posterior enhancement: A phenomenon in ultrasound where the area behind a fluid-filled cyst appears brighter.
- Follow-up exam: Further examinations needed to monitor changes in health status.
- Complex cyst: A cyst with varying internal compositions, often needing additional evaluation.
Step-by-step Shadowing Guide
To effectively learn English with YouTube videos like this one, employ the shadowing technique. Here’s how you can implement this approach using the video's content:
- Watch and Listen: Begin by watching the video without attempting to repeat. Familiarize yourself with the terminology and Dr. Sam's speaking pace.
- Pause and Repeat: Play short segments of the video, pausing after each sentence. Attempt to repeat Dr. Sam's words as closely as possible, mimicking his intonation and pronunciation.
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- Practice Aloud: Speak along with the video, focusing on rhythm and enunciation. This can significantly improve your speaking skills for contexts such as IELTS speaking practice.
- Record Yourself: Capture your voice while shadowing and compare it to Dr. Sam’s delivery. Identifying differences will help refine your accent and fluency.
By using the combination of structured learning and the shadowing technique, English learners can enhance their speaking skills and gain a deeper understanding of specialized terminologies found in medical contexts. Try integrating these practices with tools like Shadowspeak to maximize your learning experience!
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.
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