Figure S1.Power Doppler sonogram of a breast cancer shows typically malignant vascularity with numerous irregular vessels penetrating the tumor from multiple sites on the periphery.
Figure S2.Invasive lobular carcinoma. Extended-field-of-view sonogram shows the ill-defined tumor associated with shadowing. The margins are not well demarcated and the measurement with sonography can only be approximate.
Figure S3.Patient with a known cancer in the 11 o’clock position, 7 cm from the nipple.
A) Staging whole-breast sonogram demonstrates a small (0.5-cm) irregular hypoechoic mass in the subareolar region (arrow). Power Doppler imaging showed vascularity associated with the lesion.
B) Sonogram obtained during ultrasound-guided FNA shows the needle (arrows) with its tip inside the lesion. Cytology confirmed malignancy and thus confirmed multicentric disease.
Figure S4.Normal level I axillary node. The node is mostly echogenic with an even, thin, hypoechoic cortex.
Figure S5.Axillary lymph node metastasis. The metastatic deposit (M) is markedly hypoechoic and replaces about half of the node. The left, normal half of the node (arrows) is echogenic with a very thin residual cortical lining.
Figure S6. Large axillary lymph node metastasis. Power Doppler sonogram shows total lack of vascularity inside the metastatic deposit (M) Note the displacement of a normal hilar vessel by the metastasis.
Figure S7.Benign reactive hyperplasia in an axillary node. Left) Gray-scale sonogram shows a node with a prominent hypoechoic cortex. The thickening of the nod is grossly even its hypoechogenicity is not markedly less than that of the adjacent subcutaneous fat. Right) Power Doppler sonogram shows hypervascularity covering the entire cortex from hilum to capsule without disorganization.
Figure S8.Ultrasound-guided FNA of a left internal mammary lymph node metastasis. Transverse sonogram obtained during the sampling shows the echogenic shaft of the needle, which has been inserted as “parallel” as possible to the pleura to minimize the risk of pleural injury. The bevel of the needle is distinctly seen, which guarantees its safest placement in the targeted node. In this case, the needle is coursing over the internal thoracic vessels (arrows), which lie lateral to the node.
Figure S9.Level II axillary lymph node metastasis. Transverse sonogram of the axilla shows a 1-cm node (N) with the appearance of a metastasis posterior to the pectoralis minor muscle (Pm). PM, pectoralis major muscle.
Figure S10.Metastasis to the pectoralis major muscle. Sonogram of the infraclavicular region during the staging of a breast cancer patient shows a hypervascular metastasis to the pectoralis major muscle (arrowheads).
Figure S11.Thyroid metastasis detected incidentally during the staging sonographic examination of the supraclavicular fossa. Sonogram shows a poorly defined hypoechoic mass in the thyroid (arrows). Ultrasound-guided FNA confirmed a metastasis to the thyroid from the known breast cancer.