Data sheet

1/ patient information:
Age ( ) sex:
Family history : Yes ( ) No ( )

2/ Clinical finding :
Generally soft breast : firm glandular

3/ Border of lesion :
Well define ( ) Ill define ( )

4/Echo texture of the lesion :

Homogeneous ( ) Heterogeneous( )

5/ Type of lesion :
a/Cyst : Simple ( ) Abscess ( ) b/ Solid ( ) Complex ( )

6/ Shape of the lesion :

Oval ( ) Round ( ) Regular ( ) Irregular ( )
Taller rather than wider ( ) Lobulated ( )

7/Location of lesion :
One ( ) Two ( ) Three ( ) Four ( ) Five ( )
Six ( ) Seven ( ) Eight ( ) Nine ( ) Ten ( )
Eleven ( ) Twelve ( ) Retro areolar ( ) supra areolar ( )
Away of nipple ( )

8/Pregnant or lactating :
Pregnant ( ) lactating ( ) no ( )

10/Side of breast masses :

Right ( ) Left ( ) Both. (. )

11/Lesion echogensity :
Iso- echoic ( ) Hypo-ehoic ( ) Hyper-echoic ( )
Mixed echogensity ( ) anechoic ( )

12/Lesion calcification :
Micro calcification ( ) Macro calcification ( ) No calcification ( )

13/Number of lesion : Simple ( ) Multiple ( )

14/Lymph node :
With lymphadenopathy ( ) Without lymphadenopathy ( )
15/Nipple discharging :
Number of ducts ( ) Color ( ) Change in size ( ) No ( )

16/ Need biopsy :

Yes ( ) No ( )

17/ Need mammography

Yes( ) No ( )

18/ Vascularity by Doppler

Yes ( ) No ( )

19/ BI-RADS assessment category :

In complete exam ( ) Negative ( ) Benign finding ( )
probably benign finding. ( ) Suspicions abnormality ( )
Highly suggestive of malignancy ( ) Proven malignancy. ( )

20/ Ductal dilation :

Yes ( ) No ( )

21/ Skin thickening :

Yes ( ) No ( )
22/ Nipple retraction ( physiological )
Yes ( ) No ( )

23/ Axillary enlarged lymph node :

Yes ( ) No ( )

24/ Lesion finding :

Unilateral ( ) Bilateral ( )

25/ Edge shadowing :

Yes ( ) No ( )

27/ Recommendations :
Follow up after 6 month( ) True cut biopsy ( ) For oncological ( )
For close follow up after 3 month ( ) Annual follow up ( )
mammography at age of 40 years ( )

28/ measuring of lesion: Rt. Lt.

29/ suspicious of lesion :