from Foreword

... in the world of healthcare, the practice of many doctors has been built on the same culture of quality as an art form. Especially in the field of morphology, ultrasound image diagnosis is possibly the most reliant on this: practitioners base their judgment on naked-eye impressions of sonograms that are not clearly quantified. This requires the intuition and sensitivity to spot elusive clues and give an image reading... In order to master image diagnosis, there is only one possible method: building experience with many case studies.
As such, this manual presents numerous case studies set out in problem format. When first examining a case, please look closely at the set of two sonograms on the page displaying their corresponding case study number. Once you’ve come up with your own image reading, see the commentary page...
... It is my eternal hope that under the care of all who read this manual, many patients will be saved.

Case Study Structure
Each case study is divided into a case study information page and a case study review page.

Case Study Information Page Content
1. Age and Gender
This is all the patient information given; there is no family history, medical history, or any other examination data available. However, the most important clue to diagnosing diseases of the mammary gland is age. Accordingly, I believe the above two pieces of information are sufficient as a hint for making an image reading.
2. Ultrasound Images
Two ultrasound images are presented in each case study. As a rule, they depict the largest cross-sectional area of a lesion and another cross-section orthogonal to this. In some cases, there are also images that show different areas to these; this is a hint in itself.

Case Study Review Page Content
3. Ultrasound Images (with Annotation)
As a rule, ultrasound images showing the largest mass cross section are annotated. Alternatively, an annotated ultrasound image may show a cross section that best captures a lesion’s characteristics, or indicate an image reading that needs to be commented on in the review section.
4. Image Reading
Firstly, the location of a lesion and its size are noted. If immeasurable or unnecessary, the size of a lesion is omitted. Image readings do not consist of diagnostic criteria listed in verbatim; they mainly give observations that are important in the diagnosis of a lesion.
5. Diagnosis
The author’s image diagnoses in this section are entirely based on their own view. Diagnoses are given as typical examples of how an image should be read, and may not be consistent with the findings of histopathological diagnoses. Where multiple diagnoses are put forward, they are not enumerated as a list; rather, they are phrased as suggestions that give several open-ended possibilities...
6. Outcome
In all cases of breast cancer, comments in this section include histopathological diagnoses…. For cases of benign diseases where no histopathological diagnoses were obtained, either the outcome of a fine needle aspiration cytology(FNAC) examination or a clinical finding that affirms such cases as benign is given...
7. Review Important factors that were taken into account in diagnoses are commented on here…. Searching for Case Studies by Disease Type at the end of this manual is a list of case studies in this manual according by disease type, based on their final diagnoses. This list can be used as a contents page to perform a reverse lookup of case studies.

When using this manual, please bear in mind: The histopathological classification of mammary gland masses and the categorization of mammography findings in this manual is based on the categories set forth by the Japanese Breast Cancer Society.