Breast Imging by DR Lina
Breast Imging by DR Lina
Breast Imging by DR Lina
1. X-ray
-Mammography
-Digital Breast Tomosynthesis (DBT)
-Xeromammography
-Galactography
2.MRI
3.Ultrasound
4.Scintimammography
5.Diffuse optical mammography
Digital mammography
Film screen mammography
T
• Home work : read
• X-ray tube. The most commonly used target-filter
combination is a molybdenum (Mo) target with 0.03
mm Mo filter. The peak kilovoltage is normally in the
range 26-30 kV and typically 28 kV.
• Target filter combination :
Mo/MO is suited to the average or small-sized
breast. Other combinations are suited for large
breasts , eg: Mo/ rhodium, Mo/palladium,
rhodium/rhodium.
Standard views:
Lateral oblique (MLO)
Craniocaudal (CC)
b
a
c
Correct positioning for mediolateral oblique view. a = Nipple
i n profile. b = Pectoralis muscle visible down to level of the nipple.
c = Inframammary fold visible. d = Glandular tissue evenly compressed and
adequately penetrated
Mammography : *diagnostic
*screening
Mammography indications :
• Screening asymptomatic women aged 50 years and over
• Screening asymptomatic women aged 35 years and over who have a
high risk of developing breast cancer:
-women who have one or more first degree relatives who have been
diagnosed with premenopausal breast cancer
-women with histologic risk factors found at previous surgery, e.g.
atypical ductal hyperplasia
• Investigation of symptomatic women aged 35 years and over with a
breast lump or other clinical evidence of breast cancer
• Surveillance of the breast following local excision of breast carcinoma
• Evaluation of a breast lump in women following augmentation
mammoplasty
• Investigation of a suspicious breast lump in a man
Skin thikness:0.5—2 mm
The main duct branches repeatedly within the breast and the most distal
branches of the duct system are called the terminal ducts.
The terminal duct consists of extralobular and intralobular
portions. The intralobular portion, together with the acini, forms a
lobule. The extralobular terminal duct and the lobule form a terminal
ductal lobular unit (TDLU). The TDLU is the site of origin of most
malignant and benign diseases of the breast.
Variant anatomy
C
D
Calcifications
The level of suspicion for malignancy is assessed from analysis of
the mammographic signs on magnification views. The key features
that are analyzed are:
• Particle shape
• Particle density
• Cluster shape
• Distribution
Suspicious calcifications
In general tend to be smaller and less regular than typically benign
calcifications .
• According to BI-RADS 5th edition lexicon , 4 descriptors of suspicious calcification
morphology on mammography, listed in order of increasing suspicion :
• Coarse heterogeneous: irregular, generally 0.5-1 mm
• Amorphous : indistinct and/or small ("powdery", "cloud", or
"cottony"), such that another specific shape cannot be
determined
• Fine pleomorphic: variable shape ("shards of glass" or "crushed
stone"), generally <0.5 mm
• Fine linear or fine-linear branching: thin (<0.5 mm), linear,
branching or irregularly arranged ("casting")
Suspicious calcification distribution: listed in
increasing order of suspicion
• Regional : scattered in a larger volume (>2 cm in greatest linear dimension)
of breast tissue and not in the expected ductal distribution
• Grouped : a cluster of at least 5 calcifications within 1 cm from each other,
in an area at most 2 cm in greatest linear dimension
• Linear : calcifications arrayed in a line suggestive of deposition along ducts
• Segmental : calcium deposits in ducts and branches of a segment or lobe
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Longitudinal scan
Ducts can be
observed in the
nipple as
hypoechoic tubular
structures.
oil cyst / Fat Necrosis
Fibroadenolipoma
A hamartoma or fibroadenolipoma is a benign
tumor composed of normal mammary tissue
(adipose, fibrous, and glandular), including ducts
and lobules of varying amounts
Since the lesions are made
up of breast tissue, breast
cancer of any type can
arise in hamartomas .
microcyst: <3 mm
macrocyst: >3 mm
Microcysts are found commonly in fibrocystic changes.
Mammography CC
MLO
Cysts appear as a breast
mass with the following
features:
Ultrasound
Typically :well-circumscribed,
round to ovoid, or macrolobulated mass
generally uniform hypoechogenicity.
Intra lesional detectable calcification may be
seen in ~10% of cases .
Thin echogenic rim (pseudocapsule) may be
seen.
Mammography
Spectrum of features : well-circumscribed discrete oval mass
hypo- or isodense to the breast glandular tissue, to a mass
with macrolobulation or partially obscured margin.
Involuting lesions in older, typically postmenopausal patients
may contain calcification, often classic coarse popcorn
calcification . In some cases the whole lesion is
calcified. Calcification may also present as crushed stone-
like microcalcification which makes differentiation from
malignancy difficult.
HISTORY: A 49-year-old woman with a
palpable RT breast mass.
DDx
A, Screening mammogram shows
retraction of the interface between
the fibroglandular tissue and
subcutaneous fat ( arrow ) on the
mediolateral oblique (MLO) view.
Ultrasound
Mammography
The BI-RADS Atlas, fifth edition, contains three mammographic findings that should be
categorized as BI-RADS 3 :
Grouped round calcifications
circumscribed, round or oval mass without calcification
focal asymmetry without calcification or architectural distortion
Ultrasound
The following sonographic findings may be categorized as BI-RADS 3 :
complicated cyst with uniform low-level echoes
microlobulated or oval mass composed of clustered microcysts (although
BI-RADS 2 may be appropriate if the appearance is classic 7)
hypoechoic mass, circumscribed, oval, parallel, without posterior features or
with minimal posterior enhancement
hyperechoic mass with central hypoechoic to anechoic components and
surrounding edema consistent with, but not diagnostic of, fat necrosis
refraction shadowing without an associated mass
architectural distortion thought to be due to postsurgical scar