radiology day 1 mammography
TRANSCRIPT
DR. VIBHAY PAREEKRADIATION ONCOLOGY
JUPITER HOSPITAL
BREAST MAMMOGRAPHY
ANATOMY OF THE BREAST
• Vary In Shape & Size• Cone Shaped With The Post Surface
(Base) Overlying The Pectoralis & Serratus Muscles
• Axillaries Tail Extends From Lat. Base Of The Breasts To Axillaries Fossa
• Tapers Ant. From The Base Ending In Nipple, Surrounded By Areola
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• Consists Of 15-20 Lobes• Divide Into Several Lobules• Lobules Contain Acini, Draining Ducts And
Interlobular Connective Tissue.• By Teenage Years Each Breast Contains
Hundreds Of Lobules
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• Breast Profile:• A Ducts• B Lobules• C Dilated Section Of Duct To Hold Milk• D Nipple• E Fat• F Pectoralis Major Muscle• G Chest Wall/Rib Cage•
Enlargement:• A Normal Duct Cells• B Basement Membrane• C Lumen (Center Of Duct)
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• Lymph Node Areas Adjacent To Breast Area.• A Pectoralis Major Muscle• B Axillary Lymph Nodes: Levels • C Axillary Lymph Nodes: Levels • D Axillary Lymph Nodes: Levels • E Supraclavicular Lymph Nodes• F Internal Mammary Lymph Nodes
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LYMPH NODES
Lymphatic Vessels Of The Breast Drain Laterally And Medially
• Laterally Into The Axillary Lymph Nodes (C & D)
• 75& Drain Toward Axilla• Medially Into The Mammary Lymph
Nodes• 25% Toward Mammary Chain (F)
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QUADRANTS OF THE BREAST
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Types Of Breast Tissue
Glandular• Ducts• Lobes• Lobules• TDLU
Stromal
• Fatty Tissue
• Connective Tissue
• (Cooper’s Ligaments – Suspensatory Ligaments
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3 Tissue Types
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EQUIPMENT
• CC - CRANIO CAUDAD• MLO – MEDIOLATERAL OBLIQUE
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POSITIONING
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Compression Important:
Evens Density of Breast
Reduces Motion
AEC choice depends of size and composition of breast
CC
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MLO – RT BREAST
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TRUE LAT CONE-MAG
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MAGNIFICATION = INCREASE OID
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BREAST CHANGES WITH AGE
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Breast Classifications
FIBRO-GLANDULAR BREAST
• Fibro-glandular• Dense With Very Little Fat• Females 15-30 Years Of Age
• Or 30 Years Or Older Without Children• Pregnant Or Lactating
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FIBRO-FATTY BREAST
• Fibro-fatty• Average Density
• 50% Fat & 50% Fibro-glandular• Women 30-50 Years Of Age
• Or Women With 3 Or More Children
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FATTY BREAST
• Fatty• Minimal Density• Women 50 And Older
(Postmenopausal), Men And Children
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THE MALE BREAST
38Male Mammography and Cancer
GYNECOMASTIA
• Benign Excessive Development Of Male Mammary Gland
• Occurs In 40% Of Male Cancer Pt’s
• Survival Rates With Treatment Are 97% For 5 Years
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• Most Common Causes :
• Puberty (Hormonal Growth And Changes During Adolescence)
• Estrogen Exposure (Female Hormone Present In The Body And The Environment)
• Androgen Exposure (Body-building Hormones) • Marijuana Use • Medication Side Effects (Older Men)• Klinefelter's Syndrome
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GYNECOMASTIA
• Is A Benign Male Breast (Non-cancerous) Condition
• Some Men Who Have Prominent Breasts, Or Uneven Breasts, Often Feel Some Embarrassment About Their Body Image.
• This Condition Can Also Cause Emotional Conflict Over Sexual Identity.
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MALE BREAST
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MALE MAMMOGRAPHY
• 1300 MEN GET BREAST CANCER PER YEAR• 1/3 DIE
• MOST ARE 60 YEARS OR OLDER• NEARLY ALL ARE PRIMARY TUMORS• SYMPTOMS INCLUDE:
• NIPPLE RETRACTION• CRUSTING• DISCHARGE• ULCERATION
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MALE MASTECTOMY
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COMPLICATION WITH BREAST AUGMENTATION
• mammography has a 80-90% true positive rate for detecting breast cancer in those women without implants
• decreases to 60% with implants• because 85% of breast tissue is obscured
• more images are needed than the standard two projections• there is a risk of rupturing the implant• loss of sensation from surgical scars
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ELKLAND METHOD FOR IMAGING WITH BREAST IMPLANTS
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“PUSH BACK” TECHNIQUE
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ULTRASOUND OF BREAST
APPLICATIONS
• Not Always Detect Cancers That Are Visualised Mammographically. • Ultrasound Can Detect Clinically And Mammographically Occult Cancers
Particularly When There Is A Higher Possibility Of Cancer.• New High-frequency Transducers• Irregular Masses, Abnormal Dilated Ducts Or Clustered Foci Of Increased
Echogenicity With Increased Doppler Vascularity.
Patient PositionPatient Position
Medial LesionsMedial Lesions
• Patient Is Supine
• Ipsilateral Arm Is Placed Over The Patient’s Head.
Lateral LesionsLateral Lesions
• Patient Is Opposite.
Superior LesionsSuperior Lesions
• Patient Is SITTING
Apply Gentle Uniform Pressure With The Ultrasound Apply Gentle Uniform Pressure With The Ultrasound TransducerTransducer
Increase Transducer Pressure For:
– Greater Penetration
– Scanning The Subareolar Region.
Scanning Is Done In Three Directions.
1. Radial
2. Transverse
3. Longitudinal
• Localization Is By The Clock Face.12
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Lymph Node
• Solid nodule• Ovoid• Echogenic fatty hilum
• The Subcutaneous Fat LayerSubcutaneous Fat Layer Is Demonstrated Superficially As Hypoechoic Tissue Compared To The Glandular Tissue From Which It Is Separated By A Well-defined Scalloped Margin.
• Normal Ducts Ducts Are Often Visible, Particularly In The Subareolar Region, As Anechoic Tubular Structures.
• Deep To The Glandular Tissue, A Retromammary Fat LayerA Retromammary Fat Layer Is Usually Visible And, Behind This, The Structures Of The Chest WallChest Wall.
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• Symptomatic Breast Lumps In Women Aged Less Than 35 Years.• Breast Lump Developing During Pregnancy Or Lactation.• Assessment Of Mammographic Abnormality (± Further Mammographic Views)• Assessment Of MRI Or Scintimammography Detected Lesions.• Clinical Breast Mass With Negative Mammograms.• Breast Inflammation.• The Augmented Breast (Together With MRI).• Breast Lump In A Male (Together With Mammography).• Guidance Of Needle Biopsy Or Localisation.• Follow-up Of Breast Cancer Treated With Adjuvant Chemotherapy.
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Benign CharacteristicsBenign Characteristics
• Ellipsoid Shape
• Thin Definable Capsule
• Two Or Three Lobulations
• Hyperechogenicity.
SOLID MASS - MALIGNANT
• Irregular Shape• Irregular/Ill-defined Borders• Almost Anechoic• Angular Margin• Taller Than Wide
Irregular shape• Irregular/ill-defined borders• Almost anechoic• Thick echogenic rim• Posterior shadowing
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Simple Cysts– Anechoic– Smooth, Thin Margins– Posterior Acoustic Enhancement
Benign Malignant
Shape Oval/ellipsoid Variable
Alignment Wider than deep; aligned parallel to tissue planes
Deeper than wide
Margins Smooth/thinechogenic pseudocapsule with2-3 gentle lobulations
Irregular or spiculated; echogenic 'halo'
Echotexture Variable to intense hyperechogenicity Low-levelMarked hypoechogenicity
Homogeneity of internal echoes
Uniform Non-uniform
Lateral shadowing
Present Absent
Posterior effect Minimum attenuation/posterior enhancement
Attenuation with obscured posterior margin
Other signs -------------- CalcificationMicrolobulationIntraductal extensionInfiltration across tissue planes and increasedechogenicity of surrounding fat
• The sonographic pattern varies with age and individually, and depends on the amount and type of contents, i.e. fat, fibrous and glandular tissues.
• The fibrous and glandular components are variably echogenic, while fat is hypoechoic.
BI-RADS
• BIRADS Stands For Breast Imaging- Reporting And Data System Which Is A Widely Accepted Risk Assessment And Quality Assurance Tool In Mammography, Ultrasound And MRI.
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BI-RADS ASSESSMENT CATEGORIES
MAMMOGRAPHY AND ULTRASOUND LEXICON
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MASS
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A 'Mass' is a space occupying 3D lesion seen in two different projections.If a potential mass is seen in only a single projection it should be called a 'asymmetry' until its three-dimensionality is confirmed.Shape: oval (may include 2 or 3 lobulations), round or irregularMargins: circumscribed, obscured, microlobulated, indistinct, spiculatedDensity: high, equal, low or fat-containing.
SHAPE
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