10 Indications for mammography Screening asymptomatic women aged 50 years and overScreening 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 hyperplasiaInvestigation of symptomatic women aged 35 years and over with a breast lump or other clinical evidence of breast cancerSurveillance of the breast following local excision of breast carcinoma .Evaluation of a breast lump in women following augmentation mammoplastyInvestigation of a suspicious breast lump in a man
11 Breast ultrasoundAt the minimum, a 7.5 MHZ linear array probe should be usedThe original role of breast sonography is in the differentiation of cystic and solid lesionsThe role of ultrasound complements both clinical examination and mammographyUltrasound plays an important role in the triple assessment of symptomatic lesions the dense breast
12 It is the examination of choice in young women and is valuable in the assessment of mammography ‘ dense’ breast
13 The dense breastDiffuse increase in the density of the breast tissue is caused byan increase in the glandular tissue and or/fibrous tissue
15 The dense breast 2 – edematous breast Advanced primary tumor Lymphatic spread from a primary tumor or inflammatory carcinomaBreast abscess (breast infection)Congestive cardiac failure and Renal failure (unilateral or bi lateral)
16 The dense breastAxillary lymphnode metastases from Advanced gynaecological malignancy e.g ovarian carcinoma, cervical progressively or secondary to a carcinoma of the contra lateral breastRadiotherapy (breast saving)Develop progressively following radiotherapyReach a maximum at about 6 monthsResolved approximately 18 mouths following treatment
17 The dense breastHRT (decrease in the sensitivity of screening mammography for cancer detection)loss of fat due to severe weight loss or cachexia or lack of fat due to lipodystrophy
37 Indication of breast ultrasound .Symptomatic breast lumps in women aged less than 35 years .Breast lump developing during pregnancy or lactating.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
51 Imaging – guided practical procedures The type of imaging chosen depends principally on which method (ultrasound or mamography) shows the lesion clearly.Ultrasound is used for cysts and most soft – tissue lesionsMammography is used for microcarcification and for soft – tissue lesions that are not seen or are poorly visualized on ultrasound particularly distortions
57 Indication for breast MRI Breast MRI is the technique of choice in the differentiation between postoperative scarring and local recurrenceIt has an important role in the assessment of the indeterminate mass because of its very high sensitivity for malignancy though at present, core biopsy is a more cost – effective approach.
58 Indication for breast MRI It is very accurate in the local staging of breast cancer in difficult cases (very dense breasts, mammographically occult tumours, suspected multi- focality or multicentricity and suspected chest wall involvement).It is the technique of choice in the evaluation of implant integrity and detection of cancer in the augmented breast.It is also accurate in the differentiation of axillary recurrence and brachial plexopathy post radiotherapy.
59 Indication for breast MRI Breast MRI appears highly accurate in the assessment of response to neoadjuvant and primary chemotherapy, predicting ulti- mate response before changes in tumour volume and differentiating between residual tumour and fibrosis.The place of breast MRI in screening high-risk patients has yet to be established