BREAST: anatomy, imaging techniques & clinical/radiological cases Istituto di Radiologia Ambra Sangiovanni
ANATOMY
Imaging techniques Mammography Ultrasound MRI
Imaging techniques Mammography Ultrasound MRI
MAMMOGRAPHY X-Ray compression indications: annual screening in asymptomatic women ≥ 40y women of any age with symptoms, such as a breast lump, and nipple discharge, and in patients who have a history of breast cancer for guiding biopsy (Mammotome)
MAMMOGRAPHY + US in case of dense breasts or to evaluate equivocal mammographic findings
MAMMOGRAPHY + US in case of dense breasts or to evaluate equivocal mammographic findings
MAMMOGRAPHY CRANIOCAUDAL view
MAMMOGRAPHY CRANIOCAUDAL view ext ext int int
MAMMOGRAPHY MEDIOLATERAL and MEDIOLATERAL OBLIQUE views
MAMMOGRAPHY MEDIOLATERAL view up up inf inf
MAMMOGRAPHY MEDIOLATERAL OBLIQUE view up up inf inf
MAMMOGRAPHY - summary
UPPER-EXTERNAL SECTOR MAMMOGRAPHY - summary e.g. : which sector? external upper UPPER-EXTERNAL SECTOR
MAMMOGRAPHY
Imaging techniques Mammography Ultrasound MRI
ULTRASOUND patient positioning: support elbow, flat, supine probe: linear array 7-13 MHz
ULTRASOUND mammary layer skin pre-mammary fat layer retro-mammary layer muscle pectoralis rib
ULTRASOUND indications: young (usually under 30 years of age) or pregnant patient who is symptomatic
ULTRASOUND indications: to evaluate a palpable lump with negative or equivocal mammographic findings
ULTRASOUND indications: can help to distinguish between benign vs malignant characteristics ColorDoppler and PowerDoppler can help distinguish malignant from benign tumours
ULTRASOUND BENIGN LESIONS well circumscribed shape fibroadenoma fibroadenoma simple cyst BENIGN LESIONS well circumscribed shape no Color/Power Doppler signal inside the lesion
ULTRASOUND MALIGNANT LESIONS irregular margins posterior shaddowing Color/Power Doppler signal inside the lesion
ULTRASOUND indications: for guiding biopsy
ULTRASOUND indications: for evaluation of breast implants for rupture
Imaging techniques Mammography Ultrasound MRI
MRI Sequences used T1 T2 T1 C+ (Gd) : dynamic and kinetic analysis
MRI Indications for breast MRI high risk screening : personal/family history high risk lesions : ADH / ALH / LCIS BRCA1 / BRCA2 gene positivity mantle radiotherapy (>4 Gray) extent of disease (EOD) evaluation in ipsilateral and contralateral breast
MRI Indications for breast MRI positive margins neo-adjuvant chemotherapy: to assess residual disease metastatic axillary lymphadenopathy of unknown primary to assess chest wall invasion to assess for synchronous, multifocal or multicentric disease
MRI T2w T1w fat sat T1w fat sat C+
BIRADS CLASSIFICATION BIRADS 0: incomplete, further imaging or information is required (e.g. compression, magnification, special mammographic views, ultrasound). BIRADS I: negative, symmetrical and no masses, architectural disturbances or suspicious calcifications present. BIRADS II: benign findings BIRADS III: probably benign, short interval follow-up suggested. BIRADS IV: suspicious abnormality BIRADS V: highly suggestive of malignancy (BIRADS VI: known biopsy proven malignancy) http://radiopaedia.org/articles/breast-imaging-reporting-and-data-system-birads
Annual screening; round calcified mass CASE 1 Annual screening previous mammograms: known calcified round in the right breast Age: >40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
Annual screening; round calcified mass CASE 1 Annual screening previous mammograms: known calcified round in the right breast Age: >40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
Annual screening; round calcified mass
Annual screening; round calcified mass round mass with coarse calcifications in the right breast stable for many years TYPICAL FIBROADENOMA http://www.viaradiology.com/exams/mammo-ed/storyReader$319.html
Annual screening; round calcified mass https://acsearch.acr.org/docs/69495/Narrative/
Right breast lump CASE 2 Right breast lump Age: 71 years old Gender: Female Race: Middle eastern First study? Ultrasound Mammography MRI w contrast
Right breast lump CASE 2 Right breast lump Age: 71 years old Gender: Female Race: Middle eastern First study? Ultrasound Mammography MRI w contrast
Right breast lump
Right breast lump
Right breast lump speculated opacity at the middle of the lower part lymph nodes speculated opacity at the middle of the lower part focus of macrocalcification adjacent to the mass Bilateral axillary lymph nodes microcalcifications mass
Right breast lump Second study? Ultrasound Mammography MRI w contrast
Right breast lump Second study? Ultrasound Mammography MRI w contrast
Right breast lump Right breast
Right breast lump Left breast
BREAST CANCER (BIRADS V) Right breast lump irregular mass, hypoechoic, with heavy post acoustic shadowing and hypervascularity the lymph nodes appear reactionary with preserved sinus BREAST CANCER (BIRADS V) http://radiopaedia.org/cases/breast-cancer-7
Right breast lump https://acsearch.acr.org/docs/69495/Narrative/
Palpable left breast lump CASE 3 Left breast lump Age: 45 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
Palpable left breast lump CASE 3 Left breast lump Age: 45 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
Palpable left breast lump
Palpable left breast lump
Palpable left breast lump architectural distortion area of architectural distortion with pleomorphic calcifications microcalcifications
Palpable left breast lump Second study? Ultrasound Mammography MRI w contrast
Palpable left breast lump Second study? Ultrasound Mammography MRI w contrast
Palpable left breast lump a region of architectural distortion and pleomorphic calcification BREAST CARCINOMA http://radiopaedia.org/cases/breast-carcinoma
Palpable left breast lump https://acsearch.acr.org/docs/69495/Narrative/
Skin thickening and nipple retraction CASE 4 Skin thickening and nipple retraction of the right breast Age: > 40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
Skin thickening and nipple retraction CASE 4 Skin thickening and nipple retraction of the right breast Age: > 40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
Skin thickening and nipple retraction
Skin thickening and nipple retraction lymph nodes mass Large spiculated multilobulated mass almost in all four quadrants skin thickening and nipple retraction multiple axillary lymph nodes with no distinct fatty hilum skin thickening nipple retraction LOCALLY ADVANCED BREAST CANCER http://radiopaedia.org/cases/locally-advanced-breast-cancer-1
Skin thickening and nipple retraction https://acsearch.acr.org/docs/69494/Narrative/
Prevalent round breast screen CASE 5 Prevalent round breast screen. Asymptomatic. Age: 41 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w contrast
Prevalent round breast screen CASE 5 Prevalent round breast screen. Asymptomatic. Age: 41 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w contrast
Prevalent round breast screen
Prevalent round breast screen
Prevalent round breast screen Round lobulated right breast mass with sharp outline and halo Lucent lines within the mass due to air within the lesion SKIN LESION: NAEVUS http://radiopaedia.org/cases/breast-naevus
Prevalent round breast screen https://acsearch.acr.org/docs/69494/Narrative/
Two concentric opacities CASE 6 Racing pulse and anxiety Age: 34 years old Gender: Female Race: Caucasian First study? Chest X-Ray Ultrasound Mammography MRI w contrast
Two concentric opacities CASE 6 Racing pulse and anxiety Age: 34 years old Gender: Female Race: Caucasian First study? Chest X-Ray Ultrasound Mammography MRI w contrast
Two concentric opacities
Two concentric opacities normal breast tissue capsule of the implant
Two concentric opacities BREAST PROTHESES http://radiopaedia.org/cases/breast-prostheses
Breast implants CASE 7 Breast implants; complications? Age: 30 years old Gender: Female Race: Hispanic/Latino First study? Ultrasound Mammography MRI w/o contrast
Breast implants CASE 7 Breast implants; complications? Age: 30 years old Gender: Female Race: Hispanic/Latino First study? Ultrasound Mammography MRI w/o contrast
Breast implants axial T1w T2w
Breast implants BREAST IMPLANTS without complications sagittal – T2w R http://radiopaedia.org/cases/breast-implants-mri
Breast implants - sudden softening of the right breast CASE 8 Right mastectomy for breast cancer and reconstruction with a silicone implant Age: 47 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast
Breast implants - sudden softening of the right breast CASE 8 Right mastectomy for breast cancer and reconstruction with a silicone implant Age: 47 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast
Breast implants - sudden softening of the right breast T2w STIR
Breast implants - sudden softening of the right breast “LINGUINE SIGN” fibrous capsule (scar) around the implant shell intracapsular rupture: the contents of the implant are contained by the fibrous scar, while the shell appears as a group of wavy lines. INTRACAPSULAR BREAST IMPLANT RUPTURE http://radiopaedia.org/cases/intracapsular-breast-implant-rupture-linguine-sign
Annual screening CASE 9 Annual screening Age: 56 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast MRI w contrast
Annual screening CASE 9 Annual screening Age: 56 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast MRI w contrast
Annual screening CASE 9 Annual screening Age: 56 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography: "Architectural distortion" (BI-RADS III) MRI w/o contrast MRI w contrast
Annual screening CASE 9 Annual screening Age: 56 years old Gender: Female Race: Caucasian Second study? Ultrasound Mammography MRI w/o contrast MRI w contrast
Annual screening CASE 9 Annual screening Age: 56 years old Gender: Female Race: Caucasian Second study? Ultrasound Mammography MRI w/o contrast MRI w contrast
Annual screening T2w T1w fat sat T1w fat sat C+
INVASIVE LOBULAR BREAST CANCER Annual screening INVASIVE LOBULAR BREAST CANCER http://radiopaedia.org/cases/invasive-lobular-breast-cancer
Annual screening https://acsearch.acr.org/docs/69494/Narrative/
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