1. Breast Neoplasm
In this section we will be discussing breast neoplasm.

2. Normal Mammogram
The main tool utilized in evaluation for breast neoplasm is a mammogram, an x-ray technique using low kilovoltage energy allowing us to evaluate subtle attenuation differences within the soft tissues of the breast. Here is an example of a normal mammogram. Two sets of views are taken of each breast, a top-down view the craniocaudad view, and a view that is taken at a slight angle along the axis, or parallel to the axis of the pectoralis muscles, the mediolateral oblique view. For my demonstrations, many times I will present these views back to back in order to provide easy review..

3. Breast Cancer Cranio-caudal view Area of density with spiculations
In this individual, the craniocaudad view of the left breast demonstrates an irregular mass in the central portion of the breast, as indicated by the white arrow. This area of density has spiculation, indicated by the small arrows.

4. Breast Cancer Mass, calcifications
Magnification view shows irregular calcifications (arrow)
On another individual, in the left breast, we see a mass with calcifications on the mediolateral oblique view, as indicated by the black arrow. A magnification view shows irregular calcifications within this mass. This representing a breast neoplasm, a comedo type carcinoma

5. Breast Cancer Spiculated density in the upper right breast
Breast cancer presentation can be varied. In this individual, a spiculated density is noted in the upper right breast as seen both on the craniocaudad to your left and the medial lateral oblique view to your right, as indicated by the white arrows.

6. Breast Mass Left craniocaudal Well marginated mass
Consider benign process
Ultrasound to determine morphology
n another individual, as indicated by the white arrows, we again identify an area of abnormality in the cranial caudad projection. This well marginated mass is more likely a benign process due to the smooth edges that we're seeing, but this cannot be definitively determined by mammography alone. Ultrasonography is frequently used as an adjunct in order to determine the underlying morphology and etiology of a breast mass identified on mammography.

7. Breast Cyst Ultrasound Sharp margins No internal echoes
Through transmission (brighter behind cyst)
In this case, ultrasonography demonstrates the presence of a sharply marginated mass with no internal echoes, as indicated by the white arrows. It also has through-transmission, a brighter area deep to the cyst, as the ultrasound beam passes are rapidly through the fluid, as indicated by the string of arrows to the left.

8. Breast Cyst Larger breast cyst in a different patient
No internal echoes
Smooth walls
Good through transmission
Here's another individual with a larger breast cyst. Note the fact that there are no internal echoes, there are smooth walls, and note the presence of good through transmission posterior or deep to the abnormality.

9. Breast Cancer Hypoechoic Irregular margins Echo shadowing posteriorly
Ductal carcinomaContrast that to an individual with breast cancer visualized ultrasonographically. A hypoechoic mass with irregular margins demonstrates echo shadowing posteriorly.

10. Mammogram with comparison
The use of comparison mammographic views is very helpful in identifying subtle differences that may occur from year to year. They're frequently demonstrated with the older films on the outside and the newer films in the center. This comparison is the most useful tool the radiologists have in evaluating for subtle changes which might represent development of interval neoplasm.

11. Diagnostic Mammogram At least two zones of microcalcification
Ductal carcinoma in situ and invasive ductal carcinoma on biopsy
On this examination, 2 areas of small calcification are identified within the breast. These 2 areas represent ductal carcinoma in situ and invasive ductal carcinoma when biopsy was performed.

12. Diagnostic Mammogram
At least two new irregular densities noted on mammography medially
Biopsy Grade 2 invasive ductal carcinoma
An additional appearance in another individual demonstrates at least 2 irregular densities on mammography, medially on this craniocaudad view spot film. At biopsy a grade 2 invasive ductal carcinoma was demonstrated.

13. Breast MRI Multiple areas of abnormal vascularity right breast
At least one abnormal area medial left breast
A recent introduction to the armamentarium of the breast imager is Breast MRI examination. MRI is useful both for evaluation of morphology of abnormalities within the breast, as well as to evaluate vascular kinetics, which could have some implication in evaluation for possible neoplasm. Here we see multiple areas of abnormal vascularity within the breast, as indicated by the arrows. At least one abnormal area in the medial portions of the breast on your left side and two seen on the breast to your right side.

14. Breast MRI
Computer aided detection, or computer aided diagnosis, has been added to MRI evaluation. Here, we’re able to color areas of abnormal kinetics red to indicate an area where we may want to look at more closely to determine whether this may be indeed a breast cancer or a benign process.

15. Breast MRI
Potential for evaluating for multi-focal breast cancer during staging
Potential for evaluation of patients with BRCA-1 or -2
Potential for evaluating equivocal findings in Mammography or breast Ultrasound
Breast MRI has the potential for evaluating multifocal breast cancer during the staging process. There’s also potential to possibly use this as a screening tool for the evaluation patients with a BRCA 1 or 2 gene. Also, there is a potential for utilizing breast MRI in the evaluation of equivocal findings demonstrated by mammography or breast ultrasound.

16. PET Scanning Breast Carcinoma
And finally PET scanning has value in the evaluation of breast cancer, primarily in the use for breast cancer staging. But, as we can see in this individual, the presence of considerable uptake of the FDG radionuclide in the mass within the right breast is the result of the presence of a breast cancer.