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Introduction to Clinical Radiology: The Breast
Priscilla J. Slanetz MD, MPH Assistant Professor of Radiology
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Imaging Strategies: The Breast
Mammography and ultrasound are the two primary modalities for imaging the breast Selected clinical scenarios utilize MR, CT and/or nuclear imaging Percutaneous biopsies can be guided by stereotaxis, ultrasound, CT or MR
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Imaging Strategies: Basics of Mammographic Interpretation
Overview – breast density, positioning, quality control Look for masses, calcifications, and asymmetries If present, Mass/asymmetry -- shape, margins, size, density, and location Spiculated, irregular and high density suggestive of malignancy Calcifications – morphology and distribution Pleomorphic linear branching clustered calcifications suggestive of malignancy BIRADS Assessment (0 → 6) BIRADS 0 need additional imaging work-up BIRADS 1 and 2 typically all set BIRADS 3 need short interval follow-up imaging BIRADS 4 and 5 usually warrant biopsy BIRADS 6 is known malignancy
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Standard mammographic projections
The Medio-Lateral Oblique (MLO) view The Cranio-Caudal (CC) view Note that the view is named for the orientation of the x-ray tube (which determines the polarization of the beam) with respect to the breast
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The Breast…Clinical Approach
quadrants in the breast any finding (palpable lump, scar, etc… is noted on schematic always show the patient where you are concerned
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Imaging Strategies: The Breast
Indications: Screening (asymptomatic) Symptomatic (lump, thickening, pain, discharge) Mammography Screening Annually beginning at age 40 years; earlier if higher risk Diagnostic (symptomatic patient – pain, lump, discharge) Ultrasound To evaluate a palpable abnormality or to further characterize a finding on mammography Magnetic resonance imaging (MR) To assess silicone implant integrity, evaluate cancer extent, screen high-risk women, and problem solving tool
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42 year old with a palpable lump…
Mammography first, then… An ultrasound reveals a round mass which is completely anechoic consistent with a simple cyst RMLO RCC
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An irregular shaped mass is seen on the mammogram.
54 year old with left breast lump 48 year old with a lump… An irregular shaped mass is seen on the mammogram.
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MR of both breasts detected the known invasive ductal cancer in the left breast and a contralateral invasive ductal cancer in the right breast
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The End
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