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Introduction to Clinical Radiology:
The Breast
Priscilla J. Slanetz MD, MPH
Assistant Professor of Radiology
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
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
Standard mammographicprojections
The Cranio-Caudal (CC) viewThe Cranio-Caudal (CC) view
Note that the view is named for the orientation Note that the view is named for the orientation of the x-ray tube (which determines the polarizationof the x-ray tube (which determines the polarization of the beam) with respect to the breastof the beam) with respect to the breast
The Medio-Lateral Oblique The Medio-Lateral Oblique (MLO) view(MLO) view
The Breast…Clinical ApproachClinical Approach
• quadrants in the breastquadrants in the breast
• any finding (palpable any finding (palpable lump, scar, etc… is noted lump, scar, etc… is noted on schematicon schematic
• always show the patient always show the patient where you are concernedwhere you are concerned
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
42 year old with a palpable lump…
An ultrasound reveals a An ultrasound reveals a round mass which is round mass which is completely completely anechoic anechoic consistent with a simple consistent with a simple cystcyst
RCCRCC RMLORMLO
Mammography first, then…
54 year old with left breast lump
An irregular shaped mass is seen on the mammogram.
48 year old with a lump…
MR of both breasts detected the known invasive ductal cancer in the left breast and a contralateral invasive ductal cancer in the right breast
The EndThe End
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