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