IMAGING OF BREAST DISORDERS.............

radiology in breast disorder

1. IMAGING OF BREAST
DISORDERS
Dr Azzahra Nurul Azman
Consultant Radiologist
Hospital Teluk Intan

4. - 2005

5. BREAST CANCER STATS BASED
ON AGE GROUPS-, Malaysia
Frequency of patients from different age group
Age Group
90-9980-8970-7960-6950-5940-4930-3920-29
F
r
e
q
u
e
n
c
y
120
100
80
60
40
20
0
25
49
83
118
45
9

6. BREAST CANCER
•The incidence of getting breast cancer is
1:19 in Malaysia, compared to 1:8 in
Europe and the United States.
•Breast cancer - commonest cancer in all ethnic
groups
•1 in 14 Chinese women,
•1 in 15 Indian women
• 1 in 24 Malay women.

7. What is breast Awareness?
Breast awareness simply means
•Awareness of breast cancer risks
•Awareness of screening methods
•Awareness of what your breasts look and
feel like

8. RISK FACTORS
•More than 70 percent of cases occur in women
who have no identifiable risk factors
•Screening mammography for breast cancer
may be performed biennially in women aged 40
- 74 years in the general population.
•For those with high risk, offer screening from
30 years of age.

10. BREAST AWARENESS
Monthly breast self-examination
FIVE-POINT CODE
•Know what is normal for you
•Look and feel
•Know what changes to look for
•Report any changes without delay
•Attend for breast screening if aged 40 and above

11. SCREENING
•What is screening?
Screening for a disease means that a test,
investigation or procedure is done on a
person who has no symptoms of any disease
in the hope of detecting the disease. This is
one of the methods for detecting a disease
early where the chance of cure is the
highest.

12. WHY SCREEN?
•Best chance of cure for breast cancer is to
treat it at its earliest stage
•The key to early detection is SCREENING
•Most women diagnosed with breast cancer
have no identifiable risk factors.
•Reduce mortality and morbidity
•Advances in treatment have improved the five-
year survival rate for women to 89%. And when
found early, that survival rate is 98%.

13. BI-RADS (Breast Imaging-Reporting and Data
System)
•BI-RADS® is
designed to
standardize
breast imaging
reporting and to
reduce confusion
in breast imaging
interpretations

14. MAMMOGRAM
•Gold standard
•Advantages:
•Best screening modality
available
•Demonstrates
•-microcalcification
•- lumps
•- architectural distortion
•Stereotactic biopsy
•Ductography
•Disadvantages:
•Radiation-Effective
absorbed dose is 0.7mSv
per study
•Compression
Note: Typical mammogram
is equal to 2 hours of
standing in the sun or 2
weeks of background
radiation.

17. 4 VIEW MAMMOGRAM
Cranio Caudal Medio Lateral Obliques

19. TYPES OF BREASTS
•a- The breast are almost
entirely fatty.
•Mammography is highly
sensitive in this setting.
•b- There are scattered areas of
fibroglandular density.
•c- The breasts are
heterogeneously dense, which
may obscure small masses.
•d - The breasts are extremely
dense, which lowers the
sensitivity of mammography.

20. Breast lumps

22. Compression/spot view

23. Microcalcification
Spot magnification view

24. MICROCALCIFICATION
DCIS :Intraductal
calcifications are
suspicious of
malignancy- BI-RADS 4
or 5.

25. Dense breasts

26. •USE SOUND WAVES
•PAINLESS
•TO COMPLEMENT
MAMMOGRAPHY
•IN YOUNGER PATIENTS

27. ULTRASOUND

29. Breast cysts

30. FIBROADENOMAS

32. Screening mammogram

33. Ductography
papilloma
DCIS

34. Mammo Digital Tomosynthesis
Tomosynthesis - a 3-dimensional technique. - an x-
ray source moves over an arc of excursion,
providing thin, tomographic slices, which are
reconstructed into 3-dimensional images.
This technique minimizes the effect of overlapping
structures in the breast.
The need for repeat mammograms may be reduced,
and clinicians may be able to detect cancers more
accurately, especially in patients with dense breasts.
Total radiation dose used tomosynthesis (1.0 mSv)
is higher than that used in conventional
mammography (0.5 mSv).

35. DIGITAL TOMOSYNTHESIS
•Less Compression
than standard
mammogram
•Xray tube moves in
an arc (tomogram)

37. Digital tomosynthesis
2D Mammogram DBT-Tomosynthesis

38. Magnetic Resonance Imaging
When to use?
•Dense breasts-strong family
history
•Occult cancer
•Implants & Injection Granulomata
•Inconclusive Mammo/US
(problem solving)
•Further evaluation after initial
diagnosis with Breast Cancer –
alter management
•Assess extent of disease
•Evaluate response to
Chemotherapy
•?Residual tumours &
Recurrence
•Biopsy Planning
•Axillary LN malignancy or
Cancer of unknown origin
•Differentiate between scarring
and breast cancer

39. Limitations
•NOT FOR ROUTINE
•High Cost Low availability
•“Excessive” Sensitivity
•Requires breast coil
•High end processing software
•Complement Mammo +/or ultrasound

40. MAGNETIC RESONANCE
IMAGING

41. MRI OF BREASTS

42. MRI

44. Ultrasound Guided Biopsy

46. Screening/diagnostic tests
•There are two different stages of testing.
•Screening tests (such as an annual
mammogram) look for signs of disease in
women without symptoms; they should be
part of every healthy woman's routine.
•Diagnostic tests become part of the picture
when breast cancer is suspected or has been
diagnosed.

47. MODALITIES USED
•Despite the advances of imaging
modalities available – the routine
modalities used are still:
•MAMMOGRAM
or
•ULTRASOUND
•MRI
OR
In combinations.

48. FLOW CHART
GUIDELINES

>40yrs < 40yrs
• Mammogram Ultrasound
• Normal Abnormal Normal Abnormal
• Reassurance Biopsy Reassurance Biopsy

49. Protocol for assessment of breast
diseases
•Breast lumps:
•< 40yrs-ultrasound of breasts
•>40yrs- mammograms +/- ultrasound

Nipple discharge
< 40yrs-ultrasound of breasts
>40yrs- mammograms +/- ultrasound
- ductography

50. TAKE HOME POINT!
•All women 40 and older should have a
yearly mammogram and clinical exam and
a monthly self-exam.
•Younger women should do self-exams each
month and have a clinical exam at least
every three years.

51. TAKE HOME POINT!
•The reality is, with today’s equipment, radiation is
minimal. It is far more dangerous not to find
breast cancer at its earliest stage than to be
exposed to a low dose of radiation.
•In addition:
“No woman has ever been shown to develop
breast cancer as a result of mammography” - Dr
Stephen Feig, Radiological Society of North
America, December 1997