Lec_3_ Techniques_19-3-25 (1).pdf.......

Digferent technique used for diagnosis

2. Clinical Imaging of Breast
Mammography
DR. MUHAMMAD JAMIL AKHTAR
Associate Professor, FAHS
University of Lahore

3. Course outline
⚫Introduction Breast imaging
⚫Breast anatomy
⚫Breast Imaging techniques
⚫Breast Sonography
⚫Mammography
–Physics
–Instrumentation
–Clinical application
⚫Radiology of breast lesions
⚫Breast & Sentinel node biopsy
⚫Case reporting

4. MRIMAMMOGRAPHY

5. MRI mammography
⚫MRIacts as a complementary imaging tool
⚫MRI give better soft tissue contrastand provide better detailed
information of lesion
⚫Primarily used to further evaluate suspicious findings detected
on mammograms, especially in high-risk individuals, by providing
detailed soft tissue contrast to better characterize breast lesions
and assess the extent of cancer, particularly when dense breast
tissue or breast implants might obscure details on mammography
alone;
⚫It's often used for pre-operative staging of breast cancer
⚫This can be valuable for detecting multifocal or multicentric
tumors that might be missed on other imaging modalities.

6. Key points about MRI in mammography:
1.High sensitivity for cancer detection:
–MRI is considered more sensitive than mammography in
detecting small breast cancers, especially in dense breasts or
in women with a high genetic risk of breast cancer.
2.Characterizing lesions:
–MRI can distinguish between benign and malignant breast
lesions based on their enhancement pattern after contrast
injection.
3.Staging of cancer:
–When a breast cancer is diagnosed, MRI can be used to
assess the extent of the tumor, including involvement of
nearby lymph nodes and to determine the optimal surgical
approach.
MRI mammography

7. 4.High-risk women:
–Women with a strong family history of breast cancer, genetic
mutations like BRCA, or dense breast tissue
5.Suspicious mammogram findings:
–When a mammogram shows an indeterminate lesion that
requires further evaluation
6.Post-surgical monitoring:
–To check for recurrence after breast cancer surgery
7.Not a primary screening tool:
–While highly sensitive, MRI is not typically used as the
primary screening tool due to its higher cost, longer scan
time, and potential for false positives, especially in women
with average risk.
–When MRI might be used in conjunction with
mammography:

9. The images on the left show a large, abnormally enhancing area in the left breast.
The CAD has detected some very small areas with type 3 washout (in red).
When you look at CAD images, take note of the worst (red) areas.
This was a large invasive ductal carcinoma.

10. Invasive lobular carcinoma with
heterogenous enhancement

11. Invasive ductal carcinoma with rim
enhancement

12. Axial T1C+ Fat sat

13. Axial T1C+ Fat sat

14. SCINTIMAMMOGRAPHY

15. Scintimammography
⚫Scintimammography is a relatively new imaging method
to demonstrate cancer tissue in the breast.
⚫A radiopharmaceutical agent (Tc-99m Sestamibi) is
administered intravenously and images of the breast are
taken under a Gamma Camera
⚫Scintimammography is also known as nuclear medicine
breast imaging, Breast Specific Gamma Imaging (BSGI)
and Molecular Breast Imaging (MBI).
⚫PET is another nuclear medicine modality used for
scintimammography for diagnostic problems and
staging and recurrence

16. Modalities
⚫Planner imaging
⚫SPECT
⚫PET
⚫Radioimmunoassay
⚫Hybrid Imaging
⚫SPRCT-CT
⚫PET-CT
Scintimammography

17. Indications
⚫High-risk patients with difficult mammographic evaluation
–(dense breasts, breast structural abnormalities, implants)
⚫Patients with multiple suspicious lesions or calcifications
⚫Lobular carcinoma
⚫Scars from previous biopsy visible on mammography
⚫Palpable breast mass, not detectable by mammography or ultrasound
staging
⚫Evaluation of response to pre-operative chemotherapy
⚫Detection of residual disease following mastectomy
⚫Patients with palpable axillary lymph nodes with unknown primary
focus
⚫Patients with potentially premalignant mammary conditions (pre-
and postchemopreventivetreatment)
⚫Patients with increased serum CGRP
⚫Selection of patients with metastatic breast cancer for treatment with
188Re(V)-DMSA
Scintimammography

18. Benefits
1.Scintimammography can reduce unnecessary
invasive procedures by helping doctors determine
whether a breast abnormality requires biopsy.
2.Scintimammography can detect breast cancer even
when dense breast tissue or breast implants are
present.
3.Scintimammography can be used for some patients
who cannot have a breast MRI.
* Scintimammography is not a primary screening tool.
* It does not replace mammography
Scintimammography

19. Risks
1.Low radiation exposure.
2.Thus, the potential benefits of an exam outweigh
the very low radiation risk.
3.Nuclear medicine has been used as diagnostic
procedures for more than six decades.
4.There are no known long-term adverse effects
from such low-dose exposure.
Scintimammography

20. Risks
1.Allergic reactions to radiotracers are extremely rare and
usually mild.
2.The radiotracer injection may cause slight pain and
redness. This should rapidly resolve.
3.Women should always tell their doctor and radiology
technologist if there is any possibility that they are
pregnant, or they are breastfeeding.
Scintimammography

22. THERMAL MAMMOGRAPHY

23. Thermal mammography
⚫Thermography uses an infrared camera to detect heat emissions
from the targeted body region.
⚫Thermography devices have only been cleared by the FDA as an
“adjunctive” tool, referring to use alongside a primary screening
test like mammography.
⚫Digital infrared thermal imaging is the thermography used to
diagnose breast cancer.
⚫This method shows high accuracy and is a cost-effective form of
diagnosis.
⚫Breast thermography has many advantages as it is non-invasive,
safe and painless.
⚫Thermography has not been shown to be effective as a stand
alone test for breast cancer screening and detecting early-stage
breast cancer

24. A mammogram (L) is an X-ray image of the breast that can identify tissue types with different
densities, such as masses within the breast. Thermography (R) produces an infrared image that
shows the patterns of heat on or near the surface of the body.

25. ❖The AMA, ACS and ACR recommends a
baseline mammogram by age 40, biannual
examinations between ages 40 and 50, and
yearly examinations after age 50
❖NCI recommends women in their 40s, 50s and
older should be screened every one to two years
with mammography
❖Breast Self Examination and Clinical Breast
Examination are used in the women under 40 yo
to detect palpable masses.
Recommendations

26. At 40 and older Breast Self Examination and
Clinical Breast Examination are used to
detect breast cancers not seen on a
mammogram because of technical
limitations, interval tumor growth or breast
cancers missed on the mammogram.
Recommendations

27. American Cancer Recommendations for
Screening Mammography
Begin screening at age 40 unless the woman
has a mother or sister who developed breast
cancer before menopause.
Screen annually.
No end age for screening mammography.
Recommendations

28. Take Home Points
⚫At 40 and older mammography is used to screen
for breast cancer in women without symptoms
⚫A mammogram can find breast cancer when it is
very small --2 to 3 years before you can feel it.
⚫No screening tool is 100% effective. Good quality
mammograms can find 85-90% of cancers.
Some cancers are not found until they reach this size
A mammogram can find cancer when it is only this size

30. THANK YOU