Mammography: Breast Anatomy & Imaging Techniques.pdf

Mammography: Breast Anatomy & Imaging Techniques for mammographers

1. BreastBreast
AnatomyAnatomy
& Imaging& Imaging
TechniquesTechniques
Soft Tissue Imaging

2. MammographyMammography
radiographic examination of the breast.
X-ray mammography has proved to be an accurate and simple method of
detecting breast cancer, but it is not simple to perform.

3. History
1920s
As a distinct type of
radiographic examination,
mammography was first
attempted.
late 1950s
Robert Egan renewed
interest in mammography
with his demonstration of
a successful technique
that used low kVp, high
mAs, and direct film
exposure—no radiographic
intensifying screens.
1960s
Wolf and Ruzicka showed
that xeromammography
was superior to direct film
exposure at
a much lower patient
radiation dose.

4. History
1992
the US government
mandated regulations
in the Mammography
Quality Standards Act
(MQSA).
1990
Xeromammography was
retired because single
screen-film mammography
provided better images at
even lower patient
radiation dose.

5. Breast Cancer 2nd leading cause of death from
cancer in women
Approximately 260,000 new cases of breast
cancer and 40,000 deaths from breast cancer are
reported in the United States.
Basis of Mammography

6. In 1995 the National Cancer Institute reported
the first reduction in breast cancer mortality
in 50 years, and this trend continues. With
early mammographic diagnosis, more than
90% of patients are cured.

7. Chapter 23, Box 23-1, Bushong 10th Ed., Page 375

8. 50-69 y.o.: mortality reduction 16-35%
40-49 y.o.: mortality reduction 15-20%
–Lower incidence
–Rapidly growing tumors
–Dense breasts
Mortality Reduction

9. Screening
mammography
It is performed on
asymptomatic women with
the use of a two-view
protocol, usually medial
lateral oblique and cranial
caudad, to detect an
unsuspected cancer.
Screening mammography in
patients 50 years or older
reduces cancer mortality.
Types ofTypes of
MammographyMammography

11. Sensitivity in women > 50 y.o.
98%fatty breast
84% dense breasts
Specificity
82-98%
Diagnostic Accuracy of
Screening Mammography

12. Diagnostic
mammography
It is performed on patients
with symptoms or elevated
risk factors. Two or three
views of each breast
may be required.
Types ofTypes of
MammographyMammography

13. Surface AnatomySurface Anatomy
The breast is located on the anterior thoracic wall. It extends horizontally from
the lateral border of the sternum to the midaxillary line. Vertically, it spans
between the 2nd and 6th costal cartilages. It lies superficially to the pectoralis
major and serratus anterior muscles.
The breast can be considered to be composed of two regions:
Circular body –largest and most prominent part of the breast.
Axillary tail-smaller part, runs along the inferior lateral edge of the
pectoralis major towards the axillary fossa.

14. Surface AnatomySurface Anatomy
At the centr of the breast is the nipple, composed mostly of smooth muscle fibers.
Surrounding the nipple is a pigmented area of skin termed the AREOLAE. There are
numerous sebaceous glands within the areolae–the seen large during pregnancy,
secreting an oily substance that acts as a protective lubricant for the nipple.

16. Chapter 23, Fig. 23-1, Bushong 10th Ed., Page 376

17. Modified sweat glands. They consist of a series of
ducts and secretory lobules (15-20).
Each lobule consists of many alveoli drained by a
single lactiferous duct. These ducts converge at
the nipple like spokes of a wheel.
Mammary Gland

18. The connective tissue stromais a supporting structure which
surrounds the mammary glands. It has a fibrous and a fatty
component.
The fibrous stroma condenses to form suspensory ligaments
(of Cooper). These ligaments have two main functions:
Attach and secure the breast to the dermis and
underlying pectoral fascia.
Separate the secretory lobules of the breast.
Connective Tissue Stroma

19. The base of the breast lies on the pectoral fascia –a flat
sheet of connective tissue associated with the pectoralis
major muscle. It acts as an attachment point for the
suspensory ligaments.
There is a layer of loose connective tissue between the
breast and pectoral fascia–known as the retromammary
space. This is a potential space, often used in reconstructive
plastic surgery.
Pectoral Fascia

21. VasculatureVasculature
Arterial supply to the medial aspect of the breast is via the internal thoracic
artery (also known as internal mammary artery)–a branch of the subclavian
artery.
The lateral part of the breast receives blood from four vessels:
Lateral thoracic and thoracoacromial branches–originate from the axillary
artery.
Lateral mammary branches–originate from the posterior intercostal arteries
(derived from the aorta). They supply the lateral aspect of the breast in the
2nd 3rd and 4th intercostal spaces.
Mammary branch– originates from the anterior intercostal artery.
The veins of the breast correspond with the arteries, draining into the
axillary and internal thoracic veins.

22. LymphaticsLymphatics
The lymphatic drainage of the breast is of great clinical importance due to its
role in the metastasis of breast cancer cells.
There are three groups of lymph nodes that receive lymph from breast tissue–the
axillary nodes (75%), parasternal nodes (20%) and posterior intercostal nodes
(5%).
The skin of the breast also receives lymphatic drainage:
Skin–drains to the axillary, inferior deep cervical and infraclavicular nodes.
Nipple and areola–drains to the subareolar lymphatic plexus.

24. Nerve Supply
The breast is innervated by the anterior and lateral cutaneous branches of the
4th to 6th inter costal nerves. These nerves contain both sensory and
autonomic nerve fibres (the autonomic fibres regulate smooth muscle and
blood vessel tone).
It should be noted that these nerves do not control the production and secretion
of milk. This is regulated by the hormones prolactin and oxytocin, which are
secreted from the pituitary gland.

26. PHYSIOLOGY
BREASTS ARE EXOCRINE
GLANDS WHOSE
PRIMARY FUNCTION IS
LACTATION DURING
PREGNANCY

27. Physiology
Amastia—complete absence of one or both
breasts.
Athelia—complete absence of the nipple.
Amazia—absence of the breast tissue with
presence of the nipple.
Nipple inversion—nipple inverts inward.
Polymastia—accessory or supernumerary
breast.
Polythelia—accessory nipple; most common
breast anomaly

28. Congenital Breast Anomalies