Radiology day 1 mammography

X Ray Mammography and USG Mammography and its role in Breast Cancer and other related lesions

1. DR. VIBHAY PAREEK
RADIATION ONCOLOGY
JUPITER HOSPITAL
BREAST MAMMOGRAPHY

2. ANATOMY OF THE BREAST
•Vary In Shape & Size
•Cone Shaped With The Post Surface
(Base) Overlying The Pectoralis &
Serratus Muscles
•Axillaries Tail Extends From Lat. Base Of
The Breasts To Axillaries Fossa
•Tapers Ant. From The Base Ending In
Nipple, Surrounded By Areola
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3. •Consists Of 15-20 Lobes
•Divide Into Several Lobules
•Lobules Contain Acini, Draining Ducts And
Interlobular Connective Tissue.
•By Teenage Years Each Breast Contains
Hundreds Of Lobules
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4. •Breast Profile:
•A Ducts
•B Lobules
•C Dilated Section Of Duct To Hold Milk
•D Nipple
•E Fat
•F Pectoralis Major Muscle
•G Chest Wall/Rib Cage
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Enlargement:
•A Normal Duct Cells
•B Basement Membrane
•C Lumen (Center Of Duct)
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5. •Lymph Node Areas Adjacent To Breast Area.
•A Pectoralis Major Muscle
•B Axillary Lymph Nodes: Levels
•C Axillary Lymph Nodes: Levels
•D Axillary Lymph Nodes: Levels
•E Supraclavicular Lymph Nodes
•F Internal Mammary Lymph Nodes
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6. LYMPH NODES
Lymphatic Vessels Of The Breast Drain
Laterally And Medially
•Laterally Into The Axillary Lymph
Nodes (C & D)
•75& Drain Toward Axilla
•Medially Into The Mammary Lymph
Nodes
•25% Toward Mammary Chain (F)
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7. QUADRANTS OF THE BREAST
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8. Types Of Breast Tissue
Glandular
•Ducts
•Lobes
•Lobules
•TDLU
Stromal
•Fatty Tissue
•Connective Tissue
•(Cooper’s Ligaments – Suspensatory
Ligaments
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3 Tissue Types

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12. EQUIPMENT

13. • CC - CRANIO CAUDAD
• MLO – MEDIOLATERAL OBLIQUE
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POSITIONING

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Compression Important:
Evens Density of Breast
Reduces Motion
AEC choice depends of size and
composition of breast

22. CC
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MLO – RT BREAST

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31. TRUE LAT CONE-MAG
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33. MAGNIFICATION = INCREASE OID
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34. BREAST CHANGES WITH AGE
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Breast Classifications

35. FIBRO-GLANDULAR BREAST
•Fibro-glandular
•Dense With Very Little Fat
•Females 15-30 Years Of Age
•Or 30 Years Or Older Without Children
•Pregnant Or Lactating
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36. FIBRO-FATTY BREAST
•Fibro-fatty
•Average Density
•50% Fat & 50% Fibro-glandular
•Women 30-50 Years Of Age
•Or Women With 3 Or More Children
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37. FATTY BREAST
•Fatty
•Minimal Density
•Women 50 And Older
(Postmenopausal), Men And Children
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38. THE MALE BREAST
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Male Mammography and Cancer

39. GYNECOMASTIA
•Benign Excessive Development Of Male Mammary Gland
•Occurs In 40% Of Male Cancer Pt’s
•Survival Rates With Treatment Are 97% For 5 Years
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40. •Most Common Causes :
•Puberty (Hormonal Growth And Changes During
Adolescence)
•Estrogen Exposure (Female Hormone Present In The Body
And The Environment)
•Androgen Exposure (Body-building Hormones)
•Marijuana Use
•Medication Side Effects (Older Men)
•Klinefelter's Syndrome
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41. GYNECOMASTIA
•Is A Benign Male Breast (Non-cancerous) Condition
•Some Men Who Have Prominent Breasts, Or Uneven Breasts, Often Feel
Some Embarrassment About Their Body Image.
•This Condition Can Also Cause Emotional Conflict Over Sexual Identity.
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43. MALE BREAST
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44. MALE MAMMOGRAPHY
•1300 MEN GET BREAST CANCER PER YEAR
•1/3 DIE
•MOST ARE 60 YEARS OR OLDER
•NEARLY ALL ARE PRIMARY TUMORS
•SYMPTOMS INCLUDE:
•NIPPLE RETRACTION
•CRUSTING
•DISCHARGE
•ULCERATION
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45. MALE MASTECTOMY
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46. BREAST IMPLANTS
IS IT WORTH THE RISK?
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47. COMPLICATION WITH BREAST
AUGMENTATION
•mammography has a 80-90% true positive rate for detecting breast
cancer in those women without implants
•decreases to 60% with implants
•because 85% of breast tissue is obscured
•more images are needed than the standard two projections
•there is a risk of rupturing the implant
•loss of sensation from surgical scars
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48. ELKLAND METHOD FOR IMAGING
WITH BREAST IMPLANTS
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50. “PUSH BACK” TECHNIQUE
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ULTRASOUND OF BREAST

54. APPLICATIONS
•Not Always Detect Cancers That Are Visualised Mammographically.
•Ultrasound Can Detect Clinically And Mammographically Occult Cancers
Particularly When There Is A Higher Possibility Of Cancer.
•New High-frequency Transducers
•Irregular Masses, Abnormal Dilated Ducts Or Clustered Foci Of Increased
Echogenicity With Increased Doppler Vascularity.

55. Patient PositionPatient Position
Medial LesionsMedial Lesions
•Patient Is Supine
•Ipsilateral Arm Is Placed Over The Patient’s Head.
Lateral LesionsLateral Lesions
•Patient Is Opposite.
Superior LesionsSuperior Lesions
•Patient Is SITTING

56. Apply Gentle Uniform Pressure With The Ultrasound Apply Gentle Uniform Pressure With The Ultrasound
TransducerTransducer
Increase Transducer Pressure For:
– Greater Penetration
– Scanning The Subareolar Region.
Scanning Is Done In Three Directions.
1.Radial
2.Transverse
3.Longitudinal

57. •Localization Is By The Clock Face.
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3
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Lymph Node
• Solid nodule
• Ovoid
• Echogenic fatty hilum

64. •The Subcutaneous Fat LayerSubcutaneous Fat Layer Is Demonstrated Superficially As
Hypoechoic Tissue Compared To The Glandular Tissue From Which It Is
Separated By A Well-defined Scalloped Margin.
•Normal Ducts Ducts Are Often Visible, Particularly In The Subareolar Region,
As Anechoic Tubular Structures.
•Deep To The Glandular Tissue, A Retromammary Fat LayerA Retromammary Fat Layer Is Usually
Visible And, Behind This, The Structures Of The Chest WallChest Wall.
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65. •Symptomatic Breast Lumps In Women Aged Less Than 35 Years.
•Breast Lump Developing During Pregnancy Or Lactation.
•Assessment Of Mammographic Abnormality (± Further Mammographic
Views)
•Assessment Of MRI Or Scintimammography Detected Lesions.
•Clinical Breast Mass With Negative Mammograms.
•Breast Inflammation.
•The Augmented Breast (Together With MRI).
•Breast Lump In A Male (Together With Mammography).
•Guidance Of Needle Biopsy Or Localisation.
•Follow-up Of Breast Cancer Treated With Adjuvant Chemotherapy.
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66. Benign CharacteristicsBenign Characteristics
•Ellipsoid Shape
•Thin Definable Capsule
•Two Or Three Lobulations
•Hyperechogenicity.

67. SOLID MASS - MALIGNANT
• Irregular Shape
• Irregular/Ill-defined Borders
• Almost Anechoic
• Angular Margin
• Taller Than Wide

68. Irregular shape
• Irregular/ill-defined borders
• Almost anechoic
• Thick echogenic rim
• Posterior shadowing

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Simple Cysts
– Anechoic
– Smooth, Thin Margins
– Posterior Acoustic Enhancement

70. Benign Malignant
Shape Oval/ellipsoid Variable
Alignment Wider than deep; aligned parallel to
tissue planes
Deeper than wide
Margins Smooth/thin
echogenic pseudocapsule with
2-3 gentle lobulations
Irregular or spiculated; echogenic 'halo'
Echotexture Variable to intense hyperechogenicityLow-level
Marked hypoechogenicity
Homogeneity of
internal echoes
Uniform Non-uniform
Lateral
shadowing
Present Absent
Posterior effectMinimum attenuation/posterior
enhancement
Attenuation with obscured posterior margin
Other signs -------------- Calcification
Microlobulation
Intraductal extension
Infiltration across tissue planes and increased
echogenicity of surrounding fat

71. •The sonographic pattern varies with age and individually, and depends
on the amount and type of contents, i.e. fat, fibrous and glandular
tissues.
•The fibrous and glandular components are variably echogenic, while
fat is hypoechoic.

73. BI-RADS
•BIRADS Stands For Breast Imaging- Reporting And Data
System Which Is A Widely Accepted Risk Assessment And
Quality Assurance Tool In Mammography, Ultrasound And
MRI.
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75. BI-RADS ASSESSMENT CATEGORIES

76. MAMMOGRAPHY AND ULTRASOUND
LEXICON

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78. MASS
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A 'Mass' is a space occupying 3D lesion seen in two different
projections.
If a potential mass is seen in only a single projection it should be called
a 'asymmetry' until its three-dimensionality is confirmed.
Shape: oval (may include 2 or 3 lobulations), round or irregular
Margins: circumscribed, obscured, microlobulated, indistinct,
spiculated
Density: high, equal, low or fat-containing.

79. SHAPE
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