Breast
radiology
Presented by: Noura Jamal &
Rahma Jaber
Supervised by : Dr. Jeen Shahab
Introduction
Imaging of the breast is undertaken as part
of a comprehensive evaluation of this
organ, integrating the patient’s history,
clinical signs, and symptoms.
The primary purpose of breast imaging is to
detect breast carcinoma. A secondary
purpose is to evaluate benign disease, such
as cyst formation, infection, implant
complication, and trauma.
Film-screen and Digital Radiography
(Radiomammography)
The film-screen mammogram is created
with x-rays, radiographic film, and
intensifying screens adjacent to the film
within the cassette.
The routine examination consists of two
views of each breast, the craniocaudal (C-
C) “top-down” view and the mediolateral
oblique (MLO) view angled view from the
side with a total of four films
sensitivity of radiomammography ranges
from 85% to 95%.
Film-screen and Digital Radiography
(Radiomammography)
Limitations
Sensitivity is limited by three factors:
(1) the nature of breast parenchyma,
(2) the difficulty in positioning the organ for
imaging, and (3) the nature of breast
carcinoma.
Very dense breast tissue may obscure
masses lying within adjacent tissue. Masses
are more easily detected in a fatty breast.
Film-screen and Digital Radiography
(Radiomammography)
Screening Mammography
The standard mammogram (along with
appropriate history-taking) makes up the
entire screening mammogram. The
indication for this examination is the
search for occult carcinoma in an
asymptomatic patient
Film-screen and Digital Radiography
(Radiomammography)
Diagnostic Mammography
Indications: are (1) a palpable mass or
other symptom or sign (eg, skin dimpling,
nipple retraction, or nipple discharge that
is clear or bloody), and (2) a radiographic
abnormality on a screening mammogram.
Additionally, patients with a personal
history of breast cancer may be
considered in the diagnostic category.
Ultrasonography
US is useful in the evaluation of palpable
masses that are mammographically occult,
of clinically suspected breast lesions in
women younger than 30 years, and of
many abnormalities seen on mammograms
Ultrasonography
Major indications include the following:
Palpable mass
Focal abnormality on mammography
Breast pain
Nipple discharge
Follow-up of lesions not biopsied (mostly BIRADS-3
lesions)
Determination of lesion extent in patients with
suspicious or malignant nodules
Assessment of regional lymph nodes in patients
with suspicious or malignant lesions
Guiding interventional procedures
Ultrasonography
Ultra- sonography is a highly reliable
technique for differentiating cystic from
solid masses. If criteria for a simple cyst
are met, the diagnosis is over 99%
accurate.
A limitation of ultrasonography is that it is
very operator- dependent. Also, it images
only a small part of the breast at any one
moment. Therefore, an overall inclusive
survey is not possible in one image, and
lesions may easily be missed.
Ultrasonography
The skin, premammary and retromammary
fasciae, trabecu- lae, walls of ducts and
vessels, and pectoral fasciae are well seen as
linear structures. The glandular and fat lobules
are oval, of varying sizes, and hypoechoic
relative to the sur- rounding connective tissue.
Simple cysts are anechoic (echo-free) and
have thin, smooth walls. Increased
echogenicity is seen deep to cysts
(enhanced through-transmission).
Most solid masses are hypoechoic relative
to surrounding breast tissue.
Benign vs malignant
Benign US features include few (two or
three) gentle lobulations, ellipsoid shape,
and a thin capsule, as well as a
homogeneously echogenic echotexture.
Malignant US features include spiculation,
taller-than-wide orientation, angular
margins, ill-defined, microcalcifications, and
posterior acoustic shadowing.
Others
Magnetic resonance imaging
Ductography
Image-guided needle aspiration and biopsy
Exercises
A 34-year-old woman who
noticed a new lump in her
breast, which test should
be ordered first?
A. Screeningmammography
B. Excisionalbiopsy
C. Ultrasonography
D. Diagnostic mammography
E. Needleaspiration
A 60-year-old woman who, on the
insistence of her children, went for her
first routine physical examination in
many years. Her doctor found a mass
in her breast. Which test should be
ordered first?
A. Screeningmammography
B. Excisionalbiopsy
C. Ultrasonography
D. Diagnostic mammography
E. Needleaspiration
A 53-year-old woman thinks she feels a
hard nodule deep in her breast. Her
breasts
have al-ways been difficult to examine
because of their dense nodular texture.
What test should be ordered first?
A. Screeningmammography
B. Excisionalbiopsy
C. Ultrasonography
D. Diagnostic mammography
E. Needleaspiration
A 78-year-old woman with a soft, rounded
mass discovered during physical
examination , which one of the following
statements is true?
A. A 78-year-old will not likely benefit from
mammography.
B. Soft, rounded masses are benign and do not
require biopsy.
C. This mass should initially be aspirated with a
needle
D. If this mass is carcinoma, the patient will
probably die of this disease.
E. Her physical findings could easily be caused by a
lipoma
