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Mammogram Procedure, Types, and Findings
- 1. Mammogram Dr. D. Padmaraju DNB Surgical Oncology (First year) drpadmaraju45@gmail.com 2.10.2019
- 2. Topics Definiton Anatomy History Machine and Radiation Types of mammography Procedure and views Indications Contraindications Sensitivity, specificity, positive and negative predictive value Advantage Disadvantage How to read Differential diagnosis Reporting - BIRADS Recent advances Male mammography
- 3. Definition Mammogram is a X ray examination of the breast to detect and evaluate any change in the breast
- 4. Anatomy
- 5. History WILHELM CONRAD RONTGEN ALBERT SALOMON
- 6. Machine
- 7. Types of mammogram machine Screen film units Full field digital mammography units
- 8. Radiation from mammogram Modern machine is safe and uses the lowest doses of radiation possible
- 10. Procedure
- 11. Radiographic Views Standared view Cranio caudal view Medio lateral oblique view (Lundgrens view) Additional views Latero medial view Medio lateral view Spot compression view Extended CCV (Cleopatras view) Axillary view Cleavage view Paddle compression view Magnification view Eklund view (breast implant)
- 14. Why Compression ? Holding breast away from chest wall permits projection of most tissue & decreases noise from chest wall structure Less motion results in clearer edges (less blurring) Decrease in dose due to reducing thickness through which radiation has to pass Separates overlapping structure Minimizes geometric unsharpness More uniform thickness and uniform exposure
- 17. Sensitivity, specificity, positive and negative predictive value
- 19. Breast density is the most important factor determining the sensitivity of the mammography
- 20. Long interval
- 21. Advantages of Digital Mammography Exposure can be tailored to enhance tissue contrast Faster image acquisition - shorter examination time Improved contrast - better delineation of parenchyma & subcutaneous tissue Reproducibility Electronic transmission ( Tele-mammography) Less storage space
- 22. Disadvantage 20% of breast cancer missed by the mammogram False- positive results Younger woman Dense breast History of Breast biopsy Family H/O breast cancer Taking oestrogen Mammogram after BCT
- 23. How to read Ideal mammography Normal findings and abnormal findings Breast density Mass Calcification
- 24. Ideal film
- 25. Fibro glandular breast Fibrofatty breast Fatty breast
- 29. Mass Number, site, size, shape, margin, halo, homogenous or heterogenous
- 30. Calcification Macrocalcification Aging of arteries Old injuries Inflammation Coarse and large
- 31. Microcalcification Tiny specks of calcium May or may not be cancer
- 37. Findings on mammography for malignancy Primary signs Spiculated masses Clustered pleomorphic microcalcification Secondary signs Asymmetrical tissue density Skin thickening and Retraction Focal distortion of tissue
- 38. Spiculated or stellate mass Architectural distortion
- 39. Category Description EXAMPLES Next step in evaulation 0 Incomplete Need additional imaging evaluation, comparison with previous examinations Asymmetry Mass calcifications Special mammographic views, ultrasonography, magnetic resonance imaging; obtain previous examinations 1 Negative Normal mammography Routine screening 2 Benign finding Intramammary lymph node, oil cyst, vascular calcifications, calcifying fibroadenoma Routine screening 3 Probably benign finding Benign-appearing solid mass or clustered calcifications Follow-up imaging (mammography or ultrasonography) at six and 12 months 4 Suspicious abnormality Complex or solid mass, indeterminate clustered calcifications FNAC, percutaneous or surgical biopsy 5 Highly suggestive of malignancy Spiculated mass Percutaneous or surgical biopsy 6 Known malignancy Biopsy-proven Definitive surgery, chemotherapy, radiation therapy
- 41. Recent advances TOMOSYNTHESIS 3D mammography Scintimammography/MBI (molecular breast imaging) /Breast specific gamma imaging Electrical Impedance imaging Optical imaging PET mammography Thermal imaging
- 42. TOMOSYNTHESIS 3D mammography – arc
- 44. Scintimammography/ MBI Radioactive tracer technetium sestamibi is given IV, it attaches to breast cells and detected by Gamma camera
- 45. Electrical Impedance imaging breast cancer cells conduct electricity in a different way than normal cells
- 47. Optical imaging
- 48. PET mammography
- 49. Thermal imaging
- 53. Thank you