This document discusses how to summarize key details in mammogram reports. It notes that the breast composition type (ACR type) should be reported first as it impacts sensitivity. Lesion location should be described as upper/lower in MLO view and outer/inner in CC view. Benign lesions typically have well-defined borders while malignant lesions have irregular borders. Microcalcifications can indicate malignancy and may require stereotactic biopsy. The document provides examples of summarizing different breast composition types, lesion features, and assessments.

1. Mammogrammy
Dr sabah

3. • Usually any calcification
distributed evenly in
both breasts is benign

4. Malignant calcifications

7. • Breast composition we have 4 types:
ACR type I  completely fatty
ACR type II  scanty fibroglandular tissue ( 75% fat, 25% glandular)
ACR type III  heterogenous dense breast (50% fat, 50% glandular)
ACR type IV  completely dense
1. First point in any report of mammogramy its important to mention the ACR
type because the sensitivity for detecting lesions will change.
• For example for ACR type I fatty breast sensitivity may reach 100% and so on.
• Mammogram is usually done after 35 years of age exception is obese patients.
2. Second point is to tell the view.
• We have two views MedioLaterOblique (MLO) view and CranioCaudal (CC) view.
• Pectoralis muscle should be seen on both views, in MLO the axilla should also be seen.
3. Location of the lesion.
• In MLO we draw a line from nipple to lower part of pectoralis muscle, upper to the line is the upper
part, below the line is the lower part. So in MLO we detect whether the lesion is UPPER or LOWER.
• In CC we draw a line from nipple to lower part of pectoralis muscle, upper to the line is outer part,
below the line is the inner part. So in CC we detect whether the lesion is OUTER or INNER.

8. Benign lesions on U/S:
• Have a well defined border
• Wider than taller
• There is posterior enhancement ( behind the lesion is white which means the lesion is
not too dense)
• In U/S we also look for any associated abnormality for example any associated
abnormal LAP.
• LN should be oval in shape with central fatty hilum (high echogenicity). If loss of
fatty hilum (hypoechoic) it is suspicious.
• Hyperechoic in Lipoma, Hypoechoic in Fibroadenoma and CA.
Malignant lesions of U/S:
• Irregular border (spikes), ill defined border.
• Lesion taller than wider
• Posterior shadow (behind the lesion is black because lesion is dense)
• In advanced stage may also have abnormal LN.

9. ACR type III

10. • ACR type I mainly fat
• The white line are cooper ligament

11. ACR type I

12. • Lesion in the outer part
• If lesion is located directly behind
the nipple we say it is retroareolar
and we calculate the distance from
the nipple and mention it.

13. • ACR type III
• Two well defined border round lesions
on CC located at the outer part of the
breast and on MLO its upper part.
• No surrounding spiking or irregularity or
architectural abnormality so it’s
definitely a benign lesion.
• Two cysts by U/S
• In any breast lesion we have to follow
the triad:
1. Clinical examination
2. <35 yr. U/S, >35yrs mammogram
3. Histopathology

14. Cont.
• It’s BIRAD 2
• It’s a benign lesion with all the features of benign lesion
• Features of benign lesion by mammography:
• Well-circumscribed, no surrounding spikes, skin normal no thickening, no associated nipple
retraction, no architectural disruption, no suspicious LAP.
• Features of malignant lesion by mammography:
• Very dense, large lesion, spikes, microcalcification, architectural distortion, irregularity in th
surrounding tissue, skin thickening or tethering, very prominent nipple retraction, any
associated LAP.
• Some lesions are intermediate you can not differentiate, send for biopsy.

15. • ACR type IV mainly glandular tissue
• Microcalcification clustered in on
area is highly suspicious it is
pleomorphic in the inner upper part
of breast
• In this case we cannot take biopsy
only taken under mammogram
called stereotactic biopsy.

16. • ACR type I
• Pectoralis muscle not seen so it’s
technically a bad image.
• Dense lesion, typical spikes ( a mass
invading normal tissue), not well
defined border, skin tethering, skin
thickening.
• Dense lymph node fatty hilum is lost.
(normal lymph node have central fatty
hilum)
• BIRAD 5
• Next step is Trucut biopsy
• Fibroadenoma is BIRAD 3, next either
follow up or biopsy or surgical
removal(excision)
• Fat necrosis is BIRAD 2