brief intro to mammography for medical students

1. MAMMOGRAPHY
DR. HADEYA ANJUM (PT)
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2. What is a Mammogram
• A mammogram is an x-ray exam of
the breast to detect and evaluate any
change in the breast
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3. History
 X-rays were first used to examine breast tissue by the
German surgeon ALBERT SALOMON about a century ago
• Modern mammography came in to existence since the late
1960s
• Technology has advanced and today’s machine is different
even from those of 1980s and 1990s
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4. Mammography machine
• Today’s mammography machine expose the breast to much
less radiation
• X-rays do not go through tissue as easily as those used for
routine chest x-ray or x-rays of extremity
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5. Radiation from mammogram
• Modern machine is safe and uses the lowest dose of radiation
possible.
• If a woman with breast cancer is treated with radiation, she will get
several thousand rads.
• If she has yearly mammogram starting at age of 40 and continues
until 90 she will get total of 20-40 rads.
• Benefits of mammography outweigh any possible harm from the
radiation exposure
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6. Types of mammogram
• Screening mammogram
• Diagnostic mammogram
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7. Screening mammogram
• Mammogram of the breast for the women who have no sign
or symptom of breast cancer, usually with two x-ray views
• Finding breast cancer early, greatly improves a woman’s
chance for successful treatment
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8. Diagnostic mammogram
• X-ray of the breast for a woman with breast problem like lump
or nipple discharge or an abnormal area found in screening
by taking spot view or magnification view
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9. What diagnostic mammogram does ?
• It may reveal that an area that looked abnormal on screening
is actually NORMAL—routine checkup
• It could reveal that an area of abnormal tissue probably is
NOT CANCER but radiologist may not ready to say it normal
based on these x-rays--- re-check up in 4-6 months
• The results could also suggest that a biopsy is needed to find
out if the abnormal area is CANCER
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10. Types of mammogram machine
• Screen - film units
• Full - field digital mammography units (better in woman
younger than 50 or with dense breast tissue)
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11. How is mammogram done
Breast is briefly compressed between
2 plates attached to the mammogram
machine–
an adjustable plastic plate on top and
a fixed plate on bottom which holds
the x-ray film or the digital detector
that makes the image
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12. Typical views
• For screening:
Cranio- caudal view (CC)
Medio-lateral oblique(MLO)
• For diagnostic:
CC MLO – lateromedial (from side towards center of chest) –
mediolateral (from the center of the chest out) - Spot compression
view
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13. Craniocaudal view
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15. Mediolateral oblique view
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17. How to read mammogram
• Its challenging must be interpreted by radiologist
• Must to compare with previous mammogram
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18. Changes in breast tissue
• Calcification:
macrocalcification & microcalcification
• Mass
• Breast density
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19. Calcification (macro)
• Due to changes in breast caused by aging of breast arteries,
old injuries or inflammation
• Coarse/ large Calcium deposit
• Seen in 1 0f 10 women under 50 and about half over 50
• These deposits are related to Noncancerous condition and do
not require biopsy
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20. Calcification (micro)
• Tiny specks of calcium
• If seen it’s a matter of concern though not necessarily it is
cancer or does not mean biopsy
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21. Mass
• Mass with or without calcification
• Noncancerous mass:
Cystic – fluid filled sacs/ simple cyst
Solid – Fibro adenoma
• Complex or mixed mass: suspect cancer needs Fine Needle
Aspiration Cytology or biopsy Breast ultrasound is complementary
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22. Breast density
Density is based on:
• how much fibrous and glandular tissue
• how is the distribution within breast tissue
• how is breast made up of fatty tissue
• Dense breasts are not abnormal but they are linked to higher
risk of breast cancer
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23. Findings on mammogram
• Primary signs of breast cancer may include spiculated
masses or clustered pleomorphic microcalcification
• Secondary signs of breast cancer may include asymmetrical
tissue density, skin thickening or retraction or focal distortion
of tissue
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25. Impression
• Overall assessment of the radiological findings often includes
a classification of the mammogram using the BI-RADS
system developed by the American College Of
Radiology(ACR)
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26. Normal mammogram
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27. Mass on mammogram
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28. Recommendation
• No action necessary
• A six month follow up mammogram
• Spot views
• Breast ultrasound
• Biopsy etc
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29. Limitations of mammography
• Breast cancer screening is the best way to find cancer early
but finding cancer early does not always reduce a woman’s
chance of dying from breast cancer
• Detecting breast cancer early may not help prolong the life of
a woman who has other kind of serious or life threatening
health problem like CCF, ESRD, COPD…
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30. False negative results
• A false-negative mammogram appears normal even though
with breast cancer
• It occurs more often among younger women usually had
dense breast
• False-negative results can delay treatment and promote a
false sense of security for the woman Overall, screening
mammogram miss about 1 in 5 breast cancers
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31. False positive results
• A false- positive mammogram looks abnormal but no cancer
is actually present
• It requires diagnostic mammogram, ultrasound, MRI or even
biopsy
• It is common in younger woman, have dense breast, have
had breast biopsy or cancer in family or are taking estrogen
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32. Tomosynthesis
• Newer technique
• Basically it is an extension of digital mammogram
• Breast is compressed once, machine takes many low dose x-
rays as it moves over the breast in an arc, images can then be
combined into a 3-dimensional picture
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34. Mammogram report
• Patient information
• Clinical history
• Procedure: Screening or Diagnostic
• Findings: mass, calcification, asymmetry architectural distortion or
associated lesion
• Comparison to previous study/Any U/S
• Impression/ Final assessment
• Management Recommendation
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35. Expert quote
“Before you go to get a mammogram, make sure you know whether you're there
for a screening mammogram or a diagnostic mammogram. If you're there for
your annual screening mammogram, you may not meet with the radiologist or
get your results the same day. Sometimes, there's an advantage to this. Getting
your results later often means having two doctors look at your mammogram. A
lump, pain, nipple discharge, breast implants, or breast surgery automatically
make your mammogram diagnostic. If you have a lump, or other symptoms, tell
the mammography center so they know what they're dealing with.”
-- Susan Greenstein Orel, M.D
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36. 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 36

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38. Gynecomastia
• It 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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