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Radiology day 1 mammography
- 1. DR. VIBHAY PAREEK RADIATIONONCOLOGY JUPITER HOSPITAL BREAST MAMMOGRAPHY
- 2. ANATOMY OF THEBREAST • 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 2
- 3. • Consists Of15-20 Lobes • Divide Into Several Lobules • Lobules Contain Acini, Draining Ducts And Interlobular Connective Tissue. • By Teenage Years Each Breast Contains Hundreds Of Lobules 3
- 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 • Enlargement: • A Normal Duct Cells • B Basement Membrane • C Lumen (Center Of Duct) 4
- 5. • Lymph NodeAreas 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 5
- 6. LYMPH NODES Lymphatic VesselsOf 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) 6
- 7. QUADRANTS OF THEBREAST 7
- 8. Types Of BreastTissue Glandular • Ducts • Lobes • Lobules • TDLU Stromal • Fatty Tissue • Connective Tissue • (Cooper’s Ligaments – Suspensatory Ligaments 8
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- 13. • CC -CRANIO CAUDAD • MLO – MEDIOLATERAL OBLIQUE 13 POSITIONING
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- 21. 21 Compression Important: Evens Densityof Breast Reduces Motion AEC choice depends of size and composition of breast
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- 26. 26 MLO – RTBREAST
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- 33. MAGNIFICATION = INCREASEOID 33
- 34. BREAST CHANGES WITHAGE 34 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 35
- 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 36
- 37. FATTY BREAST • Fatty •Minimal Density • Women 50 And Older (Postmenopausal), Men And Children 37
- 38. THE MALE BREAST 38 MaleMammography and Cancer
- 39. GYNECOMASTIA • Benign ExcessiveDevelopment Of Male Mammary Gland • Occurs In 40% Of Male Cancer Pt’s • Survival Rates With Treatment Are 97% For 5 Years 39
- 40. • Most CommonCauses : • 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 40
- 41. GYNECOMASTIA • Is ABenign 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. 41
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- 44. MALE MAMMOGRAPHY • 1300MEN 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 44
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- 46. BREAST IMPLANTS IS ITWORTH THE RISK? 46
- 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 47
- 48. ELKLAND METHOD FORIMAGING WITH BREAST IMPLANTS 48
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- 54. APPLICATIONS • Not AlwaysDetect 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 MedialLesionsMedial 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 UniformPressure With The UltrasoundApply 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 IsBy The Clock Face. 12 3 66 39
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- 63. 63 Lymph Node • Solidnodule • Ovoid • Echogenic fatty hilum
- 64. • The SubcutaneousFat 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 DuctsDucts 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. 64
- 65. • Symptomatic BreastLumps 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. 65
- 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-definedborders • Almost anechoic • Thick echogenic rim • Posterior shadowing
- 69. 69 Simple Cysts – Anechoic –Smooth, Thin Margins – Posterior Acoustic Enhancement
- 70. Benign Malignant Shape Oval/ellipsoidVariable 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 hyperechogenicity Low-level Marked hypoechogenicity Homogeneity of internal echoes Uniform Non-uniform Lateral shadowing Present Absent Posterior effect Minimum 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 sonographicpattern 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 StandsFor Breast Imaging- Reporting And Data System Which Is A Widely Accepted Risk Assessment And Quality Assurance Tool In Mammography, Ultrasound And MRI. 73
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- 78. MASS 78 A 'Mass' isa 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.
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Editor's Notes
- #7 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