Breast imaging * Flashcards
where is the breast base anatomically
over 2nd-6th ribs midclavicularly
breast is anterior to what two muscles
deep pectoral fascia and low part serrates anterior
when is breast imaging used
lumps unilateral or blood stained nipple discharge skin tethering of dimpling signs of inflam axillary lumps screening
when should breast imaging not be used
pain
tenderness
symmetrical nodularity
when should someone with breast pain be imaged and which ix
associated focal/asym modulatory
USS is <40
XRM +/- >40
what is a mammogram
low dose x ray designed to specifically maximise contrast between the breast tissues whilst minimising radiation dose
why mammography
cost effect
non invasive exam
reproducible
reliably visualises microcalcificaions (<0.5mm)
types of mam
film/screen
digital (full field digital mammography FFDM)
what is a digital mam
who is digital mam best in
replaces film/screen combination
various image detectors
excellent contrast resolution
better in dense breasts,younger women
advantages of digital imaging
better contrast between dense and non dense tissues shorter exam fewer technical repeats fewer films easier image storage and transfer
indications for mam
screening
women >40 with palpable mass
to exclude/confirm malignancy and assess contralateral breast
when is a mam not indicated
women <40 screening or symptomatic
what should be present in a normal mam
skin and pores
fat of low density
glandular tissue of high density
trabeculae - think sharply defined
blood vessels +/- vascular calcifications
lymph nodes
calcifications - arteria, sebaceous glands (polo mints) eggshell curvilinear (oil cysts)
what are some normal calcifications seen on a mam
arterial, sebaceous glands (polo mints) eggshell curvilinear (oil cysts)
views for mam
mediolateral oblique (MLO)*
craniocaudal (CC)*
extended CC
laterally or medially rotated CC, rolled CCs true laterals axillary tail views localised compression or paddle views magnification views
MLO
best single view
table at 45 degrees off vertical
XR beam perpendicular to long axis breast
quality criteria for adequacy
CC
table horizontal
nipple in profiles
shows medial and most of lateral tissue not axillary tail
paddle view
very firm localised compression
less scatter more contrast
demonstration of bodies of mass
magnification views
for micro calcification
CC and lateral views
x 1.2 -2.0
breast density in normal mams
20% aged 30 have fatty breasts
40% aged 80 have dense breasts
BIRADS parenchymal patterns
a. nearly all fat
b. scattered fibroglandular densities (25-50%)
c. heterogeneously dense (51-75% glandular)
d. extremely dense (>75% glandular)
features of malignant calcifications
clutters or segmental
scattered or diffuse r usually benign
rhomboid forms
linear/branching/Y shaped forms
USS indications
characterisation of mamographic findings palpable lesions in women <40 nipple discharge breast implants or augmentation inflam conditions such as abscess evaluation of response to chemotherapy
USS equipment
high centre frequency 12-13MHz
linear phased array transuducer
cystic lesions
cysts - fluid collections
clustered cysts
complex cysts
aspirate
solid nodules that are benign
circumscribed hypo echoic/hyperechoic wider than they are tall homogenous peripheral/no vascularity often multiple
solid nodules that are malignant
poorly circumscribed hypoechoic heterogeneous taller than they are wide speculate oedema/peritumoral fat
types of elastography
MRI based
USS based
USS based elastography
sonoelasticity vibration)
single/multi step compression
sheer wave elastography
devices for vacuum assisted biopsy
mammotome
SUROS
EnCor
disadvantages of mam
decreased sensitivity in dense breasts so in over 50s
advantages of MRI
good contrast
no compression
no ionising radiation
accuracy independent of breast density
MRI contraindications
cardiac pacemakers, cochlear implants, ferromagnetic aneurysm clips, renal impairment
pregnancy, lactation
MRI indications
implants diagnosis of malig dx staging residual disease response assessment - chemo recurrent disease screening
MRI indications for screening
high risk groups:
previous irradicaition
BRCA 1, 2, TP53 mutation
personal history of breast cancer
