BREAST IMAGING

1
BREAST IMAGING

• MG, USS, MRI WHEN AND WHOM?
• Isabella Mor March 2005

2
Introduction

• Triple assessment cornerstone in work up of
  breast disease
• Clinical assessment
• Imaging
• Biopsy

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Mammogram

• Primary imaging for breast cancer screening and
  diagnosis
• Soft tissue xray of breast
• Standard views
• CC medial part of breast
• MLO lateral breast axillary tail

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Mammogram

• Extra views
• True lateral
• Coned/Compression

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Mammogram

• Intermediate density
• Fibroglandular tissue
• Ductal tissue
• Blood vessels
• LN

• Low density (dark)
• Fatty tissue
• High density (white)
• Calcification
• Silicone
• Foreign bodies

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Mammogram

• Assessment
• Symmetry
• Mass lesions
• Architectural distortions
• Microcalcifications

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Mammogram

• Benign
• Fibroadenoma / Cyst
• Oval - round
• Low-intermed density
• Hamartoma/Galactocoele
• Mixed density

• Benign calcs
• Cup saucer
• Round pinpoint

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Mammogram

• Suspicious

• Irregular
• Poorly defined
• Spiculated
• Architectural distortion
• Malignant microcalcs

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Mammogram

• Calcification
• Le Gal classification
• Malignant calcification is pleomorphic

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Ultrasound

• Primary modality in young patients
• Useful post radiotherapy and augment
• Operator dependent
• Blind spot deep to nipple

• Assess
• Mass lesions
• Areas of distortion
• Lymphadenopathy

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Ultrasound

• Assessment
• N tissue planes
• Skin 3mm
• Subcut fat
• Parenchyma - regular appearance of echogenic
  structures arranged in multiple layers parallel
  to the chest wall
• Solid or cystic
• Size/dimensions
• Surrounds

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Ultrasound

• Benign

• Smooth, regular outline
• Roundovalellipsoid
• Thin pseudocapsule
• Uniform internal echoes
• Cyst anechoic
• No destruction
• of planes

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Ultrasound

• Suspicious
• Irregular
• Hypoechoic
• Spiculation
• Taller than wide
• Shadowing
• Posterior enhancement/Halo
• Disruption of tissue planes

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Guided biopsy / Localisation

• Ultrasound guided
• Avoids radiation
• Real time confirmation of appropriate sample
• Periop loacalisation
• Stereotactic biopsy
• Microcalcification

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MRI

• Emerging technology
• No need to flatten breast

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MRI

• Contrast enhanced MRI gt90 sensitivity
• Detects small lesions, unseen by MMG
• Suitable for dense breasts
• Enhanced evaluation of augmented breast

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Breast Screen Australia

• Free screening mammograms
• Women 50-69yo
• Women 40-49yo and gt70yo when requested
• Detects cancer at early stage 25-30 survival
  benefit

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Conclusion

• MMG
• Invaluable screening tool
• Current standard of care
• USS
• Essential adjunct
• MRI
• Watch this space
• When
• From 40yo
• Whom
• All women

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References

• Bassett,L. Kim,C. Breast Imaging Mammography
  Ultrasonography Magnetic Resonance Imaging
  Clinics of North America 9(2)251-71 May 2001
• Bomalaski,J., Tabano,M., Hooper,L. Fiorica,J.
  Mammography Current Opinion in Obstetrics
  Gynecology 13(1)15-23, Feb 2001
• Goscin, C., Berman,C. Clark, R Magnetic Imaginf
  of the Breast Cancer Control 8(5)399-406,
  Sep-Oct 2001
• Morris E Screenin for Breast Cancer with MRI
  Seminars in Ultrasound, CT MRI 24(1)45-54,
  2003 Feb
• Orel,S. MR Imaging of the Breast Radiologic
  Clinics of North America 38(4)899-913, 2000 Jul
• Sivyer, P Registrar Training Lecture 2004
• Smith, J Andreopoulou E An Overview of the
  Status of Imaging Screeing Technology for Breast
  Cancer Annals of Oncology 15 Suppl 1 I18 I26,
  2004