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Sunday, 22 July 2012

Breast Imaging

Brief notes (Radiologia-Frater Lorand)

Examination techniques:

Native film / digital mammography - 
  • High linear contrast resolution, makes differentiation bw structures of almost identical X-ray attenuation properties possible (fat, glands, connective tissue).
  • Small focus, fine granulation film are used.
  • Best time to perform it is in the second week of the menstrual cycle.
  • By compressing the breast the radiation burden also slightly decreases.
  • 45-65 year old females biannually.
  • High risk pt. if started menstruation before 12 years of age, or if entered menopause after 65 years of age. Pregnancy after 65 years of age. 
Contrast enhanced examinations:
  • Ductography: injection of iodinated (felszivodo) contrastagent
  • Pneumocystography: injection of air - for intra-cystic tumors
  • Allows for guided biopsy.
  • Helps in examining dense, fibrotic, glandular breasts.
  • Can be the initial examinations in patients <30.
  • Disadvantages: scar and tumor can give similar appearance, microcalcifications are not always visible.
  • Less linear contrast resolution compared to traditional mammography.
  • Used to differentiate between scar and tumor, to assess implants.
  • Deeply situated lesions, close to the pectoral muscle.
Nuclear medicine:
  • To detect small, non palpable lesions.
  • To detect lymphatic spread.
Invasive diagnostics:
  • Fine needle biopsy: cytology and cellular analysis.
  • Core biopsy: if the result of the above is not decisive.
  • Cyst puncture: air injected, stops refilling.
Benign tumors:
  •  Fibroadenoma:
Most common, looks like a cyst on a mammogram, oval, sometimes lobulated, sometimes has large calcifications, if > 2 cm then remove it.
  • Lipoma:
  • Intraductal papilloma: 
Can turn malignant. Located in the ducts.

Malignant tumors:
  • Intraductal carcinoma - most common
  • Lobular, medullary, mucinous, and papillary tumors are less common
  • Features: spiculated, blurred contour, microcalcifications, intraductal calcifications, decreased echogenicity on US.
  • Sarcomas: are extremly rare.
  • Source of metastases to the breasts: LUNGS, MELANOMA, LYMPHOMA (mostly non-Hodgkin). 

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