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

Ultrasound: 

• 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.

MRI:

• Less linear contrast resolution compared to traditional mammography.
• Used to differentiate between scar and tumor, to assess implants.

CT:

• 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).