BREAST IMAGING Claudia E. Galbo,M.D. USUHS Department of Radiology and Radiological Sciences

Breast Studies Film-Screen Mammography: Screening and Diagnostic Ultrasound Digital Mammography Computer Aided Diagnosis Nuclear Medicine MRI CT Galactography

Procedures Needle Placement for Excisional Biopsy US-guided Aspirations US-guided Core Biopsies Stereotactic Core Biopsies

Mammogram Standard Views Cranio-caudal View (CC) Medial-lateral Oblique (MLO)

Digital Mammography More inherent contrast than film-screen Post-processing will save on patient dose Telemammography option is an advantage Optical disc storage of images eliminates film loss At present time, resolution is better for film screen

Sensitivity of Mammography 85% - 90% in fatty replaced breasts 65% in dense breasts

Mammography Technique Resolution is the important imaging parameter needed to detect microcalcifications Contrast is the important parameter needed to detect masses

Primary Signs of Cancer on Mammography Mass Calcifications

Secondary Signs of Cancer on Mammography Nipple Inversion Architectural Distortion Skin Thickening Axillary Adenopathy Skin Retraction Tissue Asymmetry Developing “Neodensity”

American College of Radiology Screening Mammography Guidelines Baseline Mammogram by age 40 Mammogram every year after 40 Clinical Breast Examination every year after 40

MQSA Mammography Quality Standards Act Passed 1992,Implemented 1OCT1994 Federal quality standards Must be met to legally operate in the U.S.

Stereotactic/US Core Biopsy Less invasive, more economical, more efficient than excisional biopsy of the breast 11 and 14 guage needle core samples obtained As accurate as excisional biopsy

Core Biopsies Patient is supine for US core biopsies Patient is prone for most stereotactic core biopsies Stereo procedures usually are used to sample calcifications; US cores are used to sample masses

Mammography Dose Limit The FDA dose limit for a single view mammogram is 300mRAD