Introduction to Clinical Radiology: The Breast Priscilla J. Slanetz MD, MPH Assistant Professor of Radiology

Imaging Strategies: The Breast Mammography and ultrasound are the two primary modalities for imaging the breast Selected clinical scenarios utilize MR, CT and/or nuclear imaging Percutaneous biopsies can be guided by stereotaxis, ultrasound, CT or MR

Imaging Strategies: Basics of Mammographic Interpretation Overview – breast density, positioning, quality control Look for masses, calcifications, and asymmetries If present, Mass/asymmetry -- shape, margins, size, density, and location Spiculated, irregular and high density suggestive of malignancy Calcifications – morphology and distribution Pleomorphic linear branching clustered calcifications suggestive of malignancy BIRADS Assessment (0 → 6) BIRADS 0 need additional imaging work-up BIRADS 1 and 2 typically all set BIRADS 3 need short interval follow-up imaging BIRADS 4 and 5 usually warrant biopsy BIRADS 6 is known malignancy

Standard mammographic projections The Medio-Lateral Oblique (MLO) view The Cranio-Caudal (CC) view Note that the view is named for the orientation of the x-ray tube (which determines the polarization of the beam) with respect to the breast

The Breast…Clinical Approach quadrants in the breast any finding (palpable lump, scar, etc… is noted on schematic always show the patient where you are concerned

Imaging Strategies: The Breast Indications: Screening (asymptomatic) Symptomatic (lump, thickening, pain, discharge) Mammography Screening Annually beginning at age 40 years; earlier if higher risk Diagnostic (symptomatic patient – pain, lump, discharge) Ultrasound To evaluate a palpable abnormality or to further characterize a finding on mammography Magnetic resonance imaging (MR) To assess silicone implant integrity, evaluate cancer extent, screen high-risk women, and problem solving tool

42 year old with a palpable lump… Mammography first, then… An ultrasound reveals a round mass which is completely anechoic consistent with a simple cyst RMLO RCC

An irregular shaped mass is seen on the mammogram. 54 year old with left breast lump 48 year old with a lump… An irregular shaped mass is seen on the mammogram.

MR of both breasts detected the known invasive ductal cancer in the left breast and a contralateral invasive ductal cancer in the right breast

The End