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BREAST: anatomy, imaging techniques & clinical/radiological cases
Istituto di Radiologia Ambra Sangiovanni
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ANATOMY
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Imaging techniques Mammography Ultrasound MRI
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Imaging techniques Mammography Ultrasound MRI
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MAMMOGRAPHY X-Ray compression indications:
annual screening in asymptomatic women ≥ 40y women of any age with symptoms, such as a breast lump, and nipple discharge, and in patients who have a history of breast cancer for guiding biopsy (Mammotome)
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MAMMOGRAPHY + US in case of dense breasts or to evaluate equivocal mammographic findings
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MAMMOGRAPHY + US in case of dense breasts or to evaluate equivocal mammographic findings
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MAMMOGRAPHY CRANIOCAUDAL view
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MAMMOGRAPHY CRANIOCAUDAL view ext ext int int
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MAMMOGRAPHY MEDIOLATERAL and MEDIOLATERAL OBLIQUE views
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MAMMOGRAPHY MEDIOLATERAL view up up inf inf
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MAMMOGRAPHY MEDIOLATERAL OBLIQUE view up up inf inf
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MAMMOGRAPHY - summary
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UPPER-EXTERNAL SECTOR
MAMMOGRAPHY - summary e.g. : which sector? external upper UPPER-EXTERNAL SECTOR
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MAMMOGRAPHY
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Imaging techniques Mammography Ultrasound MRI
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ULTRASOUND patient positioning: support elbow, flat, supine
probe: linear array 7-13 MHz
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ULTRASOUND mammary layer skin pre-mammary fat layer
retro-mammary layer muscle pectoralis rib
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ULTRASOUND indications:
young (usually under 30 years of age) or pregnant patient who is symptomatic
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ULTRASOUND indications:
to evaluate a palpable lump with negative or equivocal mammographic findings
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ULTRASOUND indications:
can help to distinguish between benign vs malignant characteristics ColorDoppler and PowerDoppler can help distinguish malignant from benign tumours
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ULTRASOUND BENIGN LESIONS well circumscribed shape
fibroadenoma fibroadenoma simple cyst BENIGN LESIONS well circumscribed shape no Color/Power Doppler signal inside the lesion
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ULTRASOUND MALIGNANT LESIONS irregular margins posterior shaddowing
Color/Power Doppler signal inside the lesion
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ULTRASOUND indications: for guiding biopsy
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ULTRASOUND indications: for evaluation of breast implants for rupture
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Imaging techniques Mammography Ultrasound MRI
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MRI Sequences used T1 T2 T1 C+ (Gd) : dynamic and kinetic analysis
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MRI Indications for breast MRI high risk screening :
personal/family history high risk lesions : ADH / ALH / LCIS BRCA1 / BRCA2 gene positivity mantle radiotherapy (>4 Gray) extent of disease (EOD) evaluation in ipsilateral and contralateral breast
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MRI Indications for breast MRI positive margins
neo-adjuvant chemotherapy: to assess residual disease metastatic axillary lymphadenopathy of unknown primary to assess chest wall invasion to assess for synchronous, multifocal or multicentric disease
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MRI T2w T1w fat sat T1w fat sat C+
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BIRADS CLASSIFICATION
BIRADS 0: incomplete, further imaging or information is required (e.g. compression, magnification, special mammographic views, ultrasound). BIRADS I: negative, symmetrical and no masses, architectural disturbances or suspicious calcifications present. BIRADS II: benign findings BIRADS III: probably benign, short interval follow-up suggested. BIRADS IV: suspicious abnormality BIRADS V: highly suggestive of malignancy (BIRADS VI: known biopsy proven malignancy)
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Annual screening; round calcified mass
CASE 1 Annual screening previous mammograms: known calcified round in the right breast Age: >40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
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Annual screening; round calcified mass
CASE 1 Annual screening previous mammograms: known calcified round in the right breast Age: >40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
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Annual screening; round calcified mass
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Annual screening; round calcified mass
round mass with coarse calcifications in the right breast stable for many years TYPICAL FIBROADENOMA
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Annual screening; round calcified mass
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Right breast lump CASE 2 Right breast lump Age: 71 years old
Gender: Female Race: Middle eastern First study? Ultrasound Mammography MRI w contrast
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Right breast lump CASE 2 Right breast lump Age: 71 years old
Gender: Female Race: Middle eastern First study? Ultrasound Mammography MRI w contrast
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Right breast lump
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Right breast lump
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Right breast lump speculated opacity at the middle of the lower part
lymph nodes speculated opacity at the middle of the lower part focus of macrocalcification adjacent to the mass Bilateral axillary lymph nodes microcalcifications mass
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Right breast lump Second study? Ultrasound Mammography MRI w contrast
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Right breast lump Second study? Ultrasound Mammography MRI w contrast
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Right breast lump Right breast
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Right breast lump Left breast
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BREAST CANCER (BIRADS V)
Right breast lump irregular mass, hypoechoic, with heavy post acoustic shadowing and hypervascularity the lymph nodes appear reactionary with preserved sinus BREAST CANCER (BIRADS V)
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Right breast lump
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Palpable left breast lump
CASE 3 Left breast lump Age: 45 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
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Palpable left breast lump
CASE 3 Left breast lump Age: 45 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
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Palpable left breast lump
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Palpable left breast lump
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Palpable left breast lump
architectural distortion area of architectural distortion with pleomorphic calcifications microcalcifications
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Palpable left breast lump
Second study? Ultrasound Mammography MRI w contrast
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Palpable left breast lump
Second study? Ultrasound Mammography MRI w contrast
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Palpable left breast lump
a region of architectural distortion and pleomorphic calcification BREAST CARCINOMA
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Palpable left breast lump
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Skin thickening and nipple retraction
CASE 4 Skin thickening and nipple retraction of the right breast Age: > 40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
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Skin thickening and nipple retraction
CASE 4 Skin thickening and nipple retraction of the right breast Age: > 40 years old Gender: Female First study? Ultrasound Mammography MRI w contrast
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Skin thickening and nipple retraction
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Skin thickening and nipple retraction
lymph nodes mass Large spiculated multilobulated mass almost in all four quadrants skin thickening and nipple retraction multiple axillary lymph nodes with no distinct fatty hilum skin thickening nipple retraction LOCALLY ADVANCED BREAST CANCER
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Skin thickening and nipple retraction
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Prevalent round breast screen
CASE 5 Prevalent round breast screen. Asymptomatic. Age: 41 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w contrast
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Prevalent round breast screen
CASE 5 Prevalent round breast screen. Asymptomatic. Age: 41 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w contrast
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Prevalent round breast screen
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Prevalent round breast screen
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Prevalent round breast screen
Round lobulated right breast mass with sharp outline and halo Lucent lines within the mass due to air within the lesion SKIN LESION: NAEVUS
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Prevalent round breast screen
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Two concentric opacities
CASE 6 Racing pulse and anxiety Age: 34 years old Gender: Female Race: Caucasian First study? Chest X-Ray Ultrasound Mammography MRI w contrast
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Two concentric opacities
CASE 6 Racing pulse and anxiety Age: 34 years old Gender: Female Race: Caucasian First study? Chest X-Ray Ultrasound Mammography MRI w contrast
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Two concentric opacities
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Two concentric opacities
normal breast tissue capsule of the implant
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Two concentric opacities
BREAST PROTHESES
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Breast implants CASE 7 Breast implants; complications?
Age: 30 years old Gender: Female Race: Hispanic/Latino First study? Ultrasound Mammography MRI w/o contrast
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Breast implants CASE 7 Breast implants; complications?
Age: 30 years old Gender: Female Race: Hispanic/Latino First study? Ultrasound Mammography MRI w/o contrast
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Breast implants axial T1w T2w
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Breast implants BREAST IMPLANTS without complications sagittal – T2w R
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Breast implants - sudden softening of the right breast
CASE 8 Right mastectomy for breast cancer and reconstruction with a silicone implant Age: 47 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast
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Breast implants - sudden softening of the right breast
CASE 8 Right mastectomy for breast cancer and reconstruction with a silicone implant Age: 47 years old Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast
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Breast implants - sudden softening of the right breast
T2w STIR
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Breast implants - sudden softening of the right breast
“LINGUINE SIGN” fibrous capsule (scar) around the implant shell intracapsular rupture: the contents of the implant are contained by the fibrous scar, while the shell appears as a group of wavy lines. INTRACAPSULAR BREAST IMPLANT RUPTURE
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Annual screening CASE 9 Annual screening Age: 56 years old
Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast MRI w contrast
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Annual screening CASE 9 Annual screening Age: 56 years old
Gender: Female Race: Caucasian First study? Ultrasound Mammography MRI w/o contrast MRI w contrast
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Annual screening CASE 9 Annual screening Age: 56 years old
Gender: Female Race: Caucasian First study? Ultrasound Mammography: "Architectural distortion" (BI-RADS III) MRI w/o contrast MRI w contrast
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Annual screening CASE 9 Annual screening Age: 56 years old
Gender: Female Race: Caucasian Second study? Ultrasound Mammography MRI w/o contrast MRI w contrast
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Annual screening CASE 9 Annual screening Age: 56 years old
Gender: Female Race: Caucasian Second study? Ultrasound Mammography MRI w/o contrast MRI w contrast
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Annual screening T2w T1w fat sat T1w fat sat C+
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INVASIVE LOBULAR BREAST CANCER
Annual screening INVASIVE LOBULAR BREAST CANCER
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Annual screening
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GRAZIE PER L’ATTENZIONE
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