1. In The Nam of God

2. Role of Mammography and breast ultrasound in diagnosis early breast cancer
Dr. Mehri Sirous

3. * IMAGING * The standard techniques used for breast imaging are:
Screen film x-Ray mammography.
Real-Time ultrasound.
Other new techniques include:

4. MRI
Color Doppler
Contrast ultrasound
Digital Mammography
Scintimammography

5. False Negative Rate is 5-10%
Mammography
Although mammography is the most sensitive exam available for detecting small breast ca.
False Negative Rate is 5-10%

6. False negative rate ↓ * Clinical history and examination
* Combination imaging
Mammography standard views
supplementary mammographic views
Local compression views
magnification views
ultrasound
* Needle biopsy
* F.N.A.C
* Or core biopsy

10. Indications for mammography
Screening asymptomatic women aged 50 years and over
Screening asymptomatic women aged 35 years and over who have a high risk of developing breast cancer:
-women who have one or more first degree relatives who have been diagnosed with premenopausal breast cancer
- women with histologic risk factors found at previous surgery, e.g. atypical ductal hyperplasia
Investigation of symptomatic women aged 35 years and over with a breast lump or other clinical evidence of breast cancer
Surveillance of the breast following local excision of breast carcinoma .
Evaluation of a breast lump in women following augmentation mammoplasty
Investigation of a suspicious breast lump in a man

11. Breast ultrasound
At the minimum, a 7.5 MHZ linear array probe should be used
The original role of breast sonography is in the differentiation of cystic and solid lesions
The role of ultrasound complements both clinical examination and mammography
Ultrasound plays an important role in the triple assessment of symptomatic lesions the dense breast

12. It is the examination of choice in young women and is valuable in the assessment of mammography ‘ dense’ breast

13. The dense breast
Diffuse increase in the density of the breast tissue is caused by
an increase in the glandular tissue and or/fibrous tissue

15. The dense breast 2 – edematous breast Advanced primary tumor
Lymphatic spread from a primary tumor or inflammatory carcinoma
Breast abscess (breast infection)
Congestive cardiac failure and Renal failure (unilateral or bi lateral)

16. The dense breast
Axillary lymphnode metastases from Advanced gynaecological malignancy e.g ovarian carcinoma, cervical progressively or secondary to a carcinoma of the contra lateral breast
Radiotherapy (breast saving)
Develop progressively following radiotherapy
Reach a maximum at about 6 months
Resolved approximately 18 mouths following treatment

17. The dense breast
HRT (decrease in the sensitivity of screening mammography for cancer detection)
loss of fat due to severe weight loss or cachexia or lack of fat due to lipodystrophy

37. Indication of breast ultrasound
.Symptomatic breast lumps in women aged less than 35 years .
Breast lump developing during pregnancy or lactating
.Assessment of mammographic abnormality (further mammographic views)
.Assessment of MRI or scintimammography detected lesions .
Clinical breast mass with negative mammograms .
Breast inflammation
.The augmented breast (together with MRI)
.Breast lump in a male (together with mammography) .
Guidance of needle biopsy or localisation
.Follow-up of breast cancer treated with adjuvant chemotherapy

51. Imaging – guided practical procedures
The type of imaging chosen depends principally on which method (ultrasound or mamography) shows the lesion clearly.
Ultrasound is used for cysts and most soft – tissue lesions
Mammography is used for microcarcification and for soft – tissue lesions that are not seen or are poorly visualized on ultrasound particularly distortions

52. Ultrasound – guided procedures
Cyst aspiration (simple cysts with symptoms)
Abscess aspiration (simple, unilocular abscess)
Ultrasound – guided FNAC (solid lesions)
Ultrasound guided core biopsy
(small solid lesions)

53. Mammography – guided procedures
Stereotactic – guided FNAC or core biopsy
Preoperative localization of non – palpable lesions.
Ductography

55. Asymmetric soft tissue density

57. Indication for breast MRI
Breast MRI is the technique of choice in the differentiation between postoperative scarring and local recurrence
It has an important role in the assessment of the indeterminate mass because of its very high sensitivity for malignancy though at present, core biopsy is a more cost – effective approach.

58. Indication for breast MRI
It is very accurate in the local staging of breast cancer in difficult cases (very dense breasts, mammographically occult tumours, suspected multi- focality or multicentricity and suspected chest wall involvement).
It is the technique of choice in the evaluation of implant integrity and detection of cancer in the augmented breast.
It is also accurate in the differentiation of axillary recurrence and brachial plexopathy post radiotherapy.

59. Indication for breast MRI
Breast MRI appears highly accurate in the assessment of response to neoadjuvant and primary chemotherapy, predicting ulti- mate response before changes in tumour volume and differentiating between residual tumour and fibrosis.
The place of breast MRI in screening high-risk patients has yet to be established

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