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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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.

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

10. The End