6. Mammography_GB lecture_21 2.pdf

Firstmajority isfemale males butnotonly we can dofor speciallyabove4050 itearlier nlessfamilyhistoryofcancer do ofbrestCancer earlydetect mammodoto Surgicalcheck up examination of breast using 1 lowKup 2 Highcontrast softtissuecontrast think a 3compressiondevice E'Iotion 4 high mAs highdo...

Firstmajority isfemale males butnotonly we can dofor speciallyabove4050 itearlier nlessfamilyhistoryofcancer do ofbrestCancer earlydetect mammodoto Surgicalcheck up examination of breast using 1 lowKup 2 Highcontrast softtissuecontrast think a 3compressiondevice E'Iotion 4 high mAs highdose Shortnote PETIT p targetmaterial 27 back tabs 31 he vestrong milyhistory 57 spread MRI advantages examinebothinoneimage highsofttissuedetails no ionization radiatan notscreenexamination but followup Tomosenthesis examinationthat produceslices mammography crosssectionalimage canbe re processed TE smallerwithtomosynthesis if doesn'tmatter she hadfamilyhistory it is abaseline andallwomen shoulddoit d important s very Aim is highlyQualityimage censeof why becauseof pre tinydetails whatdoesthatmean not40as usual earlier 40 operator error iscriticalhere so theradiographershouldbe ii in my highly regulated Top axiallytail e it • Estrogen level change as pt around thenipple age which will stop the growth of glandular tissue —> less stimulation or disappear. undertissueofbrest • After mono pause—> e Chrombortribs glandular tissue will turn into bottom infra fatty tissue ( except woman on crease hormonal therapy mammary upper lower I inner O outer 1 2 just underthe breasttissue 1944W In pregnancy glands Retromammary space is a loose areolar tissue that separates the breast from the pectoralis major muscle. The retro-mammary space is often the site of breast implantation due to its location away from key nerves and structures that support the breast. should be in MLO hat specially d on hormons estrogen thepercentage type canchange among life my youngerage onegrandular tissue fatly Herage q blandfenest within glandsproduce milks milk I jactating forwomanswhobrestfeedingbaby's bresttissuebdular weexpectthe very because of hick dens upperasmicrocalcification very twit old milkstayonthebest itnotdangerous TE 646 2101 JE mostdense gensetissue lestdense ilwecallit50170itdependonglandulartissueandfatytissue I fibroglandularbrest g verydense dosefor woman young sowemustusedhighKuptopenetratehigh contrast to weneedhigh contr and thisislow mammo first this bettertodoMRI or US wedo notrecomendeddo mammo notgetting a lotofinformation b because of highKup Kup contrast in their20have brestfeeding Apre menopausal woman and b bestdensitybrestformammo easytopenetrate onhormone knot replacement tissue noglandular bro Glandular best Ahighdensity penetratetissue verydifficultto Fibrofatty fatty mostlyfat no fibroustissue tissue noglandular affect shorter sidetomaximaseheelaffect a 3separatethestructers a shifted rotation 368 armcan be Yama resolutionget detectors details more high heel optimizing compression as ireducethickness enhancedetails belowi r grideplaced d air gap works as patientskin clean no skin folds a Grid in mammo we use averylow no 4I no artifacts lowratiogrid YDmadeoffiberglass salt placedbelowdetector absorb back sy affect we use anodeheel becauseofthedifference in hickness between chest wall we neversee anything smaller thept nipple side cathodeover other side head anodeis side Tipple Test wall thanfocalspot it's our physical limitation Er 17 19 21 23 a preferable large small thick todense breast why toreduce doseby very tiny setlower mAs mostdensearea thicker part hear weneversee anythingsmaller hanfocalspot hysicallimitation to chest wall bringAEC toward chestwall in DM Then digitally manipulated nearesttochest wallweplaceit improvecontrast sharpness avoiddistortion 10 20 notpainful butvery uncomfortable so we shouldprepereverything beforecompression Macro Radiography M SE Notstandard to only as a followup normal CC MLO Inmammoit'shighdosebecausewe usehighmAs ammogram compression I • To differentiate and characterize it if it’s solid or cyst Followed tomamma lobdenum when theycan't my usedfor differentiate or detect notclear • Thick • Needle guided biopsy q Forgeneralpopulation Digital Mammography becauseit's screeningmodality shouldbe available cheap it Advantages easily use tosee • High spatial resolution able smaller structure • Good as an early detection modality • Readily available in most medical centers • Affordable for patients avaliableeverywhere b easilyaccessible Disadvantages • Radiation dose highdosedueto highmas • Less sensitive in younger patients moredense • Less sensitive in breast implant evaluation Can'tcompress bettertodous salientdoesn'tmove atthetube B'd kno thatwillblur everythingabove belowit Breast Tomosynthesis (3D Mammography) usedthetechniqueoftomography • In this technique the x-ray tube moves in an arc over the compressed breast capturing multiple images of each breast from different angles • A 3D image sets are obtained minimizing tissue overlap which can obscure malignancies • Improved sensitivity and specificity to small abnormalities compared to normal mammography • Improves quality of detection in dense breasts betterthanDM • Used in combination with stereotactic breast biopsy for best localization of lesions • Most likely candidate to replace standard digital mammography as a screening tool. detectevensmaller • Higher radiation dose morethanone exposure A 62-year-old woman with invasive ductal carcinoma of the superior medial R breast. (A) CC conventional digital mammogram demonstrates mass largely obscured by overlying breast parenchyma (arrow). (B) MLO conventional digital mammogram. Only very subtle architectural distortion visible at the site of the malignancy (arrow). (C) CC projection tomosynthesis image clearly demonstrates a round, speculated mass (arrow). (d) MLO tomosynthesis image demonstrates subtle but visible irregular mass with associated architectural distortion (arrow). weplace a marker in thenippletodifferentiate specially If it's notinprofile Loworhighnipple ___ A Breast Ultrasound Advantages • • • • Inexpensive Readily available Uses no ionizing radiation same asMRI Can differentiate between solid and cystic lesions • Can be used to evaluate breast implants • Used in combination with mammography for increased sensitivity and accuracy. t Disadvantages weneedsomeone • Operator dependent expert • Can increase the number of false-positives whatisthat there's whenit'stellsthat it'snot somethingbut Breast MRI • • • • Advantages multisection No ionizing radiation exposure Highly sensitive in theyoungerfemale todo detection of lesions better US MRI especially in dense breasts Highly specific when used in combination with digital mammography Can be used for preoperative staging wheathethispatientshouldgotosurgery orchemotherapyfirst tellsus there'sanyenrolment inthelymphatic or metastatic contralateralbreast or there's if if any Not suitable for screening asymptomatic population Disadvantages • • • • • Expensive Not readily available Long waiting lists Not suitable for all patients why willlyingdown Long scan times patientwhich willbe prone difficultforoldery patient now on DR helps radiologist in detecting Breast Imaging Reporting and Data meantforradiologest give an System (BI-RADS) scale notforpt evaluations • Established by the American College of Radiology • Is a scheme for putting the findings from a mammogram screening in to a small number of well-defined categories • Later the system was adopted into MRI breast imaging and also into Ultrasound. • This system mainly benefits the radiologists who report the mammogram (MRI or US) for accuracy statistics and training purposes, and to help standardize terms used in reporting breast images to avoid confusion and improve communication. It is not of much benefit to the physician or the patient. • The system helps in monitoring breast cancer treatment and research by making statistics easier to calculate BI-RADS Classifications mean p Not staging or grading 0- Incomplete it's just description 1- Negative 2- Benign findings 3- Probably benign, 6 months follow-up mammogram • 4- Suspicious abnormality where are notsure • 5- Highly suspicious of malignancy organization oftissue changes • 6- Known biopsy with proven malignancy • • • • Screening Additional evaluation of clinical or imaging 1. High risk patients findings 2. Contralateral breast in patients 1. Recurrence of breast cancer with new breast malignancy 2. Metastatic cancer where primary is 3. Patients with breast unknown and suspected to be of breast augmentation origin É Extent of Disease 3. Lesion characterization where other so's I 1. Determining the presence of multi imaging or clinical findings are inconclusive focality 4. Postoperative tissue reconstruction 2. Invasion deep to fascia evaluation 3. After conservative surgery to 5. MRI-guided biopsy in lesions that are evaluate the presence of residual demonstrable only by MRI disease forlesionthatcanonlyseeninMRI 4. Evaluation of treatment response before, during and after chemotherapy T2 weighted images show as malignancy CMinMrs toseebloodsupply leakage outside The nowaree cat mio from change reasonwe metomw tail seemaxillary c ausewe can e than the oblique muchbetter inthe lat no2 it'slatview yoh preferable canbe rapture unlesswecan't wedon'tdoit anythingelse but samemadman meters direction thesame the beamisopposite the forlymphnodes notshowmorebresttissueitbetter it 6 maybe seeoncein month doesn'tdone wedon'tsee them itreplacedbyusandMr5 Axillary view craniocandal mediolateraloblique exaggerated craniocandal Mediolateral latromedial lateral tail AT CV ID SIO FB RL it O view I I Ign startoh thesis when we do from 3rduntil7th the dayofperiod the Glandular tissue becomelessdense ng creasewhichis underRibs 6 Thebakeryshouldbeatlevelofinfra mammary gate can't rolled nipples p rofile bein smart from back there 30cmuntill isapush as made compression brest side alwayon the axillary motion breathing cancause is dose thereishigh onptbecauseofhighma scatterbut thereishardly lowry so scatter minimal shielding t hough the even regional suspected also m arker stickers markers paintumor small the tell ptinthemorningofexaminationtotakeshower clean breath and theareaanddon'tputlotion stop avoid blurring forumor duderut per medial can't marker tissueincaeMio seeallbrest m uscle include must from tomusclesoimage nipple it's the creases mammary fromaxillarytoinfra bycompression haveglandular arethat tissueor I Yemen microcalcification useat xany havealmonuimor from cream that ordude rat maybecome any clean personma mustbe shine any get we don't pectoralis major in CC butit's a musttosee it lateral in MLO beno should airgabs leansthe thebut pttoward head turnawayet 22300pt hold theotherbrest ifphave t largebrestaswecancha ngsizeohIRbutif itn't workwecandoseperalexposure nine not acceptable we doit as saplimantry view for CC when ifthe WET n't axillgondones rotation internal towardmadi linestoseeaxillaryaspect alwaysin Mio n mmmm this image cut is part tumortrue toseedepthof axillaasmuchasMo doesn'timagethe depth nMio must e it O infrmamorry better dousorMBE intocalcification If É implant is small near tochestwall wall notidealcan'tseebehindchest continuallyunttimplan compress pushand done must be byanexperintedprofessional is e minded • schedule • Ask about cycle —> 1) 10 days from period-> least stimulated glandular tissue-> ideal. 2) first day of menstration-> high stimulated glandular tissue-> hormone. • History of disease—> 1) family history of Brest cancer. 2) pregnancy-> how many. 3) Brest feeding. • Ask if she do mammo there is no less than year since the last mammo. • Instruct to wash and not apply anything. • Woman over 40y -> one year at lest the last mammo. Fibro fatty cc glandular fatty fibro dad fibro acceptable f there's skin fold cut fold spin reapeated no marker notcent higher MLO cutin fibroglandular profile nipplenotincrease Eory Pectoralis muscle T not well notcentered I Penetred notcentered inframammary crest is cut KnustTeen n MIO inframammary III MO yay crest is cut profile nipplenotin overpenetratingvisible inframammonnot nipple not in profile skin folds Aolderfemale fattybrest Calcifiedbloodvessels fatty breast cutinaxillar tail should center beclosertoch wall cut inthecrest pectoralis muscle Fatty brest axillarytail centre wrong fibrofatty fatty axillarytail nipple not in profile not axillarytail seen nonipple notcompletelyseen overpenetrating target use molybdenum nonipple cc cc