Lecture notes for medical students

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2. Breast Imaging Modalities

3. Imaging Studies

4. Imaging Studies
• X-Ray
• USG
• CT
• Angiography
• MRI
• Nuclear scan

5. X-Ray
• Mammography
• Ductography

6. USG
• Sonomammography
• Ultrasound is particularly useful in young
women with dense breasts in whom
mammograms are difficult to interpret, and
• distinguishing cysts from solid lesions.
• To localise impalpable areas of breast
pathology.
• Ultrasound of the axillary tissue is
performed when a
• cancer is diagnosed and guided
percutaneous biopsy of any suspicious

7. Mammography

8. Mammography
• A mammogram can find breast cancer when
it is very small -- 2 to 3 years before patient
can feel it.
• No screening tool is 100% effective. Good
quality mammograms can find 85-90% of
cancers

9. Mammography Positions
• CC - cranio caudal
• MLO – mediolateral oblique
• Spot Compression of suspicious areas

11. BI-RADS system
Breast Imaging Reporting and Data System
Category Definition
0 Incomplete assessment; need additional imaging evaluation
1 Negative; routine mammogram in 1 year recommended
2 Benign finding; routine mammogram in 1 year recommended
3 Probably benign finding; short-term follow-up suggested
4 Suspicious abnormality; biopsy should be considered
5 Highly suggestive of malignancy; appropriate action should be taken

12. GALACTOGRAPHY /
DUCTOGRAPHY

13. GALACTOGRAPHY /
DUCTOGRAPHY
• Breast ductography is an
imaging technique which is used to
evaluate lesions causing nipple discharge. It
helps in precisely locating the mass within
breast tissue and gives useful information
for surgical approach and planning.

14. Indications and
Contraindications

15. Indications and
Contraindications
• The most common use of galactography is to evaluate a
woman who has a unilateral bloody or clear discharge
from her breast nipple and an otherwise normal
mammogram.
• Galactography is typically NOT called for in women
with the following conditions:
• A discharge that is milky, yellow, green, or gray is
usually not a cause for concern, especially if it comes
from multiple ducts in the breast.
• A discharge that is from both breasts in a woman who
has not had children may indicate a side effect from a
drug, or may be related to a pituitary etiology.

16. X ray guided Procedures

17. X ray guided Procedures
Stereotactic guided FNAC
Core biopsy
• For lesions that are not seen or are poorly
visualised on ultrasound, mammographic
guidance is required for needle biopsy.
• The most common method currently in use
is an add-on stereotactic device which is
used with a conventional upright
mammography machine.

18. Preoperative localisation of Non
palpable lesions

19. Preoperative localisation of Non
palpable lesions
• For the non palpable breast lesions the
position of the lesion is marked using a wire
with a hook or barb on the end to prevent
movement of the wire within the breast. The
wire is contained within a needle which is
inserted into the breast under local
anaesthetic, using either X-ray or ultrasound
guidance.

20. DIGITAL TOMOSYNTHESIS
•

21. DIGITAL TOMOSYNTHESIS
• 3D reconstruction from multiple
radiographs taken at different angles.
• Extension to mammography where it offers
better detection rates with little extra
increase in radiation.
• Advantages-comfort, speed low radiation
dose
• May replace mammography.

22. Ultrasound

23. Ultrasound
• Sonomammography
• US Elastography

24. Breast MRI

25. Breast MRI
• Preoperative evaluation of patients with
newly diagnosed breast cancer:
• The purpose of MRI is to detect the
presence of multifocal and multicentric
disease as well as to detect bulky residual
disease at the lumpectomy site in order to
allow directed re-excision.
• malignancies may enhance at much more
rapid initial rates than benign lesions

26. Breast MRI
• . to monitor treatment response to
neoadjuvant chemotherapy in patients with
locally advanced cancer
• 3- evaluation of patients with metastatic
axillary lymphadenopathy and an unknown
primary malignancy.

27. Breast MRI
• Evaluation of breast cancer patients with
positive surgical margins following breast
conservation therapy.
• MRI can be useful in determining the extent of
residual disease when margins are positive and
the mammogram is not helpful.

28. Breast MRI
• Breast cancer screening in high risk
women.
• For equivocal mammographic findings and
for 3-dimensional localization of a lesion
seen.
• Evaluation of occult breast cance

29. Nuclear Studies

30. Nuclear Studies
•scinti-mammography
•PET Scanning

31. Scinti-mammography
• Scintimammography, also known as nuclear
medicine breast imaging, breast specific gamma
imaging or molecular breast imaging.
• Injection of a small amount of a radioactive
substance called technetium99 sestamibi which is
taken up by cancer cells, and a gamma camera is
used to take pictures of the breasts.

32. Scinti-mammography
• Indeterminate lesions
• Dense Breasts
• Implants
• Post Sx /RT
• Bone scan
• Sentinel node biopsy

33. CAD
• Computer-aided detection (CAD) is a computer software
system that is designed to aid the film reader by placing
prompts over areas of concern, and to try to reduce
observational oversights. CAD systems are highly sensitive
for detecting cancers on screening mammograms. CAD
software will correctly prompt around 90% of all cancers,
with 86–88% of all masses and 98% of microcalcifications
correctly marked. Specificity is much more of a problem
with a high rate of false-positive prompts. The number of
false prompts will vary according to the level of sensitivity at
which the system is set; typically there are between two and
four false prompts per study

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