Feature Extraction and Classification of Mammographic Masses
Causes of missing mammographic lesions
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Transcript of Causes of missing mammographic lesions
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Causes of missing mammographic lesions
• Dense parenchyma that obscures a lesion• Poor positioning or technique• Lesion location outside the field of view• Lack of perception of an abnormality that is
present • Incorrect interpretation of a suspect finding• Subtle features of malignancy• A slowly changing malignancy
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• . Breast cancers are easily missed when they appear as focal areas of asymmetry or distortion (eg, invasive lobular carcinoma)
• when their appearance suggests a benign cause (eg, medullary and mucinous [colloid] invasive ductal carcinomas, which usually manifest as mostly circumscribed masses).
• Bird et al (6) found that 77 of 320 cancers (24%) in a screening population were missed, primarily due to dense breasts and a developing density that was not identified by the radiologist
• Goergen et al (7) found that cancers missed at screening
mammography were significantly lower in density and were more often seen on only one of two views than were detected cancers
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Dense Breast, Palpable mass, BIRADS0
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Any patient with dense breast parenchyma, a palpable mass, and negative mammographic findings should undergo US for further evaluation of the mass.
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Obscuerd mass BIRADS0
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BIRADS2
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The negative predictive value of US with mammography for a palpable lesion to be 99.8% and 100%, respectively. Moy et al (11) found the negative predictive value of US with mammography for a palpable mass to be 97.4%. However, a palpable mass that appears solid at US warrants further evaluation with biopsy.
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POOR POSITIONING
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PROPER POSITIONING BIRADS0
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Creative Additional Views &Positioning
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LAT MED Oblique View
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Cleavage View
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craniocaudal RL = “craniocaudal rolled laterally”). craniocaudal RL = “craniocaudal rolled laterally”).
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Improper Imaging Technique
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Proper image
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Radiologists’ Errors
• Lack of Perception• Satisfaction of search• Error of Interpretation• Do not compare with Previous study
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MIRROR IMAGE INTERPRETATION
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Mirror Image Interpretation
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SUBTLE FINDING MIRROR
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MISSED CA SATISFACTION OF SEARCH
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NIPPLE TO LESION -ARC MEASUREMENT
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MUCNOUS CIRCUMSCRIBED CA
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NEW ASYMMETRIC DENSITY ILCA
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Slow Growing CA
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Tubular CA
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ConclusionAlthough mammography is the standard of reference for the detection of early breast cancer, as many as 30% of breast cancers may be missed. To reduce the possibility of missing a cancer, the radiologist should take the following steps when interpreting mammographic findings:• Do not rely on screening views alone to diagnose a detected
abnormality; complete the evaluation with diagnostic mammography.• Review clinical data and use US to help assess a palpable or
mammographically detected mass.• Be strict about positioning and technical requirements to optimize
image quality.• Be alert to subtle features of breast cancers.• Compare current images with multiple prior studies to look for subtle
increases in lesion size.• Look for other lesions when one abnormality is seen.• Judge a lesion by its most malignant features.
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Summary of Mammographic Report & BIRADS
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Reporting Mammogram Using BIRADS
• Brief description of reason for the MMG• Brief description of the type• Comparison with previous MMG• Description of finding• Final assessment categories• Recommendation
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BIRADS0, Recommendations
• Dense Breast in screening ,young high risk: MRI• Dense Breast & Palpable Mass: US, Solid, complex
cyst: CNB, Thick- wall cyst: Aspiration• Mass without fat or characteristic Mic Cal: US,
Solid, <5mm suspicious: VAB, circumscribed: local Mag view
• Absence of previous exam• Indeterminate findings: Additional views
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BIRADS 1, negative for malignancy
• Normal fatty breast: Routine FU• Negative symmetrical SFG, No change or
neodensity: FU• Heterogeneously symmetrical dense, no
pertinent finding, no change or neodensity, may recommend US
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BIRADS2, Benign finding
• An intra mammary lymph node• Benign mic cals• Fat contained masses• Thin -wall cysts with or without Int echo
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BIRADS2
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Tangential spot magnification mammogram, obtained after placement of an external marker,BIRADS2
Oil cyst
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Rod shape cal
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Milk of Calcium
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Cystic milk alkaline cal
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BIRADS3, Probably benign,<%2 malignancy, Short term FU
• An oval shape, well- defined, circumscribed or macro lobulated mass which is solid, isoechoic, and parallel on US: 6, 12, 24 moths FU, increased size of %25 : CNB
• Monomorph cluster Mic cal: 6,12, 24 months FU
• Focal asymmetry+ nonpalpable+ negative US
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B3 became B4
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B3 became B2
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BIRADS4a, 3-30% malignancy, VAB or CNB
• Probably benign appearance with a tail or mild inhomogeneity on US
• Probably benign but hypo echoic mass• Intra cystic mass, intra ductal papilloma :VAB• Thick wall cyst : Aspiration• Indeterminate Amorphus cluster Mic cal: VAB• Developing density• Focal asymmetry+ palpable lump+ Neg US
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Type 2 complex cyst+ doppler,BIRADS4a, CNB
Papillary apocrine hyperplasia with atypical ductal hyperplasia
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Infiltrating Ductal Ca
Complex cyst, irregular thick wall
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Coarse Hetergenously cluster cal
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BIRADS4b 30- 60% malignancy, VAB or CNB
• Round circumscribed masses• Round hypo echoic masses• Structural distortion without history of surgery
or infection: VAB• New asymmetry: VAB
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Fine pleomorphic cluster cal
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New Amorph cal
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BIRADS4c,% 60-95 malignancy
• No classic of malignancy, VAB or CNB • For example: micro lobulated mass
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Fine pleomorphic, linear distribution
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BIRADS 5, >%95 malignancy
• Speculated mass<5mm: VAB, >5mm: CNB• New density with irregular border < 5mm:
VAB, >5mm: CNB• Linear branching pleomorphic, fine linear or
pleomorphic linear or segmentally distributed cluster mic cal: VAB
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Fine linear Seg distributed cal
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Linear & amorph cal in a duct
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THANKS A LOT FOR YOUR ATTENTION