Imaging examinations of breasts

Department of radiology

Question

How to choose a proper examination for screening and diagnosis

What examinations we could use

Breast cancer

• Higher incident rate of breast cancer for recent ye

ars

• Risk factors: procreation, family history, environ

ment, hormone ……

• Clinic findings：mass， skin changes

• The survival rate based on the stage of breast can

cer

• Screening： ductal carcinoma in situ

Anatomy

• 15－ 18 lobes

• Lobules: Termina

l Ductal Lobular

Units (TDLUs)

Anatomy

• TDLU： 1－ 2mm

• Drained by a

terminal duct

attached to the

main duct system

• Most breast

diseases arise in

TDLU

Imaging methods

• Mammography

• Ultrasound

• MRI

Projection： CC

MLO

Mammography

Mammographic characters

• Calcification

• Mass

Calcification

PO43-

Calcium phosphat

Ca++

Calcification

• The main value : detection necrotic tissues

• Form: Casting type, powderish, granular type

• Differentiation between malignant and benign:

distribution, form, density

Calcification

Calcification

Calcification

Calcification

Mass

• Proliferation and invasion

• Stellate lesion with spicules and ill-defined bord

ers

• Differentiation between malignant and benign is

difficult

Mass

Mass

Mass

Mass

Characteristics of mammography

• Sensitive to the malignant calcificatio

n even microcalcifications

• Differentiation between benign and m

alignant mass is difficult

Characteristics of Ultrasound Exam

• Allows significant freedom in obtaining

images from almost any orientation

• excellent at imaging cysts and solid mass

• young women at high risk of the disease

• Guide biopsy

Limited of ultrasound

• Though ultrasound has excellent contrast reso

lution, it lacks the detail (spatial resolution)

• Operator and equipment factors

• unable to image microcalcifications

Benefits of MRI Exam

• Allows breast images to be taken in any plane

and from any orientation

• highly sensitive to small abnormalities, could

show multi-focal tumor

• Determining the extent of breast cancer, can

help indicate treatment

• An excellent at imaging the augmented breast

Limited of MRI Exam

• Too expensive

• Couldn’t find the microcalcification

Ductal Carcinoma in Situ

• Intraductal carcinoma: cancer cells are confined to

an intact basementmembrane

• Appearances: microcalcification (85%)

microcalcification and mass (10%)

mass or architectural distortion (5%)

Screening

physical exam mammography

P+ M+

operation

P+M-

ultrasound

Follow up

P-Ca+P-T+ P-M-

Follow upbiopsy