Introduction To Breast Imaging

Introduction to Breast Imaging
With Hetal Verma, MD

Learning Objectives
• You will learn how a mammogram is

performed
• You will understand the difference

between screening and diagnostic
mammography
• You will learn about breast density
• You will understand the BIRADS

categories and their implications
Overview
• Breast cancer is the most common cancer

in women worldwide.
High-yield
• Early detection and treatment has been

proven to save lives.
• The only proven method for breast cancer

screening is mammography.
Mammography
• Radiograph of the breasts High-yield
• Two views of each breast

are performed to ensure
inclusion of all breast tissue.
© by Hetal Verma, MD
Radiation
Standard screening mammogram (4 views) will

emit the same amount of radiation that you
normally receive in three months of exposure to
your surroundings or one transatlantic flight.
High-yield
Compression
Compression of the
breast tissue is necessary High-yield
in order to spread out the

tissues and visualize
abnormalities that may be
within the tissues.
National Cancer Institute, PD-USGov, PD

Compression
• Made of firm plastic

High-yield
• Amount of compression:
between 12 and 18
kilograms of pressure
• Uncomfortable feeling
Bill Branson, National Cancer Institute, PD

Screening Mammogram
Screening Mammogram
R L
MLO MLO
High-yield
R CC L CC
Screening Mammogram
• Performed on patients with no

clinical breast symptoms
• 4 total images, 2 on each breast:

• MLO: Medial-Lateral Oblique
• CC: Cranial Caudal
• CC images: top part shows lateral

aspect of the breast
10
Screening Guidelines
• Ideally, women should be screened every year beginning at the age

of 40 and continuing as long as they have a life expectancy of 10
years of more. Clinical pearl
• 7 large randomized controlled trials have shown a 30 % decrease in

deaths from breast cancer due to screening mammography.
• However, this is not done in many parts of the world due to the
expense of annual screening.
Diagnostic Mammogram
For a woman presenting:
An abnormality High-yield
Clinical evidence Palpable mass or
seen on screening
of breast disease other symptom
mammogram
Additional tailored images are obtained to further evaluate the area of

concern.
Abnormalities that Lead to Diagnostic Study
Palpable mass
Pain
Discharge
Skin thickening
Skin or nipple retraction
Abnormality on screening mammogram

Breast Density
The breast tissues are made of fibroglandular tissue and fatty

tissue.
High-yield
The density of the breast tissue is based on the amount of
fibroglandular tissue that is present.
Fibroglandular tissue appears white.

Breast Density
Clinical pearl
Breast Density
Dense breast tissues decrease sensitivity of

mammography and are thought to have at least
a slightly increased risk of developing breast
cancer.
Clinical pearl
Almost Entirely Fatty
Almost Entirely Fatty
High-yield
Scattered Fibroglandular
Scattered Fibroglandular
High-yield
Heterogeneously Dense
Heterogeneously Dense
High-yield
Extremely Dense
Extremely Dense
High-yield
Mammography
What kind of tissue pattern is this?
High-yield
• Inspiration • Penetration • Rotation
Male Tissue Pattern
What kind of tissue pattern is this?
Large pectoralis muscle and

minimal fibroglandular tissue
Tomosynthesis
3D
3D Used in Increases the Expensive
Mammography addition to sensitivity of upgrade to a
standard or 2D mammography standard
mammography especially in mammography
women with machine
dense breast
tissue
Birads Categories
Final assessment Assigned to every

categories mammography report
Birads Categories
Need additional imaging evaluation or prior mammogram for
0
comparison
1 Negative
2 Benign
High-yield
Probably benign (< 2 % chance of malignancy), short-interval
3
follow-up recommended
Suspicious abnormality (2 95 % chance of malignancy), biopsy
4
should be considered
Highly suggestive of malignancy (> 95 % chance of malignancy),
5
appropriate action should be taken
6 Known biopsy proven malignancy
Learning Outcomes
 You have learned how a

mammogram is performed.
 You know the difference between

screening and diagnostic
mammography.
 You have learned about breast

density.
 You know the BIRADS categories

and their implications.

Introduction To Breast Imaging

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Introduction to Breast Imaging

With Hetal Verma, MD

• You will learn how a mammogram is

• You will understand the difference

• You will learn about breast density

• You will understand the BIRADS

• Breast cancer is the most common cancer

• Early detection and treatment has been

• The only proven method for breast cancer

• Radiograph of the breasts High-yield

• Two views of each breast

Standard screening mammogram (4 views) will

in order to spread out the

National Cancer Institute, PD-USGov, PD

• Made of firm plastic

Bill Branson, National Cancer Institute, PD

• Performed on patients with no

• 4 total images, 2 on each breast:

• CC: Cranial Caudal

• CC images: top part shows lateral

• Ideally, women should be screened every year beginning at the age

• 7 large randomized controlled trials have shown a 30 % decrease in

For a woman presenting:

Additional tailored images are obtained to further evaluate the area of

Skin or nipple retraction

Abnormality on screening mammogram

The breast tissues are made of fibroglandular tissue and fatty

Fibroglandular tissue appears white.

Dense breast tissues decrease sensitivity of

What kind of tissue pattern is this?

• Inspiration • Penetration • Rotation

What kind of tissue pattern is this?

Large pectoralis muscle and

Final assessment Assigned to every

 You have learned how a

 You know the difference between

 You have learned about breast

 You know the BIRADS categories

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