Breast Imaging in Young Women - Lieberman's eRadiologyeradiology.bidmc.harvard.edu/LearningLab/respiratory/sunderland.pdf · Breast Imaging in Young Women Kelsey Sunderland. Kelsey

Breast Imaging in Breast Imaging in Young WomenYoung Women

Kelsey SunderlandKelsey SunderlandHarvard Medical School, Year IIIHarvard Medical School, Year III

Gillian Lieberman, MDGillian Lieberman, MD

Kelsey Sunderland, HMS IIIGillian Lieberman, MD

April 2011

2

OutlineOutline

1.1.

Statistics of breast cancer in young womenStatistics of breast cancer in young women2.2.

Clinical presentation of a patient with benign Clinical presentation of a patient with benign breast lesions on ultrasound and mammographybreast lesions on ultrasound and mammography

3.3.

Discussion of the recommended use of different Discussion of the recommended use of different breast imaging modalities in young patientsbreast imaging modalities in young patients

4.4.

Clinical presentation and imaging findings of a Clinical presentation and imaging findings of a patient with a malignant breast masspatient with a malignant breast mass

5.5.

Review of benign and malignant features of Review of benign and malignant features of breast lesions on ultrasound and mammographybreast lesions on ultrasound and mammography


3

Breast Cancer IncidenceBreast Cancer Incidence

Overall lifetime incidence: 1 in 8 womenOverall lifetime incidence: 1 in 8 women

207,090 new diagnoses annually in the U.S.207,090 new diagnoses annually in the U.S.

12.4% of breast cancers are diagnosed in women 12.4% of breast cancers are diagnosed in women under 45.under 45.

1.9% are in women ages 201.9% are in women ages 20--34.34.

National Cancer Institute. SEER Fact Sheets. 2010.


4

Breast Cancer MortalityBreast Cancer Mortality

Breast cancer (not lung) is the leading cause of Breast cancer (not lung) is the leading cause of death from cancer in the U.S. in women ages death from cancer in the U.S. in women ages 2020--59.59.

U.S. deaths from breast cancer per year: 40,599U.S. deaths from breast cancer per year: 40,599

1094 (2.7%) are in women under age 40.1094 (2.7%) are in women under age 40.


2007 data from Jemal

et al. ACS. 2010.

5

Breast Cancer in Young Women: Poorer PrognosisBreast Cancer in Young Women: Poorer Prognosis

Higher grade tumor (less Higher grade tumor (less wellwell--differentiated)differentiated)

Larger tumor size at time of Larger tumor size at time of diagnosisdiagnosis

More likely to involve lymph More likely to involve lymph nodes at time of diagnosisnodes at time of diagnosis

Poorer prognosis (shorter Poorer prognosis (shorter diseasedisease--free survival, higher free survival, higher mortality)mortality)

More likely to have a delayed More likely to have a delayed diagnosis after seeking diagnosis after seeking medical attentionmedical attention

From Anders CK et al. JCO 2008.

Anders CK et al. JCO 2008. Foxcroft

LM et al. Breast 2004. Sentis

M. Breast Cancer Res Treat 2010.


6

Breast Masses in Young WomenBreast Masses in Young Women

We have seen that breast cancers do occur and can be We have seen that breast cancers do occur and can be aggressive in young women.aggressive in young women.

However, 99.5% of palpable breast masses in women However, 99.5% of palpable breast masses in women under 30 are benign.under 30 are benign.

It is important to use appropriate imaging techniques It is important to use appropriate imaging techniques to differentiate between these.to differentiate between these.


Loving VA et al. AJR 2010.

7

Patient #1: Clinical PresentationPatient #1: Clinical Presentation

Healthy 29Healthy 29--yearyear--old woman on oral old woman on oral contraceptives with no family history of breast contraceptives with no family history of breast or ovarian cancer. or ovarian cancer.

Presented with left breast pain and a separate Presented with left breast pain and a separate area of palpable thickening in the left breast on area of palpable thickening in the left breast on clinical exam.clinical exam.


How should these findings be evaluated?How should these findings be evaluated?

8

Breast Imaging OptionsBreast Imaging Options

UltrasoundUltrasound

MammogramMammogram

MRIMRI


Our patient was first evaluated with a targeted Our patient was first evaluated with a targeted ultrasound of the regions of interest on her left ultrasound of the regions of interest on her left breast.breast.

9

Patient #1: Breast Cyst on UltrasoundPatient #1: Breast Cyst on Ultrasound

Ultrasound, antiUltrasound, anti--radial view, of the left breast, 3:00 position, 2 cm from the radial view, of the left breast, 3:00 position, 2 cm from the nipple, in the area of tenderness.nipple, in the area of tenderness.

Round, wellRound, well--circumscribed, anechoic lesioncircumscribed, anechoic lesion, , 0.6 x 0.6 x 0.5 cm,0.6 x 0.6 x 0.5 cm,

with good through transmission and with good through transmission and backwallbackwall

enhancementenhancement. .

Consistent with a benign Simple Cyst.Consistent with a benign Simple Cyst.


PACS, BIDMC

*

10

Patient #1: Patient #1: Solid Mass with Atypical Features on UltrasoundSolid Mass with Atypical Features on Ultrasound


Ultrasound, radial view, of the left breast, 12:00 position, Ultrasound, radial view, of the left breast, 12:00 position, 11--2 cm from the nipple, in the area of palpable thickening.2 cm from the nipple, in the area of palpable thickening.

HypoechoicHypoechoic

solid masssolid mass, 1.4 x 1.6 x 0.8 cm, with, 1.4 x 1.6 x 0.8 cm, with

microlobulations (scalloped appearance)microlobulations (scalloped appearance)..

PACS, BIDMC

*

11

Patient #1: Solid Mass with Patient #1: Solid Mass with Atypical Features on Ultrasound (2)Atypical Features on Ultrasound (2)


Ultrasound, AntiUltrasound, Anti--radial view, of the left breast, 12:00 position, 1radial view, of the left breast, 12:00 position, 1--2 cm 2 cm from the nipple, in the area of palpable thickening.from the nipple, in the area of palpable thickening.

HypoechoicHypoechoic

lesionlesion

with with branching, concerning for branching, concerning for ductalductal

extensionextension

of the lesion.of the lesion.

PACS, BIDMC

*

12

Patient 1: Additional ImagingPatient 1: Additional Imaging

This patientThis patient’’s solid breast mass was felt to be s solid breast mass was felt to be likely consistent with a likely consistent with a fibroadenomafibroadenoma

on on

ultrasound. ultrasound.

However, because of the atypical features, she However, because of the atypical features, she required a biopsy to definitively characterize this required a biopsy to definitively characterize this lesion.lesion.

Before the biopsy, she had a bilateral diagnostic Before the biopsy, she had a bilateral diagnostic mammogram.mammogram.


13

Patient #1: Dense Breast Tissue on MammogramPatient #1: Dense Breast Tissue on Mammogram


Digital mammography, Digital mammography, craniocaudalcraniocaudal

view, of the right and left breasts, view, of the right and left breasts, with a with a BBBB

indicating the site of the ultrasound abnormality.indicating the site of the ultrasound abnormality.

Breasts are Breasts are densedense

bilaterally, which obscures any possible bilaterally, which obscures any possible

finding in the area of interest. No calcifications seen.finding in the area of interest. No calcifications seen.

BB marks site BB marks site over ultrasound over ultrasound abnormalityabnormality

RCC LCCPACS, BIDMC

** **

14

Patient #1: Diagnostic WorkPatient #1: Diagnostic Work--upup

With no additional areas of concern seen on With no additional areas of concern seen on mammography (limited by breast density), this mammography (limited by breast density), this patient then proceeded to have ultrasoundpatient then proceeded to have ultrasound--

guided tissue sampling for definitive diagnosis.guided tissue sampling for definitive diagnosis.


15

Patient #1: Aspiration of Simple CystPatient #1: Aspiration of Simple Cyst


PrePre--

and postand post--aspiration images from the ultrasoundaspiration images from the ultrasound--guided fine needle guided fine needle aspiration of the cyst seen in the left breast at the 3:00 positaspiration of the cyst seen in the left breast at the 3:00 position. ion.

AspirationAspiration

of the of the simple cystsimple cyst, with removal of 0.5 , with removal of 0.5 mLmL

clear fluid, clear fluid,

which was subsequently discarded due to its benign appearance. which was subsequently discarded due to its benign appearance. PostPost--aspiration image shows aspiration image shows complete collapse of the cystcomplete collapse of the cyst..

Hypodermic needle about to enter the

cystic lesion

PACS, BIDMC PACS, BIDMC

*

16

Patient #1: Biopsy of Atypical Solid MassPatient #1: Biopsy of Atypical Solid Mass


Five Five core biopsiescore biopsies

of the of the

solid masssolid mass

were taken. were taken.

Pathology revealed Pathology revealed benign benign FibroadenomaFibroadenoma. .

Imaging findings were Imaging findings were concordant with concordant with pathology. pathology.

FollowFollow--up ultrasound up ultrasound was recommended in 6 was recommended in 6 months to document months to document stability.stability.

Core biopsy Core biopsy needle passing needle passing through lesionthrough lesion

PACS, BIDMC

*

UltrasoundUltrasound--guided core needle biopsy of guided core needle biopsy of the solid lesion in the left breast.the solid lesion in the left breast.

17

Considerations for Breast Considerations for Breast Imaging Modalities in Young WomenImaging Modalities in Young Women

Radiation:Radiation:Typical mean glandular dose from bilateral twoTypical mean glandular dose from bilateral two--view view mammography = 3.7mammography = 3.7--4.7 4.7 milligraymilligray, which is equivalent to about , which is equivalent to about 2 months of natural background radiation.2 months of natural background radiation.

Exposure to ionizing radiation at a younger age (higher cell Exposure to ionizing radiation at a younger age (higher cell proliferation rates) has a higher risk of inducing cancer.proliferation rates) has a higher risk of inducing cancer.


Hendrick

RE. Radiology. 2010.

AgeAge Incidence (per 100,000)Incidence (per 100,000) Mortality (per 100,000)Mortality (per 100,000)

2020 1818 4.54.5

4040 66 1.51.5

8080 0.150.15 <0.1<0.1

Lifetime attributable risk of breast cancer due to a single Lifetime attributable risk of breast cancer due to a single mammogram, by age at exposure:mammogram, by age at exposure:

18

Breast DensityBreast Density

Younger women are more likely than older women to have Younger women are more likely than older women to have denser breasts.denser breasts.

Mammography has significantly lower sensitivity in breast Mammography has significantly lower sensitivity in breast tissue that is dense or heterogeneously dense, especially in tissue that is dense or heterogeneously dense, especially in younger women. Ultrasound is not significantly affected by younger women. Ultrasound is not significantly affected by breast density.breast density.

Considerations for Breast Imaging Considerations for Breast Imaging Modalities in Young Women: DensityModalities in Young Women: Density


Kolb TM et al. Radiology. 2002.

19

Breast Density on MammographyBreast Density on Mammography

From Pinsky

RW, Helvie

MA. JNCCN. 2010.


20

Patient #1: Patient #1: Dense Breast Tissue on MammogramDense Breast Tissue on Mammogram


RCC LCC

Comparing our patientComparing our patient’’s breasts to these classifications, we see s breasts to these classifications, we see that her breasts are dense, consistent with BIthat her breasts are dense, consistent with BI--RADS density 3RADS density 3--44..

PACS, BIDMC

21

Breast Density Lowers Sensitivity Breast Density Lowers Sensitivity of Mammographyof Mammography


Effect of Breast Density on Imaging Sensitivity

0

10

20

30

40

50

60

70

80

90

100

Fatty Fibroglandular HeterogeneouslyDense

Extremely Dense

Sens

itiv

ity

(%)

Mammography Ultrasound

Data from Berg WA et al. Radiology. 2004.

With increasing With increasing BIBI--RADS density RADS density classification, classification, sensitivity of sensitivity of mammogram mammogram decreases from 100% decreases from 100% to 47%. Sensitivity of to 47%. Sensitivity of ultrasound remains in ultrasound remains in the 80the 80--88% range at all 88% range at all densities.densities.

22

Comparing Sensitivities of Imaging Comparing Sensitivities of Imaging Modalities in Young WomenModalities in Young Women

Mammography (%)Mammography (%)

Ultrasound (%)Ultrasound (%)

AgeAge

(Study)(Study)

58.0 78.6 <50 58.0 78.6 <50 (Kolb 2002)(Kolb 2002)

71.7 84.9 71.7 84.9 <45 <45 ((HoussamiHoussami

2003)2003)

70.870.8

92.2 <40 92.2 <40 ((FoxcroftFoxcroft

2004)2004)

8585

9595

3030--39 39 ((OsakoOsako

2007)2007)

100 <30100 <30 (Loving 2010)(Loving 2010)


In each study in younger women, the sensitivity of ultrasound isIn each study in younger women, the sensitivity of ultrasound is significantly (10significantly (10--23%) greater than that of mammography. The 23%) greater than that of mammography. The

sensitivity of ultrasound is very high (>92%) in women under agesensitivity of ultrasound is very high (>92%) in women under age 40. Specificity of ultrasound in women less than 30 is 80.5%.40. Specificity of ultrasound in women less than 30 is 80.5%.

23

Summary of Summary of Recommended Breast Imaging ModalitiesRecommended Breast Imaging Modalities

Mammography: Routine screening in women Mammography: Routine screening in women over age 40. Diagnostic imaging in symptomatic over age 40. Diagnostic imaging in symptomatic women age 30 and older.women age 30 and older.

Ultrasound: Diagnostic imaging in symptomatic Ultrasound: Diagnostic imaging in symptomatic women under age 30.women under age 30.

MRI: Recommended for routine screening in MRI: Recommended for routine screening in highhigh--risk women (e.g. BRCA mutation). risk women (e.g. BRCA mutation). Highest sensitivity, lower specificity. Used in Highest sensitivity, lower specificity. Used in prepre--surgical planning.surgical planning.


Parikh JR. ACR Appropriateness Criteria on Palpable Breast Masses. 2007.Saslow

D et al. CA Cancer J Clin. 2007.

24

Patient #1: Patient #1: Summary of Imaging Modality ChoiceSummary of Imaging Modality Choice

Consistent with these ACR guidelines, Consistent with these ACR guidelines, ultrasound was the correct first imaging ultrasound was the correct first imaging modality for this young patient.modality for this young patient.

As we have seen, ultrasound has the benefits of As we have seen, ultrasound has the benefits of higher sensitivity in dense breasts and no higher sensitivity in dense breasts and no radiation, compared with mammography. radiation, compared with mammography.

However, there is still a role for mammography However, there is still a role for mammography in younger women.in younger women.


25

Role for mammography in women Role for mammography in women under age 30under age 30

When malignancy is suspected on ultrasound or When malignancy is suspected on ultrasound or confirmed on core biopsy pathology, we can use confirmed on core biopsy pathology, we can use mammography or MRI to look for additional mammography or MRI to look for additional lesions in the lesions in the ipsilateralipsilateral

or or contralateralcontralateral

breast.breast.

Ultrasound is the better diagnostic test for a Ultrasound is the better diagnostic test for a targeted area of clinical abnormality.targeted area of clinical abnormality.

Mammography and MRI are better for screening of Mammography and MRI are better for screening of the whole breast, as these are less operatorthe whole breast, as these are less operator--

dependent than ultrasound.dependent than ultrasound.


Sentis

M. Breast Cancer Res Treat. 2010

26

Patient #2: Clinical PresentationPatient #2: Clinical Presentation

Healthy 26Healthy 26--yearyear--old woman with no family old woman with no family history of breast or ovarian cancer.history of breast or ovarian cancer.

Presented with selfPresented with self--detected right breast mass. detected right breast mass. Her primary care physician confirmed the Her primary care physician confirmed the presence of a mass on clinical exam, and presence of a mass on clinical exam, and appropriately referred the patient for a appropriately referred the patient for a diagnostic ultrasound.diagnostic ultrasound.


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Ultrasound of the right breast, Ultrasound of the right breast, antiradialantiradial

view, 11:00 position, 6 cm from the nipple.view, 11:00 position, 6 cm from the nipple.

Irregular, Irregular, hypoechoichypoechoic

massmass, 1.6 x 2.3 cm, with , 1.6 x 2.3 cm, with angular marginsangular margins

and and

spiculationspiculation

along the anterior aspect.along the anterior aspect.

Patient #2: Patient #2: Irregular Solid Mass on UltrasoundIrregular Solid Mass on Ultrasound


PACS, BIDMC

*

28

Patient #2: Patient #2: Solid Mass with Calcifications on UltrasoundSolid Mass with Calcifications on Ultrasound

Ultrasound of right breast, Ultrasound of right breast, antiradialantiradial

view, 11:00 position, 6 cm from the nipple.view, 11:00 position, 6 cm from the nipple.

Multiple Multiple punctatepunctate, , hyperechoichyperechoic

foci (likelyfoci (likely

calcifications)calcifications), ,

which are highly concerning for malignancy. There is also which are highly concerning for malignancy. There is also concern for invasion into the chest wall, given the proximity concern for invasion into the chest wall, given the proximity to and to and illill--defined margindefined margin

along the along the pectoralispectoralis

major musclemajor muscle..


PACS, BIDMC

29

Patient #2: Additional ImagingPatient #2: Additional Imaging

As with our first patient, because of the concerning As with our first patient, because of the concerning features seen on ultrasound, this patient then had a features seen on ultrasound, this patient then had a bilateral diagnostic mammogram to evaluate for any bilateral diagnostic mammogram to evaluate for any additional lesions.additional lesions.

Her mammogram was performed at an outside Her mammogram was performed at an outside hospital and the actual images are not available.hospital and the actual images are not available.

We will use the mammographic images from a We will use the mammographic images from a companion patient to demonstrate some of the companion patient to demonstrate some of the findings described on Patient #2findings described on Patient #2’’s mammogram s mammogram report.report.


30

Companion Patient: Companion Patient: PleomorphicPleomorphic

Calcifications on MammogramCalcifications on Mammogram


Patient #2Patient #2’’s Mammography Report: s Mammography Report: ““An area of increased An area of increased density in the upper outer quadrant of the right breast associatdensity in the upper outer quadrant of the right breast associated ed with with numerous numerous pleomorphicpleomorphic

calcificationscalcifications

spanning an area of spanning an area of

approximately 3cm.approximately 3cm.””

----

OMR, BIDMCOMR, BIDMC

Image from Smithuis

R, Pijnappel

R. http://www.radiologyassistant.nl/en/4793bfde0ed53

31

Patient #2: Patient #2: Additional Findings on MammogramAdditional Findings on Mammogram

Patient #2Patient #2’’s mammogram also revealed s mammogram also revealed heterogeneously denseheterogeneously dense

(BI(BI--RADS 3) breasts, which RADS 3) breasts, which

somewhat limits the sensitivity of mammography, as we somewhat limits the sensitivity of mammography, as we have previously examined. Other than the have previously examined. Other than the pleomorphicpleomorphic

calcifications noted in the area of the ultrasound calcifications noted in the area of the ultrasound abnormality, there were no additional calcifications in abnormality, there were no additional calcifications in either breast.either breast.

A right A right mediolateralmediolateral--oblique view also demonstrated a oblique view also demonstrated a suspicious suspicious enlarged lymph nodeenlarged lymph node

(1.5 cm) in the right (1.5 cm) in the right

axillaaxilla. .


32

Patient #2: Biopsy ResultsPatient #2: Biopsy Results

This patient had an ultrasoundThis patient had an ultrasound--guided core biopsy guided core biopsy of the right breast mass and right of the right breast mass and right axillaryaxillary

lymph lymph

node.node.

Pathology: Pathology: Invasive Invasive ductalductal

carcinoma, grade 3carcinoma, grade 3

of 3, with associated calcifications. of 3, with associated calcifications. LymphLymph

node with node with metastatic poorly metastatic poorly

differentiated differentiated ductalductal

carcinomacarcinoma. . ER/PR and HERER/PR and HER--2 2 immunostainsimmunostains

were positive.were positive.


33

Patient #2: Patient #2: Additional Imaging for Cancer StagingAdditional Imaging for Cancer Staging

With biopsyWith biopsy--proven invasive breast cancer proven invasive breast cancer involving lymph nodes, this patient then involving lymph nodes, this patient then underwent additional imaging to evaluate her underwent additional imaging to evaluate her disease stage, in order to determine her disease stage, in order to determine her prognosis and treatment options.prognosis and treatment options.

Her imaging included a CT torso and a Her imaging included a CT torso and a radionuclide bone scan to evaluate for distant radionuclide bone scan to evaluate for distant metastases. We will view these studies briefly.metastases. We will view these studies briefly.


34

Patient #2: Patient #2: Enlarged Lymph Node on CT ChestEnlarged Lymph Node on CT Chest


Axial CT of the chest without intravenous contrast.Axial CT of the chest without intravenous contrast.Abnormally enlarged Abnormally enlarged lymph nodelymph node

in the right in the right axillaaxilla, status post biopsy , status post biopsy

with with clip placementclip placement. No evidence of metastases to the lungs or . No evidence of metastases to the lungs or abdominal organs.abdominal organs.

Clip placed at biopsy of lymph node

PACS, BIDMC

35

Patient #2: Patient #2: Normal Radionuclide Bone ScanNormal Radionuclide Bone Scan

There is normal There is normal radiotracer uptake in the radiotracer uptake in the axial skeletonaxial skeleton

and and

normal visualization of normal visualization of the the bilateral kidneysbilateral kidneys

and and

bladderbladder. There are no . There are no abnormal foci of tracer abnormal foci of tracer uptake that would be uptake that would be concerning for bony concerning for bony metastases.metastases.


Whole body bone scan with TcWhole body bone scan with Tc--99m 99m radiotracer, anterior and posterior projections.radiotracer, anterior and posterior projections.

PACS, BIDMC

**

*

36

Patient #2: Cancer StagePatient #2: Cancer Stage

Our patient underwent a wide excision (partial Our patient underwent a wide excision (partial mastectomy) of her right breast invasive mastectomy) of her right breast invasive ductalductal

carcinoma with carcinoma with axillaryaxillary

lymph node dissection.lymph node dissection.

Staging using TNM system: Staging using TNM system: Tumor: 3.3 cm Tumor: 3.3 cm = T2 (2= T2 (2--5 cm)5 cm)Nodes: 5 Nodes: 5 axillaryaxillary

nodes = N2 (4nodes = N2 (4--9 nodes)9 nodes)

Metastases: No distant Metastases: No distant metsmets

= M0= M0

T2N2M0 = Stage IIIAT2N2M0 = Stage IIIA


Edge SB et al. AJCC Cancer Staging Manual. 2010.

37

Patient #2: Disease CoursePatient #2: Disease Course

This patient underwent a wide surgical excision This patient underwent a wide surgical excision with acceptable margins and with acceptable margins and axillaryaxillary

lymph node lymph node

dissection, as mentioned previously.dissection, as mentioned previously.

She then underwent adjuvant chemotherapy She then underwent adjuvant chemotherapy ((Taxol/Herceptin/trialTaxol/Herceptin/trial

drug).drug).

Genetic testing revealed no BRCA 1 or 2 mutation.Genetic testing revealed no BRCA 1 or 2 mutation.

She has annual screening mammograms to monitor She has annual screening mammograms to monitor for recurrence of disease. Continue to view her for recurrence of disease. Continue to view her oneone--year postyear post--op mammogram.op mammogram.


38

Patient #2: OnePatient #2: One--year Postyear Post--opop Mammogram with no CalcificationsMammogram with no Calcifications


OneOne--year postyear post--operative operative followfollow--up screening up screening mammogram. mammogram. Heterogeneously dense Heterogeneously dense breasts bilaterally. breasts bilaterally. Architectural distortionArchitectural distortion

in right upper outer in right upper outer quadrant consistent with quadrant consistent with postpost--surgical changes. surgical changes. No residual No residual calcifications seen. No calcifications seen. No evidence of residual or evidence of residual or recurrent cancer.recurrent cancer.

R MLO L MLOPACS, BIDMC

Metal wire taped on skin to mark surgical scar

Mammogram of the right and left breasts, Mammogram of the right and left breasts, mediolateralmediolateral--oblique views.oblique views.

39

Review of Patients #1 and #2Review of Patients #1 and #2

We have reviewed the use of different breast We have reviewed the use of different breast imaging modalities in patients under the age of imaging modalities in patients under the age of 30 who present with a palpable breast mass.30 who present with a palpable breast mass.

We saw ultrasound features of a benign simple We saw ultrasound features of a benign simple cyst and an atypical benign cyst and an atypical benign fibroadenomafibroadenoma

in in

Patient #1.Patient #1.

We saw ultrasound and mammographic features We saw ultrasound and mammographic features of an invasive of an invasive ductalductal

carcinoma in Patient #2.carcinoma in Patient #2.


40

Summary of Benign vs. Malignant Summary of Benign vs. Malignant Imaging FindingsImaging Findings

Ultrasound and Ultrasound and MammographicMammographic

features:features:

Benign simple cyst Benign simple cyst ––

anechoic, wellanechoic, well--circumscribed circumscribed

Benign Benign fibroadenomafibroadenoma

––

round/oval shape, orientation round/oval shape, orientation parallel to the skin, up to 2parallel to the skin, up to 2--3 gentle 3 gentle macrolobulationsmacrolobulations

Malignancy Malignancy ––

hypoechoichypoechoic, irregular shape, poorly , irregular shape, poorly circumscribed, angulated or circumscribed, angulated or spiculatedspiculated

margins, margins,

microlobulations, taller than wide, microlobulations, taller than wide, calcifications calcifications ((pleomorphicpleomorphic/fine linear/branching)/fine linear/branching), , ductalductal

extension, extension,

invasion into surroundings, invasion into surroundings, hypervascularityhypervascularity

at edgesat edges


Loving VA et al. AJR 2010. Stavros AT et al. Radiology 1995.

41

Learning ObjectivesLearning Objectives

Breast cancer can occur and be aggressive in Breast cancer can occur and be aggressive in young women, so it is important to evaluate any young women, so it is important to evaluate any new palpable mass.new palpable mass.

Ultrasound is the firstUltrasound is the first--line imaging modality in line imaging modality in symptomatic women under age 30 (higher symptomatic women under age 30 (higher sensitivity in dense breasts than mammography sensitivity in dense breasts than mammography and no radiation exposure).and no radiation exposure).

Be familiar with benign and worrisome features Be familiar with benign and worrisome features of breast lesions on ultrasound and of breast lesions on ultrasound and mammography.mammography.


42

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References (continued)References (continued)


http://www.seer.cancer.gov/statfacts/html/breast.html

http://www.seer.cancer.gov/statfacts/html/breast.html

http://www.radiologyassistant.nl/en/4793bfde0ed53

44

AcknowledgementsAcknowledgementsI would like to thank the following people for their assistance I would like to thank the following people for their assistance and and support in the preparation of this presentation:support in the preparation of this presentation:

Dr. Priscilla Dr. Priscilla SlanetzSlanetz, MD, MPH, Director of Breast MRI, MD, MPH, Director of Breast MRI

Dr. Diana Ferris, MD, PhD,Dr. Diana Ferris, MD, PhD,

Clinical Fellow in Breast ImagingClinical Fellow in Breast Imaging

Dr. Gillian Lieberman, MDDr. Gillian Lieberman, MD

Emily HansonEmily Hanson

Dr. Dr. SamirSamir

Shah, MDShah, MD

My fellow Year III Harvard medical students: My fellow Year III Harvard medical students: Chris Chris AdermanAderman, Jasmine Barrow, Jen Katz, Jasmine Barrow, Jen Katz--EriksenEriksen


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