Imaging breast mammogram

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  • What is a mammogram ?

    A mammogram is a x-ray exam of the breast to detect and evaluate any change in the breast

  • History of mammographyX-rays were first used to examine breast tissue by the German surgeon ALBERT SALOMON about a century agoModern mammography came in to existence since the late 1960Technology has advanced and todays machine is different even from those of the 1980s and 1990s

  • Mammography machine

    Todays mammography machine expose the breast to much less radiationX-rays do not go through tissue as easily as those used for routine chest x-ray or x-rays of extremity

  • Radiation from mammogramModern machine is safe and uses the lowest dose of radiation possible

    If a woman with breast cancer is treated with radiation, she will get several thousand rads.If she has yearly mammogram starting at age of 40 and continues until 90 she will get total of 20-40 radsBenefits of mammography outweigh any possible harm from the radiation exposure

  • Types of mammogram

    Screening mammogramDiagnostic mammogram

  • Screening mammogram

    Mammogram of the breast for the women who have no sign or symptom of breast cancer, usually with two x-ray viewsFinding breast cancer early greatly improves a womans chance for successful treatment

  • Diagnostic mammogram

    X-ray of the breast for a woman with breast problem like lump or nipple discharge or an abnormal area found in screening by taking spot view or magnification view

  • What diagnostic mammogram does? One of three ways----It may reveal that an area that looked abnormal on screening is actually NORMALroutine checkupIt could reveal that an area of abnormal tissue probably is NOT CANCER but radiologist may not ready to say it normal based on these x-rays--- re-check up in 4-6 monthsThe results could also suggest that a biopsy is needed to find out if the abnormal area is CANCER

  • Types of mammogram machine

    Screen- film units Full- field digital mammography units (better in woman younger than 50/or with dense breast tissue)

  • How is mammogram done?

    Breast is briefly compressed between 2 plates attached to the mammogram machine an adjustable plastic plate on top and a fixed plate on bottom which holds the x-ray film or the digital detector that makes the image

  • Typical viewsFor screening: Cranio- caudal view(CC) Medio-lateral oblique(MLO)For diagnostic: CC MLO- lateromedial(from side towards center of chest)mediolateral(from the center of the chest out)Spot compression view

  • Position

    How the breast is compressed between two plates

  • How mammogram are read?

    Its challenging must be interpreted by radiologistMust to compare with previous mammogram

  • Mammogram: Changes in breast tissue

    Calcification: macrocalcification microcalcificationMassBreast density

  • Calcification: Macrocalcification

    Due to changes in breast caused by aging of breast arteries, old injuries or inflammationCoarse/ large Calcium deposit Seen in 1 0f 10 women under 50 and about half over 50These deposit are related to Non-cancerous condition and do not require biopsy

  • Calcification: Microcalcifiation

    Tiny specks of calciumIf seen its a matter of concern though not necessarily it is cancer or does not mean biopsy

  • MassMass with or without calcificationNoncancerous mass: Cystic fluid filled sacs/ simple cyst Solid Fibro adenoma Complex or mixed mass: suspect cancer needs FNAC or biopsyBreast ultrasound is complementary

  • Breast densityDensity is based on : how much fibrous and glandular tissue : how is the distribution within breast tissue : how is breast made up of fatty tissueDense breasts are not abnormal but they are linked to higher risk of breast cancer

  • Findings on mammogramPrimary signs of breast cancer may include spiculated masses or clustered pleomorphic microcalcification

    Secondary signs of breast cancer may include asymmetrical tissue density, skin thickening or retraction or focal distortion of tissue

  • Impression

    Overall assessment of the radiological findings often includes a classification of the mammogram using the BI-RADS system developed by the American College Of Radiology(ACR)

  • Mammogram - normal

  • X-ray film versus digital mammogram

  • Mass on mammogram

  • Mass on mammography

  • Mass on mammography

  • Tissue density on mammogramFatty versus dense

  • Recommendation(optional)

    No action necessaryA six month follow up mammogramSpot viewsBreast ultrasoundBiopsy etc.

  • Breast Imaging Reporting and Data System(BI-RADS)

    Category0: additional view or ultrasound and or compare prior filmCategory1: negativeCategory2: benign(noncancerous)Category3:probably benign,repeat in 6mth

  • BI-RADS categoryCategory4: suspicious abnormality consider biopsy4A: finding with low suspicion of being cancer.4B: finding with an intermediate suspicion of being cancer4C: finding of moderate concern of being cancer but not as high as category5

  • BI-RADS category

    Category5: highly suggestive of malignancy, biopsy is recommendedCategory6: known biopsy proven malignancy, appropriate action should be taken. It is only to see how well the cancer is responding to treatment

  • BI-RADS for breast density The breast are almost entirely fatty ( little fibrous and glandular tissue )There are scattered areas of fibro glandular densityThe breasts are heterogenously dense ( more fibrous and glandular tissue ) The breasts are extremely dense ( It can lead to missing some cancer )

  • Limitations of mammogramBreast cancer screening is the best way to find cancer early but finding cancer early does not always reduce a womans chance of dying from breast cancerDetecting breast cancer early may not help prolong the life of a woman who has other kind of serious or life threatening health problem like CCF, ESRD,COPD..

  • False-negative resultsA false-negative mammogram appears normal even though with breast cancer It occur more often among younger women usually had dense breastFalse-negative results can delay treatment and promote a false sense of security for the womanOverall, screening mammogram miss about 1 in 5 breast cancers

  • False- positive results

    A false- positive mammogram looks abnormal but no cancer is actually presentIt requires diagnostic mammogram, ultrasound, MRI or even biopsyIt is common in younger woman, have dense breast, have had breast biopsy or cancer in family or are taking oesterogen

  • Over diagnosis andover treatmentWhile mammogram can find invasive breast cancer and DCIS that need to be treated, it is also possible that some invasive cancer or DCIS detected on mammography will not keep growing so not so life threatening and never would have been detected if a woman had not gotten a mammogram. Doctors often cannot be sure which cancers & cases of DICS will become life-threatening, they are all treated

  • Mammogram in younger women

    Difficult to read because breast tissue is dense and it can hide the tumourIn some younger women who are at high risk yearly MRI or mammograms are recommended at age of 30yearsRisk factors: gene mutation,strong family history or other factors

  • Mammogram plan after BCT

    Radiation and surgery both cause changes in the skin and breast tissue These changes on mammogram, making it harder to readThe changes usually peak 6mth after RTMammogram done at this time serves as a new baseline for the affected breast

  • Mammogram after mastectomywithout reconstructionWomen who had total or modified radical or radical mastectomy for breast cancer need no further routine screening mammogram of the affected sideMammograms are usually continued on the UNAFFECTED breast each yearFollow up mammogram does require only in the cases who had gone for Subcutaneous mastectomy

  • Mammogram after mastectomywith reconstruction

    Women who have had a breast fully removed and reconstructed (rebuilt) with silicone gel or saline implant do not need routine mammogram

  • Mammogram after BCT

    BCT: Breast conserving treatmentPartial Mastectomy (sometimes called Lumpectomy) is another name for BCTIt always followed by radiotherapyWoman after BCT will need to continue having regular mammogram of both breast

  • Mammogram with implantsIts special challenge to do mammography of breast with implantIn order to see as much breast tissue as possible it needs 4 extra and 4 standard picture (2 on each breast)Extra picture is implant displacement(ID) view pushing back implant against chest wall and the breast is pulled forward over itMRI IS BEST WAY TO CHECK IMPLANT

  • *Elkland Method for Imaging with Breast Implants

  • TOMOSYNTHESIS3D mammography

    Newer technique Basically it is an extension of digital mammogramBreast is compressed once, machine takes many low dose x-rays as it moves over the breast in an arc, images can then be combined into a 3-dimensional picture

  • 3 D- Images

  • MRI for BreastJust as mammogram is done with specially designe