4. ⢠PAST MEDICAL/ SURGICAL Hx
⢠MENSTRUAL/OBSTETRICAL Hx
⢠DRUG Hx
⢠FAMILY Hx
5. LUMP EXAMINATION
Location Upper inner quad.
Size 3x2 cm
Appearance Normal
Temperature Normal
Tenderness Present
Margins Irregular
Consistency Hard
Motility Immobile
21. ULTRASOUNDULTRASOUND
INDICATIONS
⢠Symptomatic breast lumps in women aged
less than 35 years.
⢠Breast lump developing during pregnancy
or lactation.
⢠Assessment of mammographic
abnormality (Âą further mammographic
views)
22. ⢠Assessment of MRI or scintimammography
detected lesions.
⢠Clinical breast mass with negative
mammograms.
⢠Breast inflammation.
⢠The augmented breast (together with
MRI).
23. ⢠Breast lump in a male (together with
mammography).
⢠Guidance of needle biopsy or localisation.
⢠Follow-up of breast cancer treated with
adjuvant chemotherapy.
32. Inflammatory breast cancer with secondary signs.
increased hyperechogenicity of the intramammary fat
resulting in loss of the normal glandular adipose
differentiation Lymphatic dilation is also apparent under
the thickened subcutaneous layer.
33. A power Doppler image of invasive grade 3
breast cancer.
irregular tortuous vessels penetrating into
the centre of the lesion.
51. MRIMRI
INDICATIONS
⢠Staging biopsy-proven primary breast
carcinoma
⢠Detecting an occult primary breast cancer
in a patient with proven axillary node
involvement but negative results on
mammography and ultrasonography
52. ⢠Ascertaining the extent of disease after
lumpectomy with positive margins or close
margins
⢠Investigating suspected pectoralis muscle
invasion
⢠Assessing response to chemotherapy,
including preoperative chemotherapy
53. ⢠Looking for suspected recurrent disease,
such as in a postsurgical scar
⢠A compelling clinical presentation with
negative or equivocal imaging results
⢠Problem solving, ie, workup of uncertain
imaging findings that could not be
resolved even after special mammographic
and ultrasonographic techniques were
used
54. ⢠Needle localization and guided biopsy
⢠Known or suspected rupture of breast
implants
⢠Screening patients with certain well-
defined risk factors for breast cancer.
55. Dense breast tissue Two lesions on contrast
enchanced MRI
Biopsy proven case of breast carcinoma
56. Pre contrastPre contrast Post contrastPost contrast
Sagittal T1 weighted gradient-echo images with fat saturationSagittal T1 weighted gradient-echo images with fat saturation
Intravenous gadolinium-DTPA.Intravenous gadolinium-DTPA.
2 malignant masses2 malignant masses
Typical heterogenous and rim enhancement of larger massTypical heterogenous and rim enhancement of larger mass
Involvement of prepectoral fascia,pectoralis major andInvolvement of prepectoral fascia,pectoralis major and
skin by inferior massskin by inferior mass
57. BI-RADSBI-RADS
⢠Breast Imaging Reporting And Data
System
⢠Made by American college of radiology
⢠Importance
â Diagnostic
â Therapeutic
â Prognostic
â Epidemiologic
â Standardized words in mammographic
reporting
â Improved communication
59. Category 0Category 0
⢠Assessment incomplete
⢠Further workup needed
⢠e.g Screening mammogram shows a
noduleâŚ..
⢠Till further workup its labelled as category
0
60. Category 1Category 1
⢠Negative
⢠mammogram shows
â No grouped or suspicious
microcalcifications
â No well-formed mass,
â A symmetrical glandular structure
â No change from any previous exam
61. Category 2Category 2
⢠definitely benign and a routine screening
⢠It include:
â Round opacities with macrocalcifications
(typical calcified fibroadenoma or cyst)
â Round opacities corresponding to a
typical cyst at ultrasonography
62. â Oval opacities with a radiolucent center
â Fatty densities or partially fatty images
(lipoma, galactocele, oil cyst,
hamartoma )
â Vascular calcifications
65. Category 3Category 3
⢠Probably Benign
⢠Positive predictive value less than 1%
⢠a follow-up of 6 months is usually
recommended.
66. Findings include:
⢠Clusters of tiny calcifications if round or
oval
⢠Non-calcified solid nodules (no size
limitation but non palpable), round, ovoid,
well-defined,
67. ⢠Selected focal asymmetric areas of
fibroglandular density (not palpable):
⢠Miscellaneous focal findings, such as a
dilated duct, or post biopsy architectural
distortion without central density
⢠Generalized distribution in both breasts.
For example, multiple similar lesions with
tiny calcifications or nodules distributed
randomly
68. ⢠In some scenerios a percutaneous biopsy
might be considered,even with category 3.
For example, extreme patient anxiety, or
plans for pregnancy, plans for breast
augmentation or reduction surgery, or if
synchronous carcinoma is present
70. Category 4Category 4
⢠Suspicious or Indeterminate abnormality
⢠The positive predictive value (the chance
of a real cancer) 20-40%.
⢠Commonly fibrocystic changes
⢠A biopsy should be recommended.
71. It is often subdivided into three smaller
sub-categories:
â "A" for low suspicion of malignancy,
â "B" for moderate suspicion,
â "C" for high suspicion.
72. Findings include:
⢠Asymmetric, localized or evolving
hyperdensities with convex contours.
⢠Indeterminate microcalcifications
appearing amorphous, indistinct
particularly if in a cluster or heterogeneous
and pleomorphic
⢠Round or oval non cystic opacities with
microlobulated or obscured contours
73.
74. Category 5Category 5
⢠Highly suggestive of malignancy
⢠A biopsy should be taken immediately.
⢠Positive predictive value 95%
Finding include :
⢠Typically malignant microcalcifications;
e.g.linear with branching pattern;
75. ⢠Clusters of microcalcifications with a
segmental or galactophorous distribution
⢠Evolving microcalcifications or associated
with an architectural distortion or opacity
⢠Poorly circumscribed opacities;
⢠Spiculated opacities with radio-opaque
center.
76.
77. Category 6Category 6
⢠Known Cancer
⢠Proven by biopsy.
⢠Used when patients undergoing breast
cancer treatment have follow-up
mammograms.
