BREAST RADIOLOGY

MAMMOGRAPHY
MAMMOGRAPHIC INTERPRETATION

Approach to films
• Lighting
o Mask out extraneous light
• Hang films
o CC views back-to-back, MLO views back-to-back
o Comparison studies over current CC & MLO views
• Technical factors
o Positioning
 All breast tissue evaluated in 2 projections?
 Compression adequacy, motion blur
o Exposure
 Contrast
 Penetration of fibroglandular tissue
• Method of review
o View images at a distance & close-up with magnification
o Masking technique (Tabar p6)
o If obvious abnormality, look away from it (ignore until remainder of breast tissue
evaluated)
• Look for abnormalities
o Diffuse changes
o Microcalcifications
o Masses
o Architectural distortion (incl. trabeculae)
o Asymmetry of parenchyma – focal or global (usually a normal variant)
o Densities
o Straight lines are abnormal unless Hx of surgery or trauma (normal breast tissue is
scalloped)
• Specific review areas
o Skin (any skin thickening?)
o Nipple
o Subareolar area (2nd most common location for cancer)
o Retroglandular area on CC & MLO views
o Medial breast tissue on CC view
o Superior cone of tissue on MLO view
o Glandular tissue-fat junctions (glandular-subcutaneous & glandular-retroglandular) –
bulging contours are abnormal (normal breast tissue scalloped)
o Axillary nodes
• Localise the abnormality
o Should be seen on two views if real & be same distance from nipple and approximately
the same size
• Compare to previous studies
o Often need to compare to earliest studies to reveal subtle changes
Tabar’s forbidden zones
a) “Milky way” 3-4cm wide parallel to edge of pectoralis muscle on MLO
b) “No man’s land” retroglandular space
c) Medial half of breast on CC
d) Retroareolar area

Approach to mammography
• Initial screening films
o MLO & CC bilateral in all patients
o Exaggerated CC views &/or anterior compression views at discretion
• If abnormality found
o Spot compression (+/- double spot compression) with &/or without magnification views
(with microfocus) in the projection in which abnormality was seen is initial starting
point (two planes)
o Rolled views (does abnormality persist, helps localise)
o Orthogonal projection (e.g. lateral view) to triangulate location of lesion

Description of abnormality - BI-RADS (Tabar)

Mass
• Location
o Distance from nipple
o Quadrant / clock face
• Size (Tabar:)
o Very large (> 5cm)
 o Intermediate (3-5cm)
o Small (< 3cm)
• Shape (form)
o Round
o Oval
o Lobular
o Irregular
• Margin (contour)
o Circumscribed (sharply outlined +/- halo or capsule)
o Microlobulated
o Indistinct (ill-defined)
o Spiculated (Tabar p94:)  always need histology!
 Tumour centre
• Distinct central mass? Suggests malignancy
• Radiolucent centre? Suggests radial scar & fat necrosis
 Radiating structure (spicules)
• Sharp, dense fine lines of variable length? Typical of cancer (the larger
the central tumour mass, the longer the spicules)
• Very fine, lower density lines bunched together? Characteristic of radial
scar, often seen in fat necrosis
 Localised skin thickening or retraction? Suggests cancer; may be present in fat
necrosis (esp. post-op); never assoc/ w/ radial scar
o Obscured
• Density
o Fat-containing (radiolucent)
o (Mixed density)
o Low density
o Isodense (low density radiopaque)
o High density (high density radiopaque)
• Other (Tabar:)
o Orientation
ULTRASOUND

ULTRASOUND INTERPRETATION