How will you approach the 35 year old, with a 2 x 2 x 2cm, firm, mobile, well circumscribed non tender mass on the right breast?

How will you approach the 35 year old, with a 2 x 2 x

2cm, firm, mobile, well circumscribed non tender mass on the right breast?

Role of imaging modality

• Mammography– plays a central part in early detection of breast cancers

because it can show changes in the breast up to two years before a patient or physician can feel them.

– Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.

• Digital and conventional mammography – both use x-rays to produce an image of the breast

• Conventional mammography: image is stored directly on film• Digital mammography: images stored as a computer file

• full-field digital mammography (FFDM); mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals used to produce images

• can be enhanced, magnified, or manipulated for further evaluation more easily

• Digital mammography advantages over conventional mammography:– Health care providers can share image files electronically, making

long-distance consultations between radiologists and breast surgeons easier.

– Subtle differences between normal and abnormal tissues may be more easily noted.

– Fewer follow-up procedures may be needed. – Fewer repeat images may be needed, reducing the exposure to

radiation.

http://www.radiologyinfo.org/en/info.cfm?pg=mammo

• Ultrasound– to differentiate solid from cystic masses; looks for shape and

texture– to provide guidance for interventional breast procedures such

as cyst aspiration or core biopsy– useful when a palpable mass is partially or poorly seen on a

mammogram, especially in young women– When added to mammography= improved breast cancer

detection in high-risk women (Journal of the American Medical Association, 2008)

A mammogram was taken as seen in the picture. Is this benign or

malignant?

Dx:BENIGN

CYST

Differentiate radiologically a benign lesion from a malignant one.

BENIGN MALIGNANT

Smooth contour Grow significantly

Well-circumscribed Stellate or star-bust shaped that extends in all directions

Encapsulated Calcifications

With “halo sign”

Will not change much in shape or size

Difference in ultrasound findings.BENIGN MALIGNANT

intense uniform hyperechogenicity Irregular/spiculated borders (“Silhouette sign”)

ellipsoid or wider-than-tall (parallel) orientation along with a thin, echogenic capsule

taller-than-wide orientation

2 or 3 gentle lobulations and a thin, echogenic capsule

angular margins

marked hypoechogenicity

posterior acoustic shadowing

punctuate calcifications

duct extension

branch pattern

microlobulation.

Should the patient have a mother who is a breast cancer survivor, how would

that information change your management?

Breast Cancer Screening Tests

• Mammogram – is the best tool available for early breast cancer detection – can often identify cancer before symptoms appear and can

reveal calcium deposits in the breast, which may be an early sign of cancer

– HIGH RISK: annual mammogram beginning at an age that is 5 to 10 years younger than the youngest member of the family with breast cancer

Breast Cancer Screening Tests• Clinical breast exam – thorough physical examination of the breasts done by

a physician or nurse practitioner – HIGH RISK: recommended every 6 to 12 months

• Self breast exam – identify breast abnormalities and should be

performed monthly, about one week after the end of your period

• Breast MRI – For extremely dense breast tissue that make

mammograms difficult to interpret

Self breast Exam

National Cancer Institute