Mammogram

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MammogramMammogram

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MammogramMammogram

Standard mammography first introduced in 1969 Digital mammogram (full-field digital mammography) first introduced in 2001

Mammogram and US reports (BI-RADS)Mammogram and US reports (BI-RADS)Category 0: additional imaging evaluationCategory 1: negative (risk of malignancy 5/10,000)Category 2: benign findingCategory 3: probably benign suggests FU in a short time frame and

regularly at least 2 yrs (risk of malignancy <2%)Category 4: suspicious abnormality, Bx should be considered, can have a wide

range of suspicious level4A: a low suspicious of being cancerous (risk of malignancy 10%)4B: intermediate suspicion (risk of malignancy 12%)4C: moderate concern of being cancerous but not as high as category 5

(risk of malignancy 36%)Category 5: highly suggestive of malignancy, Bx is strongly recommended (risk of malignancy 75-99%)

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Interpretation of Mammography and USInterpretation of Mammography and US1. Breast symmetry, density, glandular distribution, architectural

distortion

2. Masses: size, shape, margins3. Calcification: size, morphology and distribution

macrocalcification: usually benignmicrocalcification: up to 30% can related to

breast cancer (80% of Bx done are benign)4. Associated finding: skin or nipple retraction, skin thickening,

axillary adenopathy

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Accuracy of MammographyAccuracy of Mammography

Specificity 50-70%, sensitivity 80-90%

False negative result in patients with palpable mass10-15%

False negative rate of 8-10% has been reported in patientswho subsequently diagnosed with cancer ataverage delay of 45 weeks

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Breast BiopsyBreast Biopsy

Non-surgical proceduresNon-surgical procedures Five needle aspiration biopsy (FNAB) Stereotactic, US or MRI guided FNAB Core needle biopsy (CNB) Guided-CNB

Surgical proceduresSurgical procedures Vacuum-assisted (mammotome) breast biopsy for

palpable or non-palpable lesion Excisional biopsy (lumpectomy) Incisional biopsy US guide wire localization for non-palpable lesion

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ImmunohistochemistryImmunohistochemistry study study for hormonal receptors (estrogen and progesterone), proliferating index (Ki-67) c-erb-B2 and P-53

has been performed on formalin-fixed, paraffin embedded sections.The results are as follows:

ER: 4+ (76-100% of malignant cells)PgR: 4+(76-100% of malignant cells)Ki-67: 3+(51-75% of malignant cells)c-erb-B2: negative (positive 3+, equivocal 2+, negative 0/1+)P-53: 4+(76-100% of malignant cells)

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Mammogram and Ultrasound breast both sides:Mammogram and Ultrasound breast both sides:

Clinical: F/U abnormal previous studyPE: No definite mass is palpated.Technique: Digital mammogram using routine positions.Breast composition: Heterogeneously dense, which could obscure

detection of small masses.Mammographic findings:Mammographic findings:No detectable mass, architectural distortion or malignant microcalcification.Intact nipple and skin. No detectable axillary adenopathy.Sonographic findings:Sonographic findings:Cluster of micrcysts with microcalcification at Lt. 2-3 HR, 20.5 x 8.8 mm.Multiple hypoechoic nodules in each: left breast; 6.6 x 4 mm at 10 HR,

9.8 x 5.4 mm at 9 HR, 9x4 mm at 8 HR, 7.5 x 3 mm at 6 HR. Right breast 7 x 5 mm at10 HR. and 7.7 x 6.7 mm at 3 HR.multiple cysts in each.

Assessment:Assessment: BI-RADS 3, probably benign, less than 2% probability of malignancy.

Impression:Impression: Cluster of microcysts with microcalcification at Lt.2-3 HRand multiple hypoechoic nodules bilat., probably bening.

Recommendation:Recommendation: next 6 months F/U if unchanged breast self-exam, monthly.