Breast imaging basic course for medical college student
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Breast Imaging Basic Course For Medical College Student. WANG Deng-bin MD,Ph.D Dept. of Radiology,RuiJin Hospital. Introduction.

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Breast Imaging Basic Course For Medical College Student

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Breast imaging basic course for medical college student

Breast ImagingBasic Course For Medical College Student

WANG Deng-bin MD,Ph.D

Dept. of Radiology,RuiJin Hospital


Introduction

Introduction

“Breast cancer is one of the best studied human tumors, but it remains poorly understood” “ As in all medical endeavors, the practitioner should, whenever possible, use the results of scientific studies to guide clinical decision”


Breast imaging basic course for medical college student

And the imaging modalities implemented in clinical practice for breast care must be served as the tools for detection and characterization of breast lesions. As we expect, they are very important for diagnosis and treatment.


Imaging modalities

Imaging Modalities


Breast imaging basic course for medical college student

1.5T MRI

GE signa gemsow

0.5T MRI

GE signa Sys#MRS

Shanghai 2nd Medical University

Rui Jin Hospital


X ray examination mammograpy

X-ray ExaminationMammograpy

  • X-ray radiography (molybdenum X rays, rhodium X rays):MLO,CC,etc.

  • Galactography --demonstrates the ducts and ductule or their abnormalities.


Breast imaging basic course for medical college student

galactography


Breast imaging basic course for medical college student

USG

  • Ultrasonography (ultrasound)

    • B-mode US

    • Doppler US


Breast imaging basic course for medical college student

CT

  • Computed tomography

    • plain scan,

    • enhanced scan (iodine)


Breast imaging basic course for medical college student

MRI

  • Magnetic Resonance Imaging

    • high resolution for soft tissue

    • different tissue, different signal

    • enhanced scan


The others

The others

  • Infrared thermal imaging

  • Computer diaphanography imaging,etc.


Imaging guided percutaneous biopsy supply specimens for pathologic examination

Imaging-Guided Percutaneous Biopsysupply specimens for pathologic examination

  • Fine needle aspiration biopsy (FNAB)

  • Needle core biopsy (NCB)


Interventional therapy

Interventional Therapy

  • Laser

  • Radiofrequency

  • Embolization

  • and so on


Accessory breast tissue

Accessory Breast Tissue

  • The most common site is axilla


Basic imaging signs of breast lesion

Basic Imaging Signs of Breast Lesion

  • Mass/Lump

  • Calcification

  • Thickening and retraction of regional skin

  • Retraction of nipple

  • Enlargement or abnormality of blood vessels

  • Lymph nodes

  • Enhanced manifestations


Mass lump

Mass/Lump

shape:round, oval, regular/irregular

margin:clear or ambiguous, spiculation or smooth

density or signal intensity:high/low/intermediate with or without calcification

site:upper-outer quadrant breast, upper-inner quadrant breast, lower outer quadrant breast, lower-inner quadrant breast, nipple, central portion breast, axillary tail breast.

Number:solitary or multiple


Calcification

Calcification

Size: large or micro

Shape: ring-like, nodular or salt-like, branching

Distribution: scattered or clustered with or without mass

benign / malignant


Thickening and retraction of regional skin

Thickening and Retraction of Regional Skin

  • Frequently found in malignant tumors

  • Sometimes due to postsurgical scars.


Retraction of nipple

Retraction of Nipple

  • Congenital-dysplasia

  • Acquired-malignant tumor


Enlargement or abnormality of blood vessel

Enlargement or Abnormality of Blood Vessel

  • Mostly in malignant tumor due to increase of blood supply


Enlargement of lymph nodes

Enlargement of Lymph Nodes

  • Axillary or intramammary lymph nodes


Administration of contrast agents for breast lesions

Administration of Contrast Agents for Breast Lesions

  • Implication of the lesion’s hemodynamics

    • washout type--malignant

    • linear--benign

    • plateau--malignant/benign


Common diseases in breast

Common Diseases in Breast

  • Fibroadenoma

  • Cyst

  • Lobular hyperplasia

  • Cancer


Fibroadenoma overview

Fibroadenoma overview

Frequency: most common tumor of breast (benign)

Age: below 30 yrs

Distribution: unilateral or bilateral

Source tissue: connective tissue and glandular tissue

Site: upper-outer quadrant

Size: < 5cm

Surface: smooth, movable


Imaging findings of fibroadenoma

Imaging Findings of Fibroadenoma

  • X-ray

  • CT

  • MRI


X ray findings

X-ray Findings

  • Round, lobular or oval mass or nodule ,smooth nodule in high density with thin ring/ halo in low density

  • Compression of surrounding tissue

  • Large calcification:always dominated at the center of tumor


Ct findings

CT Findings

  • Round smooth mass/nodule

  • Value of CT similar to normal glandular tissue

  • Calcification

  • Intermediate enhancement, linear type or plateau,relatively long duration of enhancement


Breast cancer overview

Breast Canceroverview

  • most frequent malignancy in women

    • 1% in adult women in China

    • 34.4/100 thousand in 1989

    • 39.7/100 thousand in 1993

    • 46/100 thousand in 1997

    • 52.98/100 thousand in women of Shanghai in 2001

    • over 100/100 thousand in women in Europe and USA


Breast cancer overview1

Breast Canceroverview

Age: 40-60yrs, in China 1/5 are <35yrs

Gender: female (male)

Clinical

  • mass: unmovable mass,

  • skin,orange-peel-like,retraction

  • aching

  • retraction/discharge of nipple

  • enlargement of blood vessels

  • stiffness of breast

  • lymph nodes


Breast cancer overview2

Breast Canceroverview

  • Pathology

    Invasive ductal carcinoma65-80%

    Intraductal carcinoma 15%

    Lobular carcinoma(invasive/in situ) 5%

    Special types 10%


X ray findings of breast cancer 1

X-ray Findings of Breast Cancer(1)

  • Irregular/regular mass

  • Ambiguous border

  • Spiculations

  • Heterogeneous density, mostly higher than the Surrounding tissue

  • Site: over 50% at upper-outer quadrant


X ray findings of breast cancer 2

X-ray findings of breast cancer(2)

  • Calcification: clustered salt-like microcalcification in 1/3 cases inside/outside the mass, sometimes only the microcalcifications observed

  • Retraction of nipple

  • Thickening of skin

  • Abnormal blood vessel

  • Large patchy region in high density


Ct findings of breast cancer 1

CT Findings of Breast Cancer(1)

  • Mass: irregular/ill-shaped, coarse margin, spiculation, CT value: 25-56HU, higher than the normal breast, necrosis at the center of the large mass(mostly >= 5cm)

  • Skin, nipple

  • Infiltration into the pectoralis major muscle


Ct findings of breast cancer 2

CT Findings of Breast Cancer(2)

  • Occupying of retromammary space

  • Enlargement of lymph nodes, axillary/retromammary

  • Administration of contrast agents

    • quick enhancement (wash in) at early phase

    • the peak of enhancement occur within 50s ~1min

    • quick washout

    • time-signal intensity curve——washout type


Mri findings of breast cancer

MRI Findings of Breast Cancer

  • Signal intensity:T1WI SE,low;T2WI FSE,low,intermediate,inhomogeneous;STIR, intermediate

  • Spiculation: irregular mass (lobular)

  • Enhancement: time-signal intensity curve


Comparison of different imaging modalities for detection and characterization of breast cancer

Comparison of Different Imaging Modalities for Detection and Characterization of Breast Cancer

  • Molybdenum X-ray radiography:

    most important,widest used,most useful—not very sensitive to the small lesion at very early stage in dense breast;but digital mammography can solve the problem to great extent


Breast imaging basic course for medical college student

USG

  • Cystic or solid

  • Low spatial resolution

  • Limited ability to Differentiate benign/malignant


Breast imaging basic course for medical college student

CT

  • Wide coverage for viewing ,sensitive to cystic change,hemorrhage and calcification

  • Very useful for detection and characterization of masses ,especially in the enhanced scan, but can’t definitely view the microcalcification

  • Much more radiation,expensive


Breast imaging basic course for medical college student

MRI

  • High soft resolution

  • Better differentiation for benign/malignant

  • Wider coverage

  • Without radiation

  • High cost

  • Not sensitive to calcification


Breast imaging basic course for medical college student

CT C-

CT C+

MR C+


Combination of varying imaging modalities

Combination of Varying Imaging Modalities

  • Acquire the richest information

  • Appropriateness in application

  • Cost-effectiveness

  • Best diagnosis, timely correct therapy, better health


Breast imaging basic course for medical college student

  • To the women of the world, may breast cancer soon be eliminated as a source of dread and death

  • To breast cancer researchers and breast health caregivers, may our efforts soon be unnecessary


Breast imaging basic course for medical college student

Thank You


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