MAMMO
GENERAL
LEARN / CASES
BEST BREAST CASES 2022.pdfCORE REVIEW
BREAST CORE REVIEW.pdfBREAST CORE REVIEW.pdfCRACK THE CORE MAMMO SUPPLEMENTAL.pptxBREAST MODALITIES
MAMMOGRAPHY
First-line tool for detection of breast CA.
Sensitivity for detecting CA: screening 68-90%, diagnostic up to 93%.
Digital breast tomosynthesis (DBT) is standard of care for breast CA screening and diagnostic imaging. Compared to digital mammo, DBT decreases recall rate and increases CA detection rate.
Screening
Reserved for patients without any breast concerns.
Reduces mortality from breast CA by 30%
Diagnostic
Evaluate clinical concerns, abnormalities detect on screening mammo, follow up after lumpectomy
MRI
Most sensitive modality for breast CA detection and is the most definitive imaging modality in evaluation of implant integrity.
Indications:
Screening in high risk patients (.20% lifetime risk of developing breast CA)
Evaluation of extent of disease in patient newly diagnosed w breast CA
Evaluation of neoadjuvant chemotherapy response
Assessment for residual disease after positive surgical margins or for tumor recurrence after breast conserving treatment
Evaluation for occult breast CA in a pt w/ axillary metastases
Assessment of breast implants
Best performed day 7-14 of menstrual cycle due to reduced background enhancement
US
Important tool for evaluating sx patients when mammography is negative.
Whole breast US can detect an additional 2-4 CA per 1,000 women over mammography alone but w increased cost.
Indications:
Characterization of palpable abnormalities
Further characterization of mammographic findings
First line evaluation of breast abnormality in pt < 30 yo
Pregnant or lactating women
Guidance for interventional procedures
Evaluation of breast implants
Supplemental screening in women with dense breasts or those at high risk and unable to undergo MRI surveillance
TIssue harmonic imaging refers to isonating tissue with 1 frequency (~10-12 MHz) and then receiving at a multiple of that frequency (20-24 MHz). This reduces artifactual internal echoes in cysts (reverberation), increases ST contrast, while posterior features are retained. A significant limitation is reduced penetration which limits its use in those w large breasts and abundant fibrous tissue.
Reduced sensitivity in patients with very large breasts (>4cm in thickness) and reduced sensitivity for detecting deep lesions. Breast density does NOT alter sensitivity on US like it does in mammography.
Can be hard to detect a small/deep mass in very large breast 2/2 mobility of the breast which can alter position of target as compared to its expect position based on mammography
Using a wedge under the patient for lateral lesions can be very helpful
MOLECULAR BREAST IMAGING (MBI, BSGI)
Tc-99m sestamibi is usual radiotracter which is excreted through the biliary system and the colon is the radiation critical organ.
ACR BI-RADS Atlas 5e.pdfRSNA TOMOSYNTHESIS PHYSICS.pdfRSNA DIAGNOSTIC TOMOSYNTHESIS.pdfRSNA DEVELOPING ASYMMETRIES AT MAMMO.pdf