Mammography # 1
Week 2
Mammography Facts
• 1 in 8 women who live to 95 will develop breast cancer
• Most common malignancy in women, only lung cancer
kills more women
– One of the most treatable cancers
• Before Mammo fewer than 5% of pt’s survived 4 years
after diagnosis with a 80% recurrence
– With a radical mastectomy survival increased to 40% with a
10% recurrence
Goal of Mammography
• Detect cancer before it is palpable
• Early detection, diagnosis and treatment is
the key to a favorable prognosis
How would your family feel with
you missing from the family
picture?
How would you feel about your
father, brother or mother missing
from the family picture?
Breast
Self Exam
Breast Dimpling
Breast Cancer
Peau d’orange
Anatomy of the Breast
• Vary in shape & size
• Cone shaped with the post
surface (base) overlying the
pectoralis & serratus
muscles
• Axillaries tail extends from
lat. base of the breasts to
axillaries fossa
• Tapers ant. from the base
ending in nipple,
surrounded by areola
Female Breast
• Consists of 15-20
lobes
– Divide into several
lobules
– Lobules contain acini,
draining ducts and
interlobular
connective tissue.
– By teenage years
each breast contains
hundreds of lobules
Lymph Nodes
• Lymphatic vessels of
the breast drain
laterally and medially
– Laterally into the
axillary lymph nodes
(C & D)
• 75& drain toward axilla
– Medially into the
mammary lymph
nodes
• 25% toward mammary
chain (F)
Quadrants of the Breast
3 Tissue Types
Breast Changes with Age
Breast Classifications
Fibro-glandular Breast
• Fibro-glandular
– Dense with very little
fat
– Females 15-30 years
of age
• Or 30 years or older
without children
– Pregnant or lactating
Fibro-fatty Breast
• Fibro-fatty
– Average density
• 50% fat & 50% fibroglandular
• Women 30-50 years of
age
– Or women with 3 or
more children
Fatty Breast
• Fatty
– Minimal density
– Women 50 and older
(postmenopausal),
men and children
Positioning
Various Mammographic Positioning
Ouch! Why Compression?
• Two Reasons:
– Decrease thickness of
breast tissue
– Reduce OID
Cranio- caudad :CC
Diagram of Proper CC Positioning
CC Images
Multiple Bilateral Benign
Calcifications
Breast Cancer
Carcinoma
Microcalcifications
CC positioning
• CR Perpendicular
• Film tray brought to
level of inframammary
crease
• Wrinkles and folds
smoothed out
• Compression applied
• Markers on axillary
side
CC Criteria
• No motion
• Nipple in profile
• All pertinent anatomy
demonstrated
• Dense areas penetrated
• High contrast & optimal
resolution
• Absence of artifacts
• Marker & patient ID
visible
Medio-lateral
Oblique:
MLO
MLO Diagram for
Proper Positioning
MLO Properly Positioned
Bilateral MLO
MLO positioning
• CR & cassette (IR)
angled 45 degrees
• Top of cassette
(IR) at axilla
• Compression
applied
• Nipple in profile
• Marker at axilla
MLO criteria
• No motion
• Pectoral muscle to level
of nipple visualized
• Breast pulled away from
chest wall
• Nipple in profile
• Dense areas of breast
penetrated
• High contrast & optimal
resolution
• Absence of artifacts
• Marker & PT ID visible
What position is this?
What position is this?
Breast Implants
Are they worth it?
Complication with Breast
Augmentation
• Mammography has a 80-90% true positive
rate for detecting breast cancer in those
women without implants
– Decreases to 60% with implants
• Because 85% of breast tissue is obscured
• More images are needed than the
standard two projections
• There is a risk of rupturing the implant
Elkland Method for Imaging with
Breast Implants
Image Comparison
Which is the Push back (Elkland)?
Male Mammography and Cancer
Male Mammography
• 1300 men get breast cancer per year
– 1/3 die
• Most are 60 years or older
• Nearly all are primary tumors
• Symptoms include:
– Nipple retraction
– Crusting
– Discharge
– Ulceration
Gynemastia
• Benign excessive development of male mammary gland
• Occurs in 40% of male cancer pt’s
• Survival rates with treatment are 97% for 5 years
Old and New Equipment
Cone Magnification
Cone magnification
Mammography Equipment
Digital vs. Film