In The Name of God
BREAST IMAGING
N. Ahmadinejad
Medical Imaging Center
TUMS
BREAST IMAGING
 Screening
 Diagnostic
Mammography
An excellent detection technique
Mammography is early
detection
Not prevention
The goal of screening for breast cancer is not to detect all breast
abnormalities; the goal is to prevent deaths from breast cancer
WHO Principles of Screening
Disease is serious and prevalent;
Test is sensitive, specific, well tolerated, cheap, changes therapy or outcome
Minimal Carcinomas
 All
invasive carcinomas measuring
less than 1cm.
 All
in situ carcinoma
Lead time for mammographic
detection range from2 to 4
or more years before a
lesion becomes clinically
evident
Screening Guidelines ACS
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Women at average risk:
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Ages 20 to 39
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Age 40 and over
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clinical breast examination at least every three years
annual screening mammography and clinical breast exam
Breast self-exam (BSE) is an option for women
starting in their 20s
Elderly women
○
3/18/2016
continue screening as long as woman is in reasonably good
health and would be a candidate for cancer treatment
10
BC Screening Interval
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US: American Cancer Society, American Medical
Association: annual screening by the age of 40 Y
National cancer institute: every 1-2 Y
Biennale screening in Canada, Australia and
much Europe
Sweden: 18 mo.
40-49 and 24 mo.
grater than 50
UK: every 3 Y
Screening Guidelines ACS
High Risk Patients
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Known BRCA1 or BRCA2 mutation
First degree relative with BRCA1 or 2 and
no testing themselves
Radiation therapy to the chest between
the ages of 10 and 30 yrs
Have Li-Fraumeni, Cowden, or hereditary
diffuse gastric syndromes, or a first
degree relative with one of these
syndromes
Risk assessment tools> 20% lifetime
3/18/2016
12
Women who have a mother or sister
with premenopausal BC being
screening 5-10 Y earlier than the
age at which the immediate
relative was diagnosed
Mammography: Pros
*7 randomized trials demonstrate that
there is a relative risk reduction in BCM
by 20-30%, depending on age
*Smaller cancers are less likely to
metastasize, thus prognosis for a small
tumor is better
*Smaller cancers are amenable to breast
conservation, and more cosmetic
outcome than if tumors are larger
It is not diagnostic unless
The lesion has the typical characteristics of
a malignant or benign mass
spiculated
MAMMOGRAPHIC
PROJECTION
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STANDARD VIEWS
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Medio Lateral Obliqe
(M.L.O)
CranioCaudal(cc)
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ADDITIONAL VIEW
90-Degree lateral
Spot Compression
Magnification
Exaggerated Cranio
Caudal
Cleavage
Axilary Tail
Tangenital
Roll
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Techniqual aspect
Positioning
Evaluation
Interpretation
Digital Mammography
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Improved breast cancer detection over
analog (film-screen) mammography for:
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Women with dense breasts
Women under 50
Premenopausal women
Lower radiation dose
No increase in false positive rate
Expensive