Female breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy, made of glandular, adipose, and connective tissue Connective tissue Connective tissues originate from embryonic mesenchyme and are present throughout the body except inside the brain and spinal cord. The main function of connective tissues is to provide structural support to organs. Connective tissues consist of cells and an extracellular matrix. Connective Tissue: Histology, are hormone-sensitive organs that undergo changes along with the menstrual cycle Cycle The type of signal that ends the inspiratory phase delivered by the ventilator Invasive Mechanical Ventilation and during pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care. Breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy may be affected by various diseases, in which different imaging methods are important to arrive at the correct diagnosis and management. Mammography Mammography Radiographic examination of the breast. Breast Cancer Screening is used for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer screening Screening Preoperative Care and diagnostic evaluation of various breast-related symptoms. Ultrasonography is rarely used for screening Screening Preoperative Care, but it is typically used for diagnostic workup and during procedures (e.g., breast biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma). MRI of the breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy is used as a supplementary screening Screening Preoperative Care tool for those at high risk for developing breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer. Additionally, in individuals with breast implants, inconclusive mammographic and/or breast ultrasound Breast Ultrasound Fibrocystic Change findings, and diagnosed breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer needing evaluation pretreatment and posttreatment, MRI is an important breast radiologic tool.
Last updated: 29 Mar, 2022
There are no absolute contraindications Contraindications A condition or factor associated with a recipient that makes the use of a drug, procedure, or physical agent improper or inadvisable. Contraindications may be absolute (life threatening) or relative (higher risk of complications in which benefits may outweigh risks). Noninvasive Ventilation, but there are relative ones (owing to adverse effects of radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma exposure Exposure ABCDE Assessment).
Views | Description | |
---|---|---|
Standard views | Mediolateral oblique (MLO) view | Better view of the superior lateral quadrant of the breast Quadrant of The Breast Examination of the Breast and axilla Axilla The axilla is a pyramid-shaped space located between the upper thorax and the arm. The axilla has a base, an apex, and 4 walls (anterior, medial, lateral, posterior). The base of the pyramid is made up of the axillary skin. The apex is the axillary inlet, located between the 1st rib, superior border of the scapula, and clavicle. Axilla and Brachial Plexus: Anatomy |
Craniocaudal view (CC) |
|
|
Specialized views | Spot compression Compression Blunt Chest Trauma | Better visualization of suspicious masses, calcifications, or asymmetric breast tissue |
Magnification | ||
XCCL (exaggerated CC lateral) view | Modified CC view, focused on the lateral part of breast | |
XCCM (exaggerated CC medial) view | Modified CC view, focused on the medial part of the breast |
Normal
mammogram
Mammogram
Fibrocystic Change, depicting fibroglandular tissue:
Red stars represent pectoralis major.
CC: craniocaudal
MLO: mediolateral oblique
Breast density, almost entirely fatty
Image by Hetal Verma.Breast density, scattered fibroglandular
Image by Hetal Verma.Breast density, heterogeneously dense
Image by Hetal Verma.Breast density, extremely dense
Image by Hetal Verma.Category | Assessment | Follow-up |
---|---|---|
BI-RADS 0 | Incomplete assessment | Additional mammography Mammography Radiographic examination of the breast. Breast Cancer Screening views or ultrasound follow-up needed |
BI-RADS 1 | Negative | Continue with routine screening Screening Preoperative Care |
BI-RADS 2 | Benign Benign Fibroadenoma findings | Continue with routine screening Screening Preoperative Care |
BI-RADS 3 | Probably benign Benign Fibroadenoma findings | Diagnostic mammography Mammography Radiographic examination of the breast. Breast Cancer Screening or ultrasound in 6 months |
BI-RADS 4 | Suspicious abnormality | Biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma should be considered. |
BI-RADS 5 | Highly suggestive of malignancy Malignancy Hemothorax | Biopsy Biopsy Removal and pathologic examination of specimens from the living body. Ewing Sarcoma should be performed. |
BI-RADS 6 | Biopsy-proven malignancy Malignancy Hemothorax | Management for breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer |
Ultrasound image of a normal breast:
The fibroglandular parenchyma is echogenic and surrounded by
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) fat.
Ultrasound image of a lactating breast:
The
skin
Skin
The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.
Skin: Structure and Functions is displayed as an echogenic line. The glandular tissue is
hyperechoic
Hyperechoic
A structure that produces a high-amplitude echo (lighter grays and white)
Ultrasound (Sonography), with lines representing the epithelial lining, and the fat is slightly more
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography).
Radiologic technique that uses magnetic fields and radiofrequency pulses to produce highly detailed images of the breasts Breasts The breasts are found on the anterior thoracic wall and consist of mammary glands surrounded by connective tissue. The mammary glands are modified apocrine sweat glands that produce milk, which serves as nutrition for infants. Breasts are rudimentary and usually nonfunctioning in men. Breasts: Anatomy.
A breast MRI is contraindicated in MRI-incompatible hardware or anaphylaxis Anaphylaxis An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. Type I Hypersensitivity Reaction to gadolinium Gadolinium An element of the rare earth family of metals. It has the atomic symbol gd, atomic number 64, and atomic weight 157. 25. Its oxide is used in the control rods of some nuclear reactors. Magnetic Resonance Imaging (MRI).
Findings are grouped into 3 categories:
Ultrasound image shows a well-defined oval anechoic Anechoic A structure that produces no echo at all (looks completely black) Ultrasound (Sonography) mass with imperceptible walls and posterior acoustic enhancement consistent with a simple cyst.
Image: “A 37-year-old female with a palpable breast mass” by Ojeda-Fournier H, Nguyen JQ. License: CC BY 2.0, cropped by Lecturio.
Breast ultrasound
Breast Ultrasound
Fibrocystic Change (US) shows a simple cyst (A), presenting as an
anechoic
Anechoic
A structure that produces no echo at all (looks completely black)
Ultrasound (Sonography) lesion with posterior enhancement and a cyst (B) with a septum (arrow).
Breast US (C) in a 26-year-old woman with a painless palpable lump in her left breast shows a complex cyst, with an eccentrically placed echogenic focus (arrow) representing the
scolex
Scolex
Taenia/Taeniasis of a cysticercus granuloma.
She also had a similar
swelling
Swelling
Inflammation in the right
upper arm
Upper Arm
The arm, or “upper arm” in common usage, is the region of the upper limb that extends from the shoulder to the elbow joint and connects inferiorly to the forearm through the cubital fossa. It is divided into 2 fascial compartments (anterior and posterior).
Arm: Anatomy, a US (D) of which also revealed a cyst (arrow) with an echogenic
scolex
Scolex
Taenia/Taeniasis (arrowhead) within.
Ultrasound image showing a focal area of thickening with patchy appearance (A, arrows), scattered, discrete, thin-walled
cysts
Cysts
Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues.
Fibrocystic Change (B, arrowheads), and a cluster of tiny
cysts
Cysts
Any fluid-filled closed cavity or sac that is lined by an epithelium. Cysts can be of normal, abnormal, non-neoplastic, or neoplastic tissues.
Fibrocystic Change (C, arrows)
The characteristics of these lesions suggest
fibrocystic
Fibrocystic
Fibrocystic Change changes.
Mammogram Mammogram Fibrocystic Change showing focal microcalcifications (thin arrows) with surrounding dense parenchyma, suggestive of fibrocystic Fibrocystic Fibrocystic Change changes
Image: “An illustrative example showing segmentation Segmentation Gastrointestinal Motility of microcalcifications in a mammogram Mammogram Fibrocystic Change” by Wang J, Yang X, Cai H, Tan W, Jin C, Li L. License: CC BY 4.0, cropped by Lecturio.Ultrasound image showing a homogeneous Homogeneous Imaging of the Spleen, hypoechoic Hypoechoic A structure that produces a low-amplitude echo (darker grays) Ultrasound (Sonography) mass that is oval-shaped and has a greater transverse diameter, suggesting a fibroadenoma Fibroadenoma Fibroadenomas are the most common benign tumor of the female breast and the most common breast tumor in adolescent and young women. The tumors are well-circumscribed, mobile, and unencapsulated, with a rubbery or firm consistency. Fibroadenoma
Image: “ Fibroadenoma Fibroadenoma Fibroadenomas are the most common benign tumor of the female breast and the most common breast tumor in adolescent and young women. The tumors are well-circumscribed, mobile, and unencapsulated, with a rubbery or firm consistency. Fibroadenoma” by Shah G, Jankharia B. License: CC BY 2.0, cropped by Lecturio.Mammogram Mammogram Fibrocystic Change showing popcorn calcifications (arrows) and upper lateral mass (circle), suggestive of fibroadenomas
Image by Hetal Verma.Ultrasound image of a well-defined subtly echogenic mass ( lipoma Lipoma A lipoma is a benign neoplasm of fat cells (adipocytes) and the most common soft tissue tumor in adults. The etiology is unknown, but obesity is a predisposing factor; genetics also play a role, with multiple lipomas occurring in various inherited disorders. Lipoma) with a lamellar pattern and a well-defined, thin capsule Capsule An envelope of loose gel surrounding a bacterial cell which is associated with the virulence of pathogenic bacteria. Some capsules have a well-defined border, whereas others form a slime layer that trails off into the medium. Most capsules consist of relatively simple polysaccharides but there are some bacteria whose capsules are made of polypeptides. Bacteroides (arrows)
Image: “ Lipoma Lipoma A lipoma is a benign neoplasm of fat cells (adipocytes) and the most common soft tissue tumor in adults. The etiology is unknown, but obesity is a predisposing factor; genetics also play a role, with multiple lipomas occurring in various inherited disorders. Lipoma” by Gokhale, S. License: CC BY 2.0Ultrasound image of a
hypoechoic
Hypoechoic
A structure that produces a low-amplitude echo (darker grays)
Ultrasound (Sonography) mass with irregular borders, spiculated margins, and posterior acoustic shadowing (arrow)
Characteristics of the mass suggest a malignant
tumor
Tumor
Inflammation.
MRI with contrast shows a heterogeneously enhancing irregular mass with spiculated margins, suggestive of breast cancer.
Image: “A 55-year-old woman with a palpable abnormality” by Ojeda-Fournier H, Nguyen JQ. License: CC BY 2.0, cropped by Lecturio.
A: MRI of breast shows a primary
tumor
Tumor
Inflammation (thin arrow) and
axillary lymphadenopathy
Axillary Lymphadenopathy
Lymphadenopathy (arrowheads).
B: Postchemotherapy MRI of breast shows resolution of the mass and
lymphadenopathy
Lymphadenopathy
Lymphadenopathy is lymph node enlargement (> 1 cm) and is benign and self-limited in most patients. Etiologies include malignancy, infection, and autoimmune disorders, as well as iatrogenic causes such as the use of certain medications. Generalized lymphadenopathy often indicates underlying systemic disease.
Lymphadenopathy.
Mammogram Mammogram Fibrocystic Change showing a group of pleomorphic Pleomorphic Bacteroides microcalcifications, suggestive of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
Image: “ Screening Screening Preoperative Care mammogram Mammogram Fibrocystic Change in a 63-year-old woman” by Ojeda-Fournier H, Nguyen JQ. License: CC BY 2.0Mammogram Mammogram Fibrocystic Change showing a spiculated mass, suggestive of breast cancer Breast cancer Breast cancer is a disease characterized by malignant transformation of the epithelial cells of the breast. Breast cancer is the most common form of cancer and 2nd most common cause of cancer-related death among women. Breast Cancer
Image: “ Screening Screening Preoperative Care mammography Mammography Radiographic examination of the breast. Breast Cancer Screening in a 67-year-old woman” by Ojeda-Fournier H, Nguyen JQ. License: CC BY 2.0Ultrasound image showing a lesion of mixed echogenicity, reported as fat
necrosis
Necrosis
The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
Ischemic Cell Damage/oil cyst
Biopsy
Biopsy
Removal and pathologic examination of specimens from the living body.
Ewing Sarcoma confirmed fat
necrosis
Necrosis
The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
Ischemic Cell Damage.
Mammogram Mammogram Fibrocystic Change showing well-circumscribed lesion (arrows) with soft border and several calcifications near the lesion, suggestive of an oil cyst
Image: “ VA VA Ventilation: Mechanics of Breathing, US and mammography Mammography Radiographic examination of the breast. Breast Cancer Screening images” by Alizad A, Mehrmohammadi M, Ghosh K, Glazebrook KN, Carter RE, Karaberkmez LG, Whaley DH, Fatemi M. License: CC BY 4.0, cropped by Lecturio.Mammogram Mammogram Fibrocystic Change showing coarse and eggshell calcification, suggestive of fat necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage
Image: “A 52-year-old woman presented with a palpable abnormality following breast reduction Breast Reduction Fat Necrosis of the Breast surgery” by Ojeda-Fournier H, Nguyen JQ. License: CC BY 2.0Mammogram Mammogram Fibrocystic Change showing a fat-containing oval mass, suggestive of hamartoma Hamartoma A focal malformation resembling a neoplasm, composed of an overgrowth of mature cells and tissues that normally occur in the affected area. Colorectal Cancer
Image: “A 26-year-old pregnant female with a new palpable mass” by Ojeda-Fournier H, Nguyen JQ. License: CC BY 2.0