Background: Breast symptoms are not uncommon among Nigerian adult females. Most worrisome are symptoms associated with the possibility of breast cancer. Mammography is an imaging technique being introduced in third world practice as an aid for screening and diagnosis of patients with breast symptoms. Objective: To document the pattern of mammographic findings in symptomatic females referred for mammography. Two standard views cranio-caudal-CC and medio-lateral oblique-MLO were done on both breasts for each patient.
These descriptors are arranged according to the risk of malignancy:. In these cases, breast biopsies are considered unnecessary. Mammography is also not reliable following radiation therapy, surgery, and hormonal replacement therapy. Lesbian sex positions pictures group of women Radiographic breast diseases a known family history of breast cancer was recommended not to repeat X-ray mammography. By Radiographic breast diseases Category 4 into 4A, 4B and 4Cit is encouraged that relevant probabilities for malignancy be indicated within this category so the patient and her physician can make an informed decision on the ultimate course of action. Here we have proof that the mass is caused by an intramammary lymph node, since the mammographic mass contains the contrast.
Anal guys. Updated version
Pockaj, M. In order to receive the special rate, reservations must Radiographic breast diseases made before the room block is filled or before the expiration date of October 14, ; whichever comes first. Most times, breast pain signals a noncancerous benign breast condition and rarely indicates breast cancer. Recent news. Mastalgia breast pain. Recommend surgical, radiation, and medical oncology management and treatment options for newly diagnosed breast cancer patients. Search and filter AC topics and ratings tables login required. Updating… Please wait. Search Topics. Course expires:. To read more about the development process, please Carmen reyes busty the information below. Create and share playlists to help advance medical information around the globe. For disclosure information regarding Mayo Clinic School of Continuous Professional Development accreditation review committee member splease go here to review disclosures.
Radiological findings of breast involvement in benign and malignant systemic diseases.
- It is seen as a wide spectrum of altered morphology in the female breast from innocuous to those associated with risk of carcinoma.
- Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology.
- Find out more.
- Jump to navigation.
- Breast pain mastalgia — a common complaint among women — can include breast tenderness, sharp burning pain or tightness in your breast tissue.
It also facilitates outcome monitoring and quality assessment. It contains a lexicon for standardized terminology descriptors for mammography, breast US and MRI, as well as chapters on Report Organization and Guidance Chapters for use in daily practice.
The table shows a summary of the mammography and ultrasound lexicon. Enlarge the table by clicking on the image. First describe the breast composition. When there is a significant finding use the descriptors in the table. The ultrasound lexicon has many similarities to the mammography lexicon, but there are some descriptors that are specific for ultrasound.
We will first discuss the breast imaging lexicon of mammography and ultrasound and then discuss in more detail the final assessment categories and the do's and don'ts in these categories. In BI-RADS the use of percentages is discouraged, because in individual cases it is more important to take into account the chance that a mass can be obscured by fibroglandular tissue than the percentage of breast density as an indicator for breast cancer risk.
In the BI-RADS edition the assignment of the breast composition is changed into a, b, c and d-categories followed by a description:. The fibroglandular tissue in the upper part is sufficiently dense to obscure small masses. So it is called c , because small masses can be obscured.
A 'Mass' is a space occupying 3D lesion seen in two different projections. If a potential mass is seen in only a single projection it should be called a 'asymmetry' until its three-dimensionality is confirmed.
The images show a fat-containing lesion with a popcorn-like calcification. All fat-containing lesions are typically benign. These image-findings are diagnostic for a hamartoma - also known as fibroadenolipoma. Always make sure that a mass that is found on physical examination is the same as the mass that is found with mammography or ultrasound.
Location and size should be applied in any lesion, that must undergo biopsy. The density of a mass is related to the expected attenuation of an equal volume of fibroglandular tissue. High density is associated with malignancy. It is extremely rare for breast cancer to be low density. Here multiple round circumscribed low density masses in the right breast.
These were the result of lipofilling, which is transplantation of body fat to the breast. Here a hyperdense mass with an irregular shape and a spiculated margin. Notice the focal skin retraction. The term architectural distortion is used, when the normal architecture is distorted with no definite mass visible. This includes thin straight lines or spiculations radiating from a point, and focal retraction, distortion or straightening at the edges of the parenchyma.
The differential diagnosis is scar tissue or carcinoma. Architectural distortion can also be seen as an associated feature. For instance if there is a mass that causes architectural distortion, the likelihood of malignancy is greater than in the case of a mass without distortion.
Notice the distortion of the normal breast architecture on oblique view yellow circle and magnification view. A resection was performed and only scar tissue was found in the specimen. Findings that represent unilateral deposits of fibroglandulair tissue not conforming to the definition of a mass. Here an example of global asymmetry. In this patient this is not a normal variant, since there are associated features, that indicate the possibility of malignancy like skin thickening, thickened septa and subtle nipple retraction.
Ultrasound not shown detected multiple small masses that proved to be adenocarcinoma. All types of asymmmetry have different border contours than true masses and also lack the conspicuity of masses. Asymmetries appear similar to other discrete areas of fibroglandulair tissue except that they are unitaleral, with no mirror-image correlate in the opposite breast.
An asymmetry demonstrates concave outward borders and usually is interspersed with fat, whereas a mass demonstrates convex outward borders and appears denser in the center than at the periphery. The use of the term "density" is confusing, as the term "density" should only be used to describe the x-ray attenuation of a mass compared to an equal volume of fibroglandular tissue. In the atlas calcifications were classified by morphology and distribution either as benign, intermediate concern or high probability of malignancy.
In the version the approach has changed. Since calcifications of intermediate concern and of high probability of malignancy all are being treated the same way, which usually means biopsy, it is logic to group them together. Calcifications are now either typically benign or of suspicious morphology.
Within this last group the chances of malignancy are different depending on their morphology BI-RADS 4B or 4C and also depending on their distribution. There is one exception of the rule: an isolated group of punctuate calcifications that is new, increasing, linear, or segmental in distribution, or adjacent to a known cancer can be assigned as probably benign or suspicious.
Read more on breast calcifications. The arrangement of calcifications, the distribution, is at least as important as morphology. These descriptors are arranged according to the risk of malignancy:. Associated features are things that are seen in association with suspicious findings like masses, asymmetries and calcifications.
Associated features play a role in the final assessment. Special cases are findings with features so typical that you do not need to describe them in detail, like for instance an intramammary lymph node or a wart on the skin. Many descriptors for ultrasound are the same as for mammography.
For instance when we describe the shape or margin of a mass. Special cases - cases with a unique diagnosis or pathognomonic ultrasound appearance:. When additional imaging studies are completed, a final assessment is made.
Always try to avoid this category by immediately doing additional imaging or retrieving old films before reporting. Even better to have the old examinations before starting the examination.
This patient presented with a mass on the mammogram at screening, which was assigned as BI-RADS 0 needs additional imaging evaluation. Additional ultrasound demonstrated that the mass was caused by an intramammary lymph node. Don't forget to mention in the report that the lymph node on US corresponds with the noncalcified mass on mammography. In the paragraph on location we will discuss how we can be sure that the lymph node that we found with ultrasound is indeed the same as the mammographic mass.
The breasts are symmetric and no masses, architectural distortion or suspicious calcifications are present. Like BI-RADS 1, this is a normal assessment, but here, the interpreter chooses to describe a benign finding in the mammography report, like:.
It is not expected to change over the follow-up interval, but the radiologist would prefer to establish its stability. Lesions appropriately placed in this category include:. Here a non-palpable sharply defined mass with a group of punctate calcifications.
Continue with follow up images. Follow-up at 6, 12 and 24 months showed no change and the final assessment was changed into a Category 2. Nevertheless the patient and the clinician preferred removal, because the radiologist was not able to present a clear differential diagnosis.
At 12 month follow up more than five calcifications were noted in a group. This proved to be DCIS with invasive carcinoma.
This category is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy. By subdividing Category 4 into 4A, 4B and 4C , it is encouraged that relevant probabilities for malignancy be indicated within this category so the patient and her physician can make an informed decision on the ultimate course of action.
This finding is sufficiently suspicious to justify biopsy. A benign lesion, although unlikely, is a possibility. This could be for instance ectopic glandular tissue within a heterogeneously dense breast. The pathologist could report to you that it is sclerosing adenosis or ductal carcinoma in situ.
Both diagnoses are concordant with the mammographic findings. Highly Suggestive of Malignancy. The current rationale for using category 5 is that if the percutaneous tissue diagnosis is nonmalignant, this automatically should be considered as discordant. Here images of a biopsy proven malignancy. On the initial mammogram a marker is placed in the palpable tumor.
Due to the dense fibroglandular tissue the tumor is not well seen. Ultrasound demonstrated a 37 mm mass with indistinct and angular margins and shadowing. After chemotherapy the tumor is not visible on the mammogram. There may be variability within breast imaging practices, members of a group practice should agree upon a consistent policy for documenting. When you use more modalities, always make sure, that you are dealing with the same lesion.
For instance a lesion found with US does not have to be the same as the mammographic or physical finding. Sometimes repeated mammographic imaging with markers on the lesion found with US can be helpful. Cysts can be aspirated or filled with air after aspiration to make sure that the lesion found on the mammogram is caused by a cyst.
Here images that you've seen before. They are of a patient with a new lesion found at screening. With ultrasound an intramammary lymph node was found, but we weren't sure whether this was the same as the mass on the mammogram.
Continue with the mammographic images after contrast injection. Contrast was injected into the node and a repeated mammogram was performed. Here we have proof that the mass is caused by an intramammary lymph node, since the mammographic mass contains the contrast. This patient presented with a tumor in the left breast.
Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. However, feedback and comments on any topic may be submitted at any time. Other Healthcare Professionals A certificate of attendance will be provided to other healthcare professionals for requesting credits in accordance with state nursing boards, specialty societies, or other professional associations. Curate focused playlists on specific topics for presentations to help other medical professionals teach radiology, or formulate quiz playlists to support medical students in their education. Jokich PM, et al. Articles Cases Courses Quiz. Still, unexplained breast pain that doesn't go away after one or two menstrual cycles or that persists after menopause needs to be evaluated by your doctor.
Radiographic breast diseases. You are here
Radiological findings of breast involvement in benign and malignant systemic diseases. Although the primary purpose of periodic mammograms in screening programs is to identify lesions suspected of being carcinomas, the findings are often related to systemic benign or malignant diseases, rather than breast cancer.
Although the involvement of breast structures in systemic diseases is unusual, it can be included in the differential diagnosis of masses, skin changes, calcifications, asymmetry, and axillary lymphadenopathy. The main diagnostic entities that can be associated with such involvement are diabetes, chronic kidney disease, heart diseases, connective tissue diseases, HIV infection, lymphoma, leukemia, and metastases from primary tumors at other sites. In many cases, information related to knowledge and treatment of chronic diseases is not available to the radiologist at the time of evaluation of the mammography findings.
The purpose of this essay is to offer relevant pictorial information to the general radiologist about systemic diseases involving the breast, expanding the range of differential diagnoses in order to avoid unnecessary invasive procedures. With the expansion of breast cancer screening programs, more mammographic examinations are being performed, and, as a consequence, the detection of breast findings not related to epithelial carcinomas is also more frequent. The major benign systemic diseases with radiological manifestations on mammography and breast ultrasound are diabetes, heart diseases, chronic kidney disease, HIV infection, granulomatous diseases e.
Within that context, patients may present, clinically, with skin changes, palpable masses and skin thickening. Malignant systemic diseases with secondary manifestations in the breasts can include lymphoma, leukemia, and metastases from primary cancer at other sites. The initial diagnostic flow chart involves the analysis of the clinical history and previous treatments. When these tools are used in conjunction with the mammography and ultrasound findings and yet do not result in a definitive diagnosis, percutaneous biopsy can be performed.
The objective of this article is to present the most common systemic diseases affecting the breasts, as well as their radiological manifestations. Although the cause is not well known, it is related to an increase in the amount of collagen, increasing the extracellular matrix in the setting of hyperglycemia 2. On mammography, it manifests as focal asymmetry or a solid mass, usually in the retroareolar region, without accompanying calcifications Figure 1.
The sonographic appearance is a hypoechoic mass with indistinct or spiculated margins, with pronounced posterior acoustic shadow, and no vascularity on the Doppler evaluation 3 , as illustrated in Figure 2. Those presentations raise the possibility of malignancy, and, consequently, percutaneous biopsy is recommended. During the biopsy procedure, the lesion is often hard, which hampers its sampling. Percutaneous biopsy of the mass resulted in a diagnosis of perilobular lymphocytic infiltrate, consistent with diabetic mastopathy.
There are two main aspects of heart diseases with manifestation in the breasts 3 : arteriopathy and edema. Arterial calcifications are common and do not cause diagnostic difficulties in mammography Figure 3 , unless they are incipient, in which case they can mimic linear suspicious calcifications.
It is not well established in the literature whether the detection of arterial calcifications is related to increased cardiovascular risk. It is intuitively assumed that calcifications and peripheral arteries are a consequence of ongoing cardiovascular disease and are associated with risk factors for coronary artery disease, and this assumption is supported by some studies showing a positive association between the presence of vascular calcifications and cardiovascular disease 4.
As can be seen in Figure 4 , the edema manifests as skin thickening, vein engorgement, and increased fibroglandular tissue density on mammography, whereas it manifests as increased echogenicity of superficial fatty planes and hypoechoic fluid collections on ultrasound 3.
These findings are associated with decompensation of congestive heart failure. The imaging findings most commonly seen in chronic kidney diseas are related to its pathophysiology. Due to fluid retention, there are radiographic findings similar to those of congestive heart failure, with increased fibroglandular density, thickening of trabeculae, and skin thickening 3. Calcifications in the medial layer of the arteries can result in prominent vascular calcifications.
Secondary hyperparathyroidism can give rise to coarse, mainly cutaneous, calcifications. An arteriovenous fistula for dialysis results in prominent venous collaterals in the ipsilateral breast Figure 5. As a consequence of the medications used in patients undergoing renal transplantation, fibroadenomas can be commonly seen in women taking cyclosporine 5 and infectious processes can result from the immunosuppressive state. In men with chronic kidney disease, the drop in serum testosterone levels may cause gynecomastia.
Mammogram showing a vascular prominence in the left breast. Axillary lymph node enlargement and infectious processes can be seen in HIV-infected individuals. The lymph nodes tend to present hyperdense and with larger dimensions, although nonspecific.
On ultrasound, the lymph nodes show diffuse, symmetrical cortical thickening. Breast composition is also affected by HIV-associated lipodystrophy, because there is a lower proportion of adipose tissue, resulting in a breast with a greater density on mammography. In HIV-infected patients, there may be filling of the breast with autologous adipose material, promoting areas of fat necrosis Figure 6. The patient had a history of adipose tissue graft in the breasts due to lipodystrophy caused by HIV infection.
Granulomatous diseases include tuberculosis and mastitis. In systemic tuberculosis, breast or axillary involvement is rare and manifests in two main forms: axillary lymphadenopathy and tuberculous mastitis.
When there is lymph node involvement, the lymph nodes are enlarged, the cortex is hypoechoic, and there can be calcifications. In mastitis, ultrasound shows abscess formation represented by complex solid-cystic masses or fluid collections Figure 7. Granulomas may also appear as irregular masses accompanied by edema of the adjacent fat tissue 3 , 6. In these situations, it is difficult to make an accurate diagnosis, given that it is often impossible to exclude a malignant lesion on the basis of imaging findings alone and a biopsy is therefore necessary.
Sputum smear microscopy was positive for acid-fast bacilli. Filariasis is a parasitic infection that can involve the breasts, caused by the helminth Wuchereria bancrofti.
The main clinical manifestations occur as a consequence of obstruction of the lymphatic vessels by the presence of active or calcified worms. In the breast, the larva penetrates the lymphatic vessels and causes lymphangitis, fibrosis, and changes in the lymphatic drainage, resulting in global or focal asymmetry accompanied by trabecular and skin thickening.
The larvae can later present as linear or serpentine calcifications 7 , as depicted in Figure 8. Connective tissue diseases are a heterogeneous group of diseases characterized by inflammatory processes in the connective tissues. They include systemic lupus erythematosus, scleroderma, dermatopolymyositis, and mixed connective tissue disease. The most common findings are bilateral axillary lymph node enlargement, skin thickening, and calcifications.
In systemic lupus erythematosus, it is common to find skin thickening with multiple subcutaneous nodules, incipient linear calcifications that later become more numerous and coarse, representing areas of fat necrosis 6 , 8 , as can be seen in Figure 9. Scleroderma manifests as thickening of the skin, trabecular thickening of the fibroglandular tissue, and coarse superficial calcifications Figure Dermatopolymyositis typically presents as cutaneous and dystrophic calcifications Figure Secondary involvement of the breasts by lymphoma is uncommon, mainly due to the rarity of lymphoid tissue.
Secondary lymphomas are associated with prior or concomitant systemic lymphoma and are more common than primary lymphomas. The most common subtype is diffuse large B-cell non-Hodgkin lymphoma. Secondary lymphomas manifest as masses, as well as focal or global asymmetry.
The masses are oval or round, with circumscribed or microlobulated margins Figure 12 , mimicking benign lesions 7. Leukemic infiltration of the breasts is extremely rare, being most common after bone marrow transplantation. Clinically, there are palpable masses; on mammography, the masses are rounded, microlobulated, and hyperdense, whereas they are hypoechoic or solid-cystic complex on ultrasound 9.
Biopsy of the mass led to a diagnosis of B-cell lymphoma. Secondary lesions in the breast are uncommon, due to the limited arterial supply. The main types of primary cancer are melanoma, thyroid cancer, and ovarian cancer. Mammography shows masses with benign characteristics-oval, circumscribed, and not calcified-as depicted in Figure Ultrasound shows masses that are oval or round, hypoechoic with posterior acoustic shadowing, due to the high cellularity, and presenting as calcifications in ovarian cancer Figure 14 or thyroid cancer.
The nodules are usually located in the superficial planes and are often palpable The patient had a history of malignant melanoma. Analysis of a percutaneous biopsy of the mass confirmed the secondary involvement of the breast by melanoma. Analysis of a percutaneous biopsy of the mass revealed that it was secondary to an ovarian carcinoma.
Although the breast is not a common site of lesions caused by systemic diseases, its involvement can occur after benign or malignant changes. Knowledge of the main changes found on breast imaging can increase the range of differential diagnoses of an imaging change and occasionally avoid an unnecessary invasive procedure. The female breast and diabetes. Diabetic mastopathy, a clinicopathological correlation of 34 cases.
Pathol Int. Mammographic signs of systemic disease. Do breast arterial calcifications on mammography predict elevated risk of coronary artery disease? Eur J Radiol. Characteristic imaging features of breast fibroadenomas in women given cyclosporine A after renal transplantation. J Clin Ultrasound. Breast manifestations of systemic diseases. Int J Womens Health. Calcified filariasis of the breast: report of four cases. Eur Radiol. The clinical significance of recognizing distinct morphologic features of systemic diseases on breast biopsies.
Adv Anat Pathol. Primary and secondary breast lymphoma: prevalence, clinical signs and radiological features. Br J Radiol. Metastatic tumors to the breast: mammographic and ultrasonographic findings. J Ultrasound Med. Correspondence: Dr. Renato Augusto Eidy Kiota Matsumoto. E-mail: renatoaekm gmail. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Services on Demand Journal. Pictorial Essay Radiological findings of breast involvement in benign and malignant systemic diseases. Abstract Although the primary purpose of periodic mammograms in screening programs is to identify lesions suspected of being carcinomas, the findings are often related to systemic benign or malignant diseases, rather than breast cancer.