Diagnostic Imaging: Breast

Anatomy and Normal Variants

Anatomy

Breast Overview

Embryology and Normal Development

Nipple-Areolar Complex and Skin

Segmental Anatomy

Pectoralis Muscle and Chest Wall

Neurovascular Supply

Lymph Nodes and Lymphatics

Axilla

Normal Variants

Axillary Breast Tissue

Pectoralis Muscle and Chest Wall Variants

Sternalis Muscle

Imaging

Modalities

Mammography: Positioning

Mammography: Diagnostic

Tomosynthesis

Contrast-Enhanced Mammography/Tomosynthesis

Ultrasound

Elastography

Automated Breast Ultrasound

Magnetic Resonance Imaging

Diffusion-Weighted Imaging (MR)

MR Spectroscopy

Molecular Breast Imaging (MBI and BSGI)

Dedicated Breast PET (PEM)

PET/CT

Interpretive Criteria

Approach to the Lexicons of Breast Imaging

Mammography BI-RADS Lexicon and Usage

Ultrasound BI-RADS Lexicon and Usage

MR BI-RADS Lexicon and Usage

Probably Benign Lesions

Molecular Breast Imaging Lexicon (Includes BSGI)

Breast PET Lexicon and Usage

Lesion Imaging Characteristics

Masses

Circumscribed and Obscured Margins

Intramammary Lymph Node

Fat-Containing Mass

Microlobulated Margins

Indistinct Margins

Spiculated Margins

High-Density Mass

Calcifications, Typically Benign

Typically Benign Calcifications

Round Calcifications

Milk of Calcium

Calcifications, Not Typically Benign

Punctate Calcifications

Coarse Heterogeneous Calcifications

Amorphous Calcifications

Fine Pleomorphic Calcifications

Fine Linear Calcifications

Calcification Distribution

Diffuse Distribution of Calcifications

Regional Distribution of Calcifications

Grouped Distribution of Calcifications

Linear Distribution of Calcifications

Segmental Distribution of Calcifications

Additional Findings

One-View-Only Findings

Asymmetries

Developing Asymmetry

Architectural Distortion

Trabecular Thickening, Edema

Multiple Bilateral Similar Findings

Duct Ectasia

Solitary Dilated Duct

Ultrasound Lesion Characteristics

Margins, Not Circumscribed (US)

Echogenic Rim (US)

Lesion Orientation (US)

Posterior Acoustic Features: Enhancement & Shadowing (US)

Posterior Shadowing (US)

Echogenicity: Anechoic (US)

Echogenicity: Isoechoic, Hypoechoic, and Mixed (US)

Echogenicity: Hyperechoic (US)

Heterogeneous Internal Echogenicity (US)

Simple Cyst (US)

Complicated Cyst With Debris (US)

Clustered Microcysts (US)

Intraductal Mass (US)

Complex Cystic and Solid Masses

Calcifications (US)

MR Findings

Background Parenchymal Enhancement (MR)

T2 Hyperintensity (MR)

Kinetic Assessment (MR)

Dark Internal Septations (MR)

Rim Enhancement (MR)

Focus (MR)

Focal Area, Regional, and Diffuse Enhancement (MR)

Linear Enhancement (MR)

Segmental Enhancement (MR)

Clumped and Clustered Ring Enhancement (MR)

Clustered Ring Enhancement (MR) [DELETE AFTER WENDIE DONE WITH IT]

Histopathologic Diagnoses

Approach to Histopathologic Diagnoses

Benign Lesions

Tubular Adenoma and Nipple Adenoma

Adenosis, Sclerosing Adenosis, Microglandular Adenosis

Apocrine Metaplasia

Columnar Cell Lesions

Cyst, Ruptured/Inflamed

Fat Necrosis, Oil Cyst

Hamartoma (Fibroadenolipoma)

Fibroadenoma

Fibroadenomatoid Change

Fibrocystic Changes

Fibrosis

Hematoma

Lipoma and Angiolipoma

Myoepithelial Neoplasms

Myofibroblastoma

Papilloma, Benign

PASH

Risk Lesions

Radial Scar, Radial Sclerosing Lesions

Atypical Ductal Hyperplasia

Atypical Lobular Hyperplasia

Flat Epithelial Atypia

Lobular Carcinoma In Situ (Classic)

Mucocele-Like Lesions

Atypical Papilloma

Locally Aggressive Lesions

Fibromatosis

Granular Cell Tumor

Phyllodes Tumor: Benign

Malignant Lesions

DCIS, General

DCIS, Low Grade

DCIS, Intermediate Grade

DCIS, High Grade

DCIS, Micropapillary

Invasive Ductal Carcinoma NOS, General

Invasive Ductal Carcinoma NOS, Grade 1, 2, 3

Invasive Lobular Carcinoma

Invasive Lobular Carcinoma, Pleomorphic

Lobular Carcinoma In Situ, Pleomorphic

Mixed Invasive Ductal and Lobular Carcinoma

Apocrine Carcinoma

Invasive Micropapillary Carcinoma

Luminal A and B Cancers

HER2-Positive Cancer

Triple-Negative and Basal-Like Breast Cancer

Adenoid Cystic Carcinoma

Medullary Carcinoma

Metaplastic Carcinoma

Mucinous Carcinoma

Tubular Carcinoma

Tubulolobular Carcinoma

Encapsulated Papillary Carcinoma

Papillary Carcinoma, Invasive

Phyllodes Tumor: Borderline and Malignant

Sarcomas

Lymphoma, Primary Breast

Signs and Symptoms

Approach to Signs and Symptoms of Disease

Nipple

Nipple Discharge

Nipple Retraction and Inversion

Paget Disease of the Nipple

Skin

Epidermoid Cyst

Sebaceous Cyst

Skin Lesions, Other

Erythema

Skin Retraction

Skin Thickening

Axilla

Axillary Adenopathy

Axillary Nodal Calcification

Metastatic Adenopathy, Unknown Primary

Breast

Palpable Lump or Thickening

Pain

Shrunken Breast

Vascular Entities

Mondor Disease

Benign Lesions of Vascular Origin

Postoperative and Post-Treatment Imaging

Approach to Postoperative Imaging Findings

Results of Benign Intervention

Benign Surgical Biopsy, Postoperative Imaging

Post-Core Biopsy and Clip Placement Imaging

Reduction Mammoplasty, Imaging

Implant, Saline

Implant, Silicone

Implant With Multiple Lumina

Implants and Cancer

Silicone Granuloma

Cosmetic Augmentation Injections

Results Following Treatment for Malignancies

Positive or Close Margins

Post Breast-Conserving Surgery

Recurrent Breast Carcinoma

Neoadjuvant Chemotherapy

Accelerated Partial Breast Irradiation

Tissue Transfer Reconstruction Imaging

Special Topics

Hormonal Changes

Hormonal Manipulation

Gender Reassignment

Terminology and Imaging Appearance

Cancer and Screening in Transgendered Patients

Pregnancy

Galactocele

Lactation

Lactating Adenoma

Pregnancy-Associated Breast Cancer

Infections and Inflammation

Abscess

Idiopathic Granulomatous Mastitis

Mastitis

Unusual Infections

Breast Manifestations of Systemic Conditions

Weight Fluctuations

Diabetic Mastopathy/Lymphocytic Lobulitis

Collagen Vascular Disease

Breast Manifestations of Organ Failure

Sarcoid

Amyloid

Leukemia

Lymphoma, Secondary

Metastases to Breast

Trauma

Trauma

Male Breast

Gynecomastia

Male, Breast Cancer

Male, Other Neoplasms

Artifacts

Artifacts: Mammography and Tomosynthesis

Artifacts: Ultrasound

Artifacts: MR

Artifacts: Nuclear Medicine

Imaging Safety

Radiation Dose and Safety: Mammography and Tomosynthesis

Gadolinium Safety

Contrast Reactions

Screening

Focused Issues in Screening

Approach to Screening

Risk Assessment Models

Screening Mammography

Screening Intervals: Annual vs. Biennial

Screening at Age Extremes (< 40, > 70 Years)

Screening in 5th Decade (40-49 Years)

Interval Cancers

Missed Cancers

CAD and Double Reading

Breast Density

Screening Ultrasound

Screening MR

Abbreviated Breast MR

Personal History of Breast Cancer Surveillance

Prior Chest Radiation Therapy, Surveillance

Genetics

Indications for Genetic Testing

BRCA1 and BRCA2 Mutation Carriers

Li-Fraumeni Syndrome

Gene Mutations Beyond BRCA

Genetic Testing Techniques (e.g., Oncotype, MammoPrint)

Treatment

Principles in Treatment

Approach to Breast Cancer

Staging: Breast

Pathology Overview

Surgery Overview

Radiation Therapy Overview

Oncology Overview (Adjuvant and Neoadjuvant)

Focused Issues in Treatment

Approach to Treatment Planning

Multifocal/Multicentric Breast Cancer

Extensive Intraductal Component

Contralateral Breast Cancer

Locally Advanced Breast Cancer

Pectoralis Muscle and Chest Wall Invasion

Skin Invasion

Inflammatory Breast Carcinoma

Internal Mammary Adenopathy

Metastatic Breast Cancer

Breast Cancer in Young Patients (< 40 Years)

Procedures

Image-Guided Procedures

Ductography

Cyst Aspiration

Fine-Needle Aspiration Biopsy, Breast

Skin Localization

Ultrasound-Guided Core Biopsy

Ultrasound-Guided Vaccum-Assisted Biopsy

Stereotactic Biopsy, Prone

Stereotactic Biopsy, Upright

MR-Guided Vacuum-Assisted Biopsy

MR-Directed Ultrasound

Imaging-Histopathologic Discordance

Preoperative Wire Localization, Mammography

Preoperative Wire Localization, Ultrasound

Preoperative Wire Localization, MR

Preoperative Localization, Tomosynthesis

Preoperative Radioactive Seed Localization

Preoperative Localization in Axilla

Preoperative Lesion Localization, Bracketing

Preoperative Magnetic, Other Nonradioactive Localization

Specimen Imaging

Image-Guided Thermal Ablation (and Cryotherapy)

Surgical Procedures

Sentinel Lymph Node Biopsy

Axillary Lymph Node Dissection

Targeted Axillary Dissection

Breast-Conserving Surgery

Mastectomy

Oncoplastic Techniques

Reduction Mammoplasty, Procedure

TRAM and Other Flap Procedures