mammo
Techniques
Under age 30 w/ palpable abnormality → start work-up with US rather than mammo
Breast MR should be done on days 7-17 of cycle
Regarding biopsy of developing densities → regardless of a needle biopsy result, surgical excision is recommended
Cystic Masses
Inspissated Cyst
Apocrine Cyst
Septated Hypoechoic Cyst
Fat containing masses
Lipoma
Fat necrosis
Galactocele
Hamartoma
BIRADS 3 Scenarios
First ever mammo with benign appearing lesion (such as a Focal Asymmetric Density)
Lesion identified which is also, in retrospect, seen on the old study, stable, and benign appearing
Status post concordant benign breast biopsy (1 year) or post-lumpectomy f/u (3 years)
Lobular Carcinoma
very slow growing
looks like breast tissue
Inflammatory Carcinoma
Breast MRI
MRI Guidelines
Hormone Replacement Therapy - The patient should be off HRT treatments for at least 3 months or 6 months (optimal). Imaging may be done earlier but it must be known that the results may be compromised
Post Biopsy - The patient should wait at least two weeks or 30 days (optimal) after biopsy before having a breast MRI.
Menstrual Cycle - Patients should be scanned 7-10 days after the onset of their menstrual cycle. Otherwise, results may be compromised.
Indications for MRI
Work-up of extent of disease of a known breast cancer, when the extent is in question on the mammogram or ultrasound, or if the patient is status post lumpectomy with positive margins
Neoadjuvant chemotherapy
Axillary metastases with unknown primary and negative mammogram and ultrasound
Lobular carcinoma
Recurrence monitoring
Evaluate for silicone implant rupture
The indications for MRI are growing, and have been somewhat controversial. Possible other indications for MR:
Types of Enhancement on MR
homogeneous
heterogeneous
stippled
clumped
reticular-dendritic
Enhancement Curves on MR
Progressive
Plateauing
Early/Rapid Washout
Clumped Enhancement
Fibroadenoma
Phylloides
if suspected on MMG, then surgical excision is recommended
path can be confusing
can be benign or malignant or have sarcomatous degeneration
has osseous, chondroid, or adipose matrix
Large Highly Vascular Mass in Young Patient
Types of DCIS
Extensive Intraductal Component DCIS
Inflamed Breast Post-Lumpectomy
DDx Axillary LAD
leukemia, lymphoma
HIV
scleroderma
mets (breast, ovary)
lupus
DDx Calcified Nodes
Male Breast
mammo.txt · Last modified: 2017/07/07 18:30 (external edit)