PTCUT

IMAGING

LECTURE 6 - MAMMOGRAPHY
( PART 1 )

By :

ed
Adham Moham
 Mammography
Mastography

It a process of imaging the breast using low energy X-rays (30 kVp)
It can be used in both screening ( patient without symptoms ) or for
diagnosis in presence of symptoms.
the goal of mammography is the early
detection of breast cancer and to find any
mass or calcification.

‫ بين لوحين بيضغطوا عليه‬breast ‫ بتحط ال‬mammogram ‫لما المريضة تيجي تعمل‬
‫ بالتالي الصورة تطلع احسن‬X-ray ‫ المعرض ل‬soft tissue ‫عشان يقللوا سمك ال‬
‫ هنشوفه في الصور قدام‬scale ‫عشان هيقل تشتت االشعة و بيبقا علي اللوحين دول‬
‫عشان يحددوا حجمه و يقارنوا بين حجم االتنين‬

Causes of compressing breast between the two parallel plates :

Increase the quality of the photo by reducing the thickness of
the tissue to be penetrated.
Decrease the amount of scattered radiation.
Holding breast still so prevent blurring in photo.
Decrease dose of radiation dose.

Egan's technique for screening Mammography :

Craniocaudal (CC) view Medio-lateral oblique (MLO) view

 It shows medial part and
external portion of the
breast
All glandular tissue
identified.
Nipple in profile.
Nipple in the midline of the
image.
Length of posterior nipple
line (PNL) within 1 cm in
seize compared from PNL
on MLO view.
Images are symmetric.
It shows pectoralis major
muscle.
Pectoral shadow seen
down to the level of nipple
or lower.
Nipple in profile .
Inframammary fold well
seen.
Length of posterior nipple
line (PNL) within 1 cm in
seize compared from PNL
on CC view.
Images are symmetric.

N.B. In some cases photo have multiple calcium spots and

misdiagnosed as cancer, that occurs in patients put deodorant, talc
powder or lotion as they interacts with X-ray. Women during
menstruation have water retention which may be appear one
breast larger than the other

Ductography :
A technique of administering a 1-
2ml of radiocontrast agent to the
ducts of mammary gland to
determine the lesion causing
nipple discharge, it helps to
precisely locate the mass.

Ductography
 A male is doing mammography (A) MLO view (B) CC view
showing a scale of Ds which has less fatty tissue
determine the size.

Heterogeneous Dense Fatty

Scattered fibroglandular tissue

may be suspicious tumor or
Dense may be tumor and require lactating women or after
another investigation by US lactation
Breast cancer :
Symptoms ; Risk factors :
lump in the breast Female.
change in breast shape Obese.
dimpling of the skin Drinking alcohol.
fluid coming from the nipple Hormonal therapy during
red scaly patch of skin. menopause.
Tingling. Ionized radiation.
Itching. Family history of breast
Hypersensitivity. cancer.
Nipple inversion (occurs in Klinefilter's syndrome ( XXY )
early stage ) Liver cirrhosis.
Orange peel skin texture
In late stages ;
Bone pain.
Swollen lymph nodes.
Dyspnea.
Yellow skin.

Stages of breast cancer :

Stage 0 ; precancerous it is intraductal carcinoma in situ DCIS or
intralobular carcinoma in situ LCIS
Stage 1-3 ; Spreading of the tumor within the breast and
regional lymph nodes.
Stage 4 ; METASTASIS

BI-RADS scoring system for breast cancer :

Usually, it is from 0 to 6 but in mammography it isfrom 1 to 5 .
1. Normal
2. Benign
3. Indeterminant
4. Suspicious of malignancy
5. Malignant
 A lump or tumor will appear in mammogram as white , high
dense tissue, note, seize, shape and edges.

Masses Calcification

Architectural distortion

Retracted nipple Inverted nipple

N.B.
Breast cyst and fibroadenoma may happen during pregnancy due to change in
hormones.
Most breast cancers are derived from the epithelium lining the ducts or lobules.
TNM system :
Tx ; size of tumor
T0 : no evidence for tumor.
T1 : Less than 3 cm.
T2 : From 3 cm to 5 cm
T3 : From 5 cm to 7 cm
T4 : Larger than 7 cm
Nx ; number of affected lymph
nodes
N0 : No regional lymph nodes.
N1 : One lymph node.
N2 : Two lymph nodes.
N3 : All lymph nodes.

Mx ; metastasis
M0 : No distance metastasis
M1a : Metastasis near the area
of tumor
M1b : Distance metastasis
E.G.
T2N2M0 ; means there is a tumor
with a size from 3 cm to 5 cm and
2 lymph nodes are affected with
no metastasis.

Tumor markers :
A blood sample that its examined substances produced by cancer
cells or by body cells in response to cancer ; Cancer antigen 15-3
normally under 30 U/ml, CA 27.29, Carcinoembryonic antigen CEA,
Circulating tumor cells CTCs. Tumor markers are not diagnostic

Benefits :
Evaluating progression of the disease after chemotherapy.
Monitor to genetic markers in families.
Help in Diagnosis.
Prognosis.
Guide and monitor the treatment
Breast cancer can be found in men as women (1 : 100) especially in
obese people which have high level of estrogen. Men take
estrogen in cases of testicular cancer,Prostate enlargement and
aromatase deficiency ( reduced levels of the female sex hormone
estrogen and increased levels of the male sex hormone
testosterone.)

Mammography shows Male mammography MLO view

gynecomastia shows discharged nipple