Evolve.

Adapt.
Overcome.
CEFI is now ready.

LESSON 3: MAMMOGRAPHIC APPEARANCE

OF PATHOLOGY
RT 311: MAMMOGRAPHY

DELCIE FLORES-JADER, RRT, MAED

College Of Radiologic Technology
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MASSES
• Tumour, also spelled tumor, also called neoplasm, a mass of
abnormal tissue that arises without obvious cause from preexisting
body cells, has no purposeful function, and is characterized by a
tendency to independent and unrestrained growth.
• Tumours are quite different from inflammatory or other swellings
because the cells in tumours are abnormal in appearance and other
characteristics.
• Abnormal cells—the kind that generally make up tumours—differ
from normal cells in having undergone one or more of the following
alterations:
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(1) hypertrophy, or an increase in the size of individual cells; this feature is

occasionally encountered in tumours but occurs commonly in other conditions;

(2) hyperplasia, or an increase in the number of cells within a given zone; in some
instances it may constitute the only criterion of tumour formation;

(3) anaplasia, or a regression of the physical characteristics of a cell toward a more

primitive or undifferentiated type; this is an almost constant feature of malignant
tumours, though it occurs in other instances both in health and in disease.
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BIRADS Breast imaging- reporting and data system

• BIRADS
Latest version classifies lesions into 0 - 6 categories:

BIRADS 0: Incomplete, further imaging or information is required. Eg:

Compression, magnification, special mammographic views, ultrasound.
This is also used when previous images not available at the time of
reading.
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• BIRADS I: Negative, symmetrical and no masses, architectural

disturbances or suspicious calcification present.

• BIRADS II: Benign findings, interpreter may wish to describe a benign

appearing finding. Eg: Calcified fibro adenomas, multiple secretory
calcifications, fat containing lesions like Oil cysts, breast lipomas,
galactoceles and mixed density hamartomas, simple breast cysts. These
lesions should have characteristic appearances and may be labeled with
confidence and make sure there is no mammographic evidence
suggesting malignancy.
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• BIRADS III: probably benign, short interval follow up suggested.

• BIRADS IV: suspicious abnormality.

There is mammographic appearance which is suspicious of malignancy.
Biopsy should be considered.
BIRADS IVa: low level of suspicion
BIRADS IVb: intermediate level of suspicion
BIRADS IVc: moderate level of suspicion for malignancy
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• BIRADS V: there is a mammographic appearance which is highly

suggestive of malignancy, action should be taken.

• BIRADS VI: known biopsy proven malignancy

The vast majority of mammograms fall into BIRADS I or II.

Risk of Cancer: BIRADS III: ~ 2% BIRADS IV: ~ 30% BIRADS V : 95%
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3 TYPES OF BREAST TISSUE

1. GLANDULAR
2. FIBROUS OR CONNECTIVE
3. ADIPOSE
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BREAST CLASSIFICATION
1. FIBRO-GLANDULAR
- Younger breast normally is quiet dense and contains little fatty tissue.
- Postpuberty up to 30 y.o
- Women 30 years old who have never given birth to a live infant
- Pregnant or lactating women of any age
- Breast compression is very comfortable

(GRAVIDA: 1 PARA: 0)
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2. FIBRO-FATTY
- Low amount of fatty tissue gradually shifts to a more equal distribution
- 30-50 years old
- Several pregnancies early in a woman’s reproductive life will accelerate her breast
conversion toward this classification.
- Requires Less exposure
- Produce better radiographic contrast
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3. FATTY BREAST
• Occurs after menopause
• 50 years and older
• Most glandular tissue is converted to fatty tissue in a process called involution.
• Requires less exposure
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• LET me use this link for our discussion:

• https://www.slideshare.net/ArchanaKoshy/imaging-of-breast-pathologies
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