Breast screening and imaging modalitiesexternal image breast-cancer-ribbon.jpg

  • Mammography
  • MRI
  • Scintimammography-Nuclear Medicine
  • Ultrasound


Mammography


external image mammogram-281x300.jpg





Ø Gold standard for breast imaging
Ø Used as a diagnostic for symptomatic patients or as a screening tool for asymptomatic women ages 40 and over
Ø The goal is early detection of breast cancer
Ø Proven to reduce mortality rate from breast cancer
Ø Uses low dose ionizing radiation to create images
Ø It can detect tumors long before they can be palpated

Brest lesion seen on Mammogram
Brest lesion seen on Mammogram



Magnetic Resonance Imaging of the Breast (MRI)

external image IR_breast_MRI.jpg


Ø Noninvasive test that uses a powerful magnetic field, radiofrequency pulses and a computer to acquire images
Ø Provides good contrast between soft tissues and evaluation of dense breasts
Ø Used as follow up to other breast imaging modalities
Ø Used to stage the extent of breast cancer
Ø May be used as a screening tool for women with very high risk of developing breast cancer
Disadvantages
· Increased cost
· Increased exam time
· Differentiation between benign and malignant tumors
MRI scan of the breast
MRI scan of the breast


breast scintimammogram
breast scintimammogram



Scintimammography- Nuclear Medicine Test


Ø Used to detect cancer cells in the patients with abnormal mammograms
Ø Not used for screening or in the place of a mammogram
Ø Uses a small amount of a radioactive substance called technetium 99, a tracer injected into the patients vein, which is then taken up by cancer cells
Ø Improved evaluation of dense breasts and lesions difficult to identify with mammography
Ø Radiation is a great diadvantage






Ultrasound

  • Typically used for further evaluation of masses found on mammography or for palpable masses
  • Allows us to obtain images in almost any orientation
  • Especially usefull in patients with dense breasts.( common in younger women)
    • Masses in patients with dense breasts are difficult to detect on mammograms
  • Guided interventional procedures of the breast

Used as screening tool for women ages 30 and under that have a high risk for developing breast canner or for in patients presenting with:
§ palpable breast lump
§ dense breasts
§ pregnant or lactating patients
§ breast augmentation


Innovation in Breast Ultrasound Imaging

Automated Breast Volume Scanner - ABVS –Ultrasound System
o Acquires full volume images of the breast
o Offers a more comprehensive representation of the global anatomy of the breast
o Ideal for dense breasts
o Can distinguish between fatty and dense tissue
o Diagnostic confidence is significantly increased
o Allows us to aquire coronal view images ( view from nipple line to the breast wall)
o Improved comfort and significantly reduced examination time
external image workflow-solutions.jpg





Elastography

v New and invaluable screening tool
v Real time scanning technique
v Looks at the mechanical properties of tissue
v Determines the stiffness of the tissue by measuring the degree of distortion un external force application
v Provides further insight into potential pathology
v Has a good sensitivity for distinguishing benign vs. malignant lesion
v Reproducible, more accurate diagnosis
v Provides better care and management of the patient

Breast lesions appearance with Elastography vs.B Mode
Stiff Masses( tissue) =Anechoic
Non-stiff(soft) tissue= Echogenic


CYSTS
Cyst- Elastography
Cyst- Elastography

Simple Cyst-B Mode
Simple Cyst-B Mode

Appearance
Target Sign lesion
Posterior enhancement
Cyst looks smaller that what it looks like on B Mode US

Benign Lesions- Fibroadenoma
external image 2634_fibroadenoma_lrg.jpg
Appearance
Benign lesion usually look similar or smaller than on B-Mode Images

Suspicious (Malignant Lesions)
external image 2638_breast_mass_lrg.jpg
Malignant Lesions -Appearance
Larger than on B- Mode due to Desmoplastic reactiona around the mass.
On B Mode this reaction appears as normal tissue but at a microscopic level this tissue is in fact stiffer.

http://www.youtube.com/watch?v=uulyRhtkzmc&feature=related