Mammography can be best used in?
Ans. a (Early breast carcinoma). (Grainger, Diagnostic Radiology, 4th/pg.2245)Indications for mammography# Screening asymptomatic women aged 50 years and over# Screening asymptomatic women aged 35 years and over who have a high risk of developing breast cancer:- women who have one or more first degree relatives who have been diagnosed with premenopausal breast cancer- women with histologic risk factors found at previous surgery, e.g. atypical ductal hyperplasia# Investigation of symptomatic women aged 35 years and over with a breast lump or other clinical evidence of breast cancer# Surveillance of the breast following local excision of breast carcinoma# Evaluation of a breast lump in women following augmentation mammoplasty# Investigation of a suspicious breast lump in a man.# Before breast surgery, as it may avert an unnecessary biopsy demonstrating that the palpable mass has a character istically benign appearance.# Follow up of breast cancer patients.# Work up a patient with metastases from an unknown primary.# Mammographic screening is best screening method for carcinoma breast.- MRI is emerging as perhaps the most promising imaging investigation for breast cancer detection to date.# Positron emission tomography (PET) may not yet be sensitive enough for small occult lesions mammographically detected by screening.Mammographic features of breast cancer: (AIIMS NOV 2003)# The most common mammographic appearance of invasive carcinoma is a "spiculated" mass.# "Microcalcifications" may be seen in 30% cases of invasive carcinoma & 95% of cases of DCIS (granular & casting).# Its "sunburst" appearance readily distinguishes it from benign breast masses.# Often the tumor mass itself may not be visible, so that the only evidence of carcinoma is the presence of abnormal trabecular markings i.e. "distorted architecture".# Individual straight dense spicules with central solid mass which has little change in different views known as "white star" stellate or speculated breast lesion favours malignancy.# On mammography, this typically appears as linear, fragmented, branching, irregular and 'casting type' calcifications.Mammographic features of benign breast lesion:# Well defined nodules < 1 cm are of low risk for cancer.# 'Halo' sign of apparent lucency due to optical illusion of mach effect + true radiolucent halo is almost always benign.# Fat containing lesions (e.g. galactocele, hamartoma, traumatic cyst) are never malignant.# Granular calcification (amorphous, dot like/elongated, fragmented grouped very closely to each other) & casting calcification (fragmented cast of calcification within ducts) favour malignancy.# Clinical examination, Mammography, biopsy/cytology = TRIPLE ASSESSMENT for carcinoma breast.# The mammographic appearance of the breast depends on the relative amounts of fat and glandular tissue which are present. The young womanys breast contains a large proportion of glandular tissue which appears as soft-tissue density on the mammogram; in older women, when involution of the glandular tissue has occurred, most of the breast tissue appears of fatty density.
Early breast carcinoma
Mastitis
Fibroadenoma
Phylloides tumor
Miscellaneous