Mammography # 1

Week 2

Mammography Facts

• 1 in 8 women who live to 95 will develop breast cancer

• Most common malignancy in women, only lung cancer kills more women– One of the most treatable cancers

• Before Mammo fewer than 5% of pt’s survived 4 years after diagnosis with a 80% recurrence– With a radical mastectomy survival increased to 40% with a

10% recurrence

Goal of Mammography

• Detect cancer before it is palpable

• Early detection, diagnosis and treatment is the key to a favorable prognosis

How would your family feel with you missing from the family picture?

How would you feel about your father, brother or mother missing

from the family picture?

Breast Self Exam

Breast Dimpling

Breast Cancer

Peau d’orange

Anatomy of the Breast

• Vary in shape & size• Cone shaped with the post

surface (base) overlying the pectoralis & serratus muscles

• Axillaries tail extends from lat. base of the breasts to axillaries fossa

• Tapers ant. from the base ending in nipple, surrounded by areola

Female Breast• Consists of 15-20

lobes– Divide into several

lobules– Lobules contain acini,

draining ducts and interlobular connective tissue.

– By teenage years each breast contains hundreds of lobules

Lymph Nodes

• Lymphatic vessels of the breast drain laterally and medially– Laterally into the

axillary lymph nodes (C & D)

• 75& drain toward axilla

– Medially into the mammary lymph nodes

• 25% toward mammary chain (F)

Quadrants of the Breast

3 Tissue Types

Breast Changes with Age

Breast Classifications

Fibro-glandular Breast

• Fibro-glandular– Dense with very little

fat– Females 15-30 years

of age• Or 30 years or older

without children

– Pregnant or lactating

Fibro-fatty Breast

• Fibro-fatty– Average density

• 50% fat & 50% fibro-glandular

• Women 30-50 years of age

– Or women with 3 or more children

Fatty Breast

• Fatty– Minimal density– Women 50 and older

(postmenopausal), men and children

Positioning

Various Mammographic Positioning

Ouch! Why Compression?

• Two Reasons:

– Decrease thickness of breast tissue

– Reduce OID

Cranio- caudad :CC

Diagram of Proper CC Positioning

CC Images

Multiple Bilateral Benign Calcifications

Breast Cancer

Carcinoma

Microcalcifications

CC positioning

• CR Perpendicular• Film tray brought to

level of inframammary crease

• Wrinkles and folds smoothed out

• Compression applied• Markers on axillary

side

CC Criteria

• No motion• Nipple in profile• All pertinent anatomy

demonstrated• Dense areas penetrated• High contrast & optimal

resolution• Absence of artifacts• Marker & patient ID

visible

Medio-lateral Oblique:

MLO

MLO Diagram for Proper Positioning

MLO Properly Positioned

Bilateral MLO

MLO positioning

• CR & cassette (IR) angled 45 degrees

• Top of cassette (IR) at axilla

• Compression applied

• Nipple in profile• Marker at axilla

MLO criteria

• No motion• Pectoral muscle to level

of nipple visualized• Breast pulled away from

chest wall• Nipple in profile• Dense areas of breast

penetrated• High contrast & optimal

resolution• Absence of artifacts• Marker & PT ID visible

What position is this?

What position is this?

Breast ImplantsAre they worth it?

Complication with Breast Augmentation

• Mammography has a 80-90% true positive rate for detecting breast cancer in those women without implants– Decreases to 60% with implants

• Because 85% of breast tissue is obscured

• More images are needed than the standard two projections

• There is a risk of rupturing the implant

Elkland Method for Imaging with Breast Implants

Image ComparisonWhich is the Push back (Elkland)?

Male Mammography and Cancer

Male Mammography

• 1300 men get breast cancer per year– 1/3 die

• Most are 60 years or older• Nearly all are primary tumors• Symptoms include:

– Nipple retraction– Crusting– Discharge– Ulceration

Gynemastia

• Benign excessive development of male mammary gland• Occurs in 40% of male cancer pt’s• Survival rates with treatment are 97% for 5 years

Old and New Equipment

Cone Magnification

Cone magnification

Mammography Equipment

Digital vs. Film