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In The Nam of God
Role of Mammography and
breast ultrasound in diagnosis
early breast cancer
Dr. Mehri Sirous
The standard techniques used for breast
imaging are:
Screen film x-Ray mammography.
Real-Time ultrasound.
Other new techniques include:
Color Doppler
Contrast ultrasound
Digital Mammography
Although mammography is the most
sensitive exam available for detecting
small breast ca.
False Negative Rate is 5-10%
False negative rate ↓
* Clinical history and examination
* Combination imaging
Mammography standard views
supplementary mammographic views
Local compression views
magnification views
* Needle biopsy
* F.N.A.C
* Or core biopsy
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
Breast ultrasound
At the minimum, a 7.5 MHZ linear array probe
should be used
The original role of breast sonography is in the
differentiation of cystic and solid lesions
The role of ultrasound complements both clinical
examination and mammography
Ultrasound plays an important role in the triple
assessment of symptomatic lesions the dense breast
It is the examination of choice in young
women and is valuable in the assessment
of mammography ‘ dense’ breast
The dense breast
Diffuse increase in the density of the
breast tissue is caused by
an increase in the glandular tissue and
or/fibrous tissue
The dense breast
2 – edematous breast
Advanced primary tumor
Lymphatic spread from a primary
tumor or inflammatory carcinoma
Breast abscess (breast infection)
Congestive cardiac failure and Renal
failure (unilateral or bi lateral)
The dense breast
gynaecological malignancy e.g ovarian carcinoma,
cervical progressively or secondary to a carcinoma of
the contra lateral breast
Radiotherapy (breast saving)
Develop progressively following radiotherapy
Reach a maximum at about 6 months
Resolved approximately
The dense breast
HRT (decrease in the sensitivity of screening
mammography for cancer detection)
loss of fat due to severe weight loss or
cachexia or lack of fat due to lipodystrophy
Indication of breast ultrasound
.Symptomatic breast lumps in women aged less than 35 years .
Breast lump developing during pregnancy or lactating
.Assessment of mammographic abnormality (further
mammographic views)
.Assessment of MRI or scintimammography detected lesions .
Clinical breast mass with negative mammograms .
Breast inflammation
.The augmented breast (together with MRI)
.Breast lump in a male (together with mammography) .
Guidance of needle biopsy or localisation
.Follow-up of breast cancer treated with adjuvant
Imaging – guided practical procedures
The type of imaging chosen depends
principally on which method (ultrasound or
mamography) shows the lesion clearly.
Ultrasound is used for cysts and most soft –
tissue lesions
Mammography is used for microcarcification
and for soft – tissue lesions that are not seen or
are poorly visualized on ultrasound
particularly distortions
Ultrasound – guided procedures
Cyst aspiration (simple cysts with symptoms)
Abscess aspiration (simple, unilocular abscess)
Ultrasound – guided FNAC (solid lesions)
Ultrasound guided core biopsy
(small solid lesions)
Mammography – guided procedures
Stereotactic – guided FNAC or core
Preoperative localization of
non – palpable lesions.
Asymmetric soft tissue
Indication for breast MRI
Breast MRI is the technique of choice in the
differentiation between postoperative scarring and
local recurrence
It has an important role in the assessment of the
indeterminate mass because of its very high
sensitivity for malignancy though at present, core
biopsy is a more cost – effective approach.
Indication for breast MRI
It is very accurate in the local staging of breast cancer in
difficult cases (very dense breasts, mammographically
occult tumours, suspected multi- focality or
multicentricity and suspected chest wall involvement).
It is the technique of choice in the evaluation of implant
integrity and detection of cancer in the augmented breast.
It is also accurate in the differentiation of axillary
recurrence and brachial plexopathy post radiotherapy.
Indication for breast MRI
Breast MRI appears highly accurate in the
assessment of response to neoadjuvant and
primary chemotherapy, predicting ulti- mate
response before changes in tumour volume and
differentiating between residual tumour and
The place of breast MRI in screening high-risk
patients has yet to be established