basic course for medical college student breast imaging basic course for medical college student...
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Breast Imaging
Basic Course For Medical College StudentBasic Course For Medical College Student
WANG Deng-bin MD,Ph.D
Dept. of Radiology,RuiJin Hospital
WANG Deng-bin MD,Ph.D
Dept. of Radiology,RuiJin Hospital
IntroductionIntroduction
“Breast cancer is one of the best studied
human tumors, but it remains poorly
understood”
“ As in all medical endeavors, the practitioner
should, whenever possible, use the results of
scientific studies to guide clinical decision”
“Breast cancer is one of the best studied
human tumors, but it remains poorly
understood”
“ As in all medical endeavors, the practitioner
should, whenever possible, use the results of
scientific studies to guide clinical decision”
And the imaging modalities implemented
in clinical practice for breast care must
be served as the tools for detection and
characterization of breast lesions. As we
expect, they are very important for
diagnosis and treatment.
And the imaging modalities implemented
in clinical practice for breast care must
be served as the tools for detection and
characterization of breast lesions. As we
expect, they are very important for
diagnosis and treatment.
Imaging ModalitiesImaging Modalities
1.5T MRI1.5T MRI GE signa gemsowGE signa gemsow
0.5T MRI0.5T MRI GE signa GE signa Sys#MRSSys#MRS
Shanghai 2Shanghai 2ndnd Medical University Medical University
Rui Jin HospitalRui Jin Hospital
X-ray Examination MammograpyX-ray Examination Mammograpy
X-ray radiography (molybdenum X rays, rh
odium X rays):MLO,CC,etc.
Galactography --demonstrates the ducts a
nd ductule or their abnormalities.
X-ray radiography (molybdenum X rays, rh
odium X rays):MLO,CC,etc.
Galactography --demonstrates the ducts a
nd ductule or their abnormalities.
galactography
USGUSG
Ultrasonography (ultrasound)
B-mode US
Doppler US
Ultrasonography (ultrasound)
B-mode US
Doppler US
CTCT
Computed tomography
plain scan,
enhanced scan (iodine)
Computed tomography
plain scan,
enhanced scan (iodine)
MRIMRI
Magnetic Resonance Imaging
high resolution for soft tissue
different tissue, different signal
enhanced scan
Magnetic Resonance Imaging
high resolution for soft tissue
different tissue, different signal
enhanced scan
The othersThe others
Infrared thermal imaging
Computer diaphanography imaging,etc.
Infrared thermal imaging
Computer diaphanography imaging,etc.
Imaging-Guided Percutaneous Biopsy
supply specimens for pathologic examination
Imaging-Guided Percutaneous Biopsy
supply specimens for pathologic examination
Fine needle aspiration biopsy (FNAB)
Needle core biopsy (NCB)
Fine needle aspiration biopsy (FNAB)
Needle core biopsy (NCB)
Interventional TherapyInterventional Therapy Laser
Radiofrequency
Embolization
and so on
Laser
Radiofrequency
Embolization
and so on
Accessory Breast TissueAccessory Breast Tissue
The most common site is axilla The most common site is axilla
Basic Imaging Signs of Breast Lesion
Basic Imaging Signs of Breast Lesion
Mass/Lump
Calcification
Thickening and retraction of regional skin
Retraction of nipple
Enlargement or abnormality of blood vessels
Lymph nodes
Enhanced manifestations
Mass/Lump
Calcification
Thickening and retraction of regional skin
Retraction of nipple
Enlargement or abnormality of blood vessels
Lymph nodes
Enhanced manifestations
Mass/LumpMass/Lump
shape: round, oval, regular/irregular
margin: clear or ambiguous, spiculation or smooth
density or signal intensity: high/low/intermediate w
ith or without calcification
site: upper-outer quadrant breast, upper-inner quadrant
breast, lower outer quadrant breast, lower-inner quadrant
breast, nipple, central portion breast, axillary tail breast.
Number: solitary or multiple
shape: round, oval, regular/irregular
margin: clear or ambiguous, spiculation or smooth
density or signal intensity: high/low/intermediate w
ith or without calcification
site: upper-outer quadrant breast, upper-inner quadrant
breast, lower outer quadrant breast, lower-inner quadrant
breast, nipple, central portion breast, axillary tail breast.
Number: solitary or multiple
CalcificationCalcification
Size: large or micro
Shape: ring-like, nodular or salt-like, branching
Distribution: scattered or clustered with or
without mass
benign / malignant
Size: large or micro
Shape: ring-like, nodular or salt-like, branching
Distribution: scattered or clustered with or
without mass
benign / malignant
Thickening and Retraction of Regional Skin
Thickening and Retraction of Regional Skin
Frequently found in malignant tumors
Sometimes due to postsurgical scars.
Frequently found in malignant tumors
Sometimes due to postsurgical scars.
Retraction of NippleRetraction of Nipple
Congenital-dysplasia
Acquired-malignant tumor
Congenital-dysplasia
Acquired-malignant tumor
Enlargement or Abnormality of Blood
Vessel
Enlargement or Abnormality of Blood
Vessel
Mostly in malignant tumor due to
increase of blood supply
Mostly in malignant tumor due to
increase of blood supply
Enlargement of Lymph NodesEnlargement of Lymph Nodes
Axillary or intramammary lymph nodes Axillary or intramammary lymph nodes
Administration of Contrast Agents for
Breast Lesions
Administration of Contrast Agents for
Breast Lesions
Implication of the lesion’s hemodynamics
washout type--malignant
linear--benign
plateau--malignant/benign
Implication of the lesion’s hemodynamics
washout type--malignant
linear--benign
plateau--malignant/benign
Common Diseases in BreastCommon Diseases in Breast
Fibroadenoma
Cyst
Lobular hyperplasia
Cancer
Fibroadenoma
Cyst
Lobular hyperplasia
Cancer
Fibroadenoma overviewFibroadenoma overview
Frequency: most common tumor of breast (benign)
Age: below 30 yrs
Distribution: unilateral or bilateral
Source tissue: connective tissue and glandular tissue
Site: upper-outer quadrant
Size: < 5cm
Surface: smooth, movable
Frequency: most common tumor of breast (benign)
Age: below 30 yrs
Distribution: unilateral or bilateral
Source tissue: connective tissue and glandular tissue
Site: upper-outer quadrant
Size: < 5cm
Surface: smooth, movable
Imaging Findings of FibroadenomaImaging Findings of Fibroadenoma
X-ray
CT
MRI
X-ray
CT
MRI
X-ray FindingsX-ray Findings
Round, lobular or oval mass or nodule ,smooth
nodule in high density with thin ring/ halo in
low density
Compression of surrounding tissue
Large calcification:always dominated at the
center of tumor
Round, lobular or oval mass or nodule ,smooth
nodule in high density with thin ring/ halo in
low density
Compression of surrounding tissue
Large calcification:always dominated at the
center of tumor
CT FindingsCT Findings
Round smooth mass/nodule
Value of CT similar to normal glandular tissue
Calcification
Intermediate enhancement, linear type or
plateau,relatively long duration of enhancement
Round smooth mass/nodule
Value of CT similar to normal glandular tissue
Calcification
Intermediate enhancement, linear type or
plateau,relatively long duration of enhancement
Breast Cancer overviewBreast Cancer overview
most frequent malignancy in women
1% in adult women in China
34.4/100 thousand in 1989
39.7/100 thousand in 1993
46/100 thousand in 1997
52.98/100 thousand in women of Shanghai in 2001
over 100/100 thousand in women in Europe and USA
most frequent malignancy in women
1% in adult women in China
34.4/100 thousand in 1989
39.7/100 thousand in 1993
46/100 thousand in 1997
52.98/100 thousand in women of Shanghai in 2001
over 100/100 thousand in women in Europe and USA
Breast Cancer overviewBreast Cancer overviewAge: 40-60yrs, in China 1/5 are <35yrs
Gender: female (male)
Clinicalmass: unmovable mass, skin,orange-peel-like,retractionachingretraction/discharge of nippleenlargement of blood vesselsstiffness of breastlymph nodes
Age: 40-60yrs, in China 1/5 are <35yrs
Gender: female (male)
Clinicalmass: unmovable mass, skin,orange-peel-like,retractionachingretraction/discharge of nippleenlargement of blood vesselsstiffness of breastlymph nodes
Breast Cancer overviewBreast Cancer overview
Pathology
Invasive ductal carcinoma 65-80%
Intraductal carcinoma 15%
Lobular carcinoma(invasive/in situ) 5%
Special types 10%
Pathology
Invasive ductal carcinoma 65-80%
Intraductal carcinoma 15%
Lobular carcinoma(invasive/in situ) 5%
Special types 10%
X-ray Findings of Breast Cancer(1)
X-ray Findings of Breast Cancer(1)
Irregular/regular mass
Ambiguous border
Spiculations
Heterogeneous density, mostly higher than
the Surrounding tissue
Site: over 50% at upper-outer quadrant
Irregular/regular mass
Ambiguous border
Spiculations
Heterogeneous density, mostly higher than
the Surrounding tissue
Site: over 50% at upper-outer quadrant
X-ray findings of breast cancer(2)X-ray findings of breast cancer(2)
Calcification: clustered salt-like microcalcificatio
n in 1/3 cases inside/outside the mass, sometim
es only the microcalcifications observed
Retraction of nipple
Thickening of skin
Abnormal blood vessel
Large patchy region in high density
Calcification: clustered salt-like microcalcificatio
n in 1/3 cases inside/outside the mass, sometim
es only the microcalcifications observed
Retraction of nipple
Thickening of skin
Abnormal blood vessel
Large patchy region in high density
CT Findings of Breast Cancer(1)
CT Findings of Breast Cancer(1)
Mass: irregular/ill-shaped, coarse margin, s
piculation, CT value: 25-56HU, higher than t
he normal breast, necrosis at the center of t
he large mass(mostly >= 5cm)
Skin, nipple
Infiltration into the pectoralis major muscle
Mass: irregular/ill-shaped, coarse margin, s
piculation, CT value: 25-56HU, higher than t
he normal breast, necrosis at the center of t
he large mass(mostly >= 5cm)
Skin, nipple
Infiltration into the pectoralis major muscle
CT Findings of Breast Cancer(2)CT Findings of Breast Cancer(2)
Occupying of retromammary space
Enlargement of lymph nodes, axillary/retromammary
Administration of contrast agents
quick enhancement (wash in) at early phase
the peak of enhancement occur within 50s ~1min
quick washout
time-signal intensity curve——washout type
Occupying of retromammary space
Enlargement of lymph nodes, axillary/retromammary
Administration of contrast agents
quick enhancement (wash in) at early phase
the peak of enhancement occur within 50s ~1min
quick washout
time-signal intensity curve——washout type
MRI Findings of Breast CancerMRI Findings of Breast Cancer
Signal intensity:T1WI SE,low;T2WI FSE,low,
intermediate,inhomogeneous;STIR, interme
diate
Spiculation: irregular mass (lobular)
Enhancement: time-signal intensity curve
Signal intensity:T1WI SE,low;T2WI FSE,low,
intermediate,inhomogeneous;STIR, interme
diate
Spiculation: irregular mass (lobular)
Enhancement: time-signal intensity curve
Comparison of Different Imaging Modalities for
Detection and Characterization of Breast
Cancer
Comparison of Different Imaging Modalities for
Detection and Characterization of Breast
Cancer
Molybdenum X-ray radiography:
most important,widest used,most useful—not
very sensitive to the small lesion at very early
stage in dense breast;but digital mammography
can solve the problem to great extent
Molybdenum X-ray radiography:
most important,widest used,most useful—not
very sensitive to the small lesion at very early
stage in dense breast;but digital mammography
can solve the problem to great extent
USGUSG
Cystic or solid
Low spatial resolution
Limited ability to Differentiate
benign/malignant
Cystic or solid
Low spatial resolution
Limited ability to Differentiate
benign/malignant
CTCT Wide coverage for viewing ,sensitive to cystic
change,hemorrhage and calcification
Very useful for detection and characterization
of masses ,especially in the enhanced scan,
but can’t definitely view the microcalcification
Much more radiation,expensive
Wide coverage for viewing ,sensitive to cystic
change,hemorrhage and calcification
Very useful for detection and characterization
of masses ,especially in the enhanced scan,
but can’t definitely view the microcalcification
Much more radiation,expensive
MRIMRI High soft resolution
Better differentiation for benign/malignant
Wider coverage
Without radiation
High cost
Not sensitive to calcification
High soft resolution
Better differentiation for benign/malignant
Wider coverage
Without radiation
High cost
Not sensitive to calcification
CT C- CT C+
MR C+
Combination of Varying Imaging Modalities
Combination of Varying Imaging Modalities
Acquire the richest information
Appropriateness in application
Cost-effectiveness
Best diagnosis, timely correct therapy,
better health
Acquire the richest information
Appropriateness in application
Cost-effectiveness
Best diagnosis, timely correct therapy,
better health
To the women of the world, may
breast cancer soon be eliminated
as a source of dread and death
To breast cancer researchers and
breast health caregivers, may our
efforts soon be unnecessary
To the women of the world, may
breast cancer soon be eliminated
as a source of dread and death
To breast cancer researchers and
breast health caregivers, may our
efforts soon be unnecessary
Thank
YouThank
You