Mammography Cancer Breast

Breast cancer / Mass  

Objectives:

• Common clinical problems presenting as breast mass

• Useful imaging studies in the study of breast mass

• Utility of imaging procedures

• Recognize Cancer breast in mammography

• Know the findings of breast cancer in mammography

• Work up of palpable mass in abnormal mammogram

CHIEF COMPLAINT:  “I have a lump in my breast” 

HISTORY:  A 71 year old female presents with a mass in the upper, outer portion of her left breast.  She first noticed the mass “several months ago” while bathing.  She did not seek medical attention at the time because “I thought it would just go away if I left it alone.”  She decided to come in today because the mass is becoming “harder, and getting larger.” 

The patient states “the lump can sometimes be painful when I touch it.”  She denies any nipple discharge or changes of the areola and nipples.   The patient’s obstetric/gynecologic history includes the following information:  menarche age 11, menses occurred regularly until age 56; patient is now postmenopausal.  Her last mammogram was >10 years ago. 

PHYSICAL EXAM:  The breasts are examined with the patient in sitting and supine positions.  The breasts are large, pendulous, and asymmetric.  The left breast is larger than the right breast, showing fullness in the upper, outer quadrant.  The skin of the upper, outer quadrant is dimpled.  Palpation of the left breast reveals a large, firm mass.  The mass is non-tender, fixed to the anterior chest wall, and has margins that are not quite clear.  Estimated size of the mass is 5.0 cm in diameter.  The left axilla contains 2-3 enlarged, firm, non-tender lymph nodes.  The nipples and areola are pink-tan and non-eczematous.  Compression of the nipples reveals no discharge.  Exam of the opposite breast and axilla reveals no abnormalities.   

Q. Review her Mammogram. What is your diagnosis?

Answer

Q. What are the primary and secondary mammographic signs of malignancy? 

Answer  

• Primary:  

  • Mass

    • Asymmetric density

    • A spiculated mass is the most common mammographic appearance.

  • Calcifications 

    • Micro calcifications may be seen on mammography in at least 30% of cases of invasive carcinoma. 

    • They are 1 mm or less and sand like

    • The calcifications represent necrotic debris

  • Developing density

• Secondary:  

  • architectural distortion

  • skin thickening or retraction

  • nipple and areolar thickening

  • abnormal ductal patterns

  • lymphadenopathy.   

  • venous engorgement

  • asymmetry of the breast tissue.   

Q:  What is the most common type of  breast cancer? (Check the answers and percentage)

Answer    

• 65%-80%      Invasive ductal carcinoma arises from the epithelium of the breast ducts, accounts for nearly 94% of breast cancers

• 03%-14%      Lobar carcinoma  Invasive lobular carcinoma arises from the acini of breast lobules and accounts for 5.5% of cases.

• 02%-08%      Tubular carcinoma   

• Less than 1% of invasive breast cancers are sarcomatous or other mesenchymal origin.   

Q: What is the role of radiologist in biopsy assistance of breast mass?

A:   The lesion can be localized by the radiologist for biopsy and/or resection with mammographic or ultrasound guidance.