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Lymph Node Evaluation in Breast Imaging

Overview This chapter provides a framework for the diagnostic approach to axillary lymphadenopathy and its differential considerations including unilateral axillary lymphadenopathy, bilateral axillary lymphadenopathy, and axillary nodal calcifications. A brief overview of the evaluation and management of axillary lymph nodes in newly diagnosed breast cancer patients concludes the chapter. Axillary lymphadenopathy can be encountered during the evaluation of a palpable lump in the axilla, as part…

After Breast Conservation Therapy

Overview This chapter will review the definition of breast conservation therapy, indications for this therapy, principles of preoperative tumor localization and surgical specimen radiography, surveillance after breast conservation therapy, expected changes after breast conservation therapy, and typical imaging findings of residual disease or recurrent cancer . The optimal therapy for breast cancer is based on a multidisciplinary approach and collaborative effort of breast radiologists, surgeons, oncologists,…

Breast Cancer Staging: What the Surgeon and Oncologist Want To Know

Overview This chapter reviews the imaging and molecular tumor profiling used in the eighth edition of the TNM staging system developed and maintained by the American Joint Committee on Cancer. The aim of staging is to guide treatment and provide prognosis for patients diagnosed with breast cancer. With significant advances in immunohistochemical and molecular profiling of tumors, staging continues to evolve from simple anatomic information to…

The Symptomatic Breast

Overview This chapter reviews the imaging evaluation and differential considerations in patients with breast symptoms, including the scenarios of palpable lump, nipple discharge, other nipple changes, breast pain, and breast swelling . Despite early detection of asymptomatic cancers from screening mammography, the breast radiologist will still frequently encounter women presenting with signs and symptoms of breast cancer. Symptomatic breast malignancies remain widely prevalent due to several…

Organized Approach to Diagnostic Imaging

Overview This chapter outlines a systematic approach to the diagnostic evaluation of noncalcified findings identified at screening mammography, including masses and asymmetries. Modalities discussed include mammography, tomosynthesis, and ultrasound. For asymptomatic patients, the purpose of the diagnostic workup is to further evaluate potential abnormalities identified at screening mammography. Specific objectives include the following: confirmation that a finding is real, lesion localization, and lesion characterization. Triangulation Describing…

Organized Approach to Screening Mammography

Overview This chapter will review the science behind screening mammography including a summary of different screening guidelines and discussion of controversies surrounding screening recommendations. The second part of this chapter will review how to systematically approach screening mammography interpretation. Why Perform Screening Mammography? (Screening Evidence) Historical Perspective Before there was mammography or any breast imaging, breast cancers presented when they became clinically apparent, for example as…

Breast Cancer Screening Guidelines and Supplemental Screening

Overview This chapter discusses screening guidelines for women at average risk and elevated risk, and supplemental screening tools beyond full-field digital mammography (FFDM). Breast cancer is the most commonly diagnosed nonskin cancer and is the second leading cause of cancer death in women in the United States. For the year 2020, the American Cancer Society estimated 268,600 new cases of invasive breast cancer and over 41,000…

Breast Cancer Risk Assessment

Overview This chapter discusses determining breast cancer risk, population subgroups at higher risk, and models to evaluate breast cancer risk. Early detection and treatment of breast cancer reduces breast cancer–related mortality. Evaluating and predicting an individual woman’s risk of developing breast cancer are important for tailoring screening regimens and breast cancer prevention strategies in order to facilitate early detection. Knowledge of risk determination will help a…

Breast Pathology and Radiologic–Pathologic Correlation

Overview This chapter covers normal breast anatomy and correlation between imaging and pathology, including management of benign lesions, high-risk lesions, and malignancies. Knowledge of breast anatomy and pathology is critical for accurate image interpretation. Understanding the spectrum of benign and malignant pathologies allows radiologists to confidently identify abnormal findings, give a reasonable differential diagnosis, and assign an accurate probability of malignancy with appropriate management recommendations. Careful…

Breast MRI Indications, Interpretation, and Interventions

Overview This chapter covers the fundamentals of breast MRI, including indications, technical considerations and MRI artifacts, MRI interpretation and reporting, and the basics of MRI-guided breast interventions. Indications Breast magnetic resonance imaging (MRI) has higher sensitivity for detecting breast cancer compared with mammography and ultrasound. While MRI initially suffered from low specificity, more recent data suggest it is improving with recent advancement of MRI technology. Nonetheless,…

Mammographic and Ultrasound-Guided Breast Biopsy Procedures

Overview This chapter covers percutaneous mammographic- and ultrasound-guided breast needle biopsies, preoperative needle/wire and wireless localization, specimen radiography, and pathology correlation. Magnetic resonance imaging (MRI)-guided breast procedures are covered in Chapter 8: Breast MRI Indications, Interpretation, Interventions . Image-Guided Breast Biopsy Image-guided percutaneous biopsy of breast lesions is an important part of breast imaging services and the current standard of care approach for obtaining tissue diagnosis.…

Basics of Digital Breast Tomosynthesis

Overview This chapter covers the basics of digital breast tomosynthesis (DBT), including acquisition, display, and interpretation techniques. Additionally, dose-related concerns and synthesized imaging will be explained . Digital breast tomosynthesis (DBT) was developed to improve on the limitations of traditional digital mammography (DM), namely the limited sensitivity in women with dense breast tissue as well as the relatively high number of patients called back from screening…

Breast Ultrasound Indications and Interpretation

Overview This chapter covers screening and diagnostic indications for breast ultrasound and Breast Imaging Reporting and Data System (BI-RADS) interpretation. Additional topics covered include ultrasound technique for optimizing image quality, basic ultrasound physics, and artifacts . Indications Breast ultrasound can be used for both screening and diagnostic indications ( Table 5.1 ). Ultrasound evaluates breast tissue without the use of ionizing radiation or the injection of…

Mammographic Analysis of Breast Calcifications

Overview This chapter covers mammographic appearance of benign, probably benign, and malignant breast calcifications. It reviews the list of typically benign breast calcifications. Analysis of breast calcifications using Breast Imaging Reporting and Data System (BI-RADS) morphology and distribution to determine appropriate assessment, and management recommendations are also covered . Breast calcifications are a common mammographic finding. The majority of calcifications in the breast are related to…

Mammographic Masses, Asymmetries, and Distortion

Overview This chapter discusses the mammographic evaluation of breast masses, asymmetries, and architectural distortion. We will introduce the Breast Imaging Reporting and Data System (BI-RADS) descriptors as a tool to categorize these noncalcified lesions within the breast along with suggested management . Breast Masses A mass occupies three-dimensional space with partially or completely convex borders, which bulges into the surrounding tissues. A mass should be identifiable…

Why BI-RADS?: Overview of Breast Imaging Reporting and Data System (BI-RADS)

Overview This chapter summarizes the purpose and history of BI-RADS; introduces the BI-RADS lexicon, assessment categories, and standardized report; and answers frequently asked questions (FAQs) of using BI-RADS to communicate breast findings . Introduction The Breast Imaging Reporting and Data System (BI-RADS) is a breast radiologist’s second language. Spend 10 minutes in a breast radiology reading room and you will likely hear the word BI-RADS and…

Introduction to Mammography: The Basics

Overview This chapter is a basic introduction to the fundamentals of mammography, including standard and special views, technical adequacy, and normal anatomy . Breast imaging is integral to the diagnosis and evaluation of breast cancer and other breast pathologies. While ultrasound and magnetic resonance radiology (MRI) also play important roles, mammography is often considered the foundation or workhorse of breast radiology. Mammography is versatile with ubiquitous…