Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Breast Implants and the Reconstructed Breast

Breast reconstruction is commonly performed for breast augmentation, for breast reduction, or for reconstruction after breast cancer surgery. Current breast reconstruction techniques are diverse and may involve the use of an implant, autologous tissue, or a combination of the two. Radiologists should be familiar with the normal postoperative imaging appearances of breast implants and reconstructed breasts; be able to diagnose complications related to breast reconstruction, such…

Breast Cancer Treatment-Related Imaging and the Postoperative Breast

This chapter provides an overview of clinically driven breast cancer evaluation; the sequence of events after a breast cancer diagnosis; locoregional breast cancer treatment options, including sentinel lymph node (SLN) biopsy; the normal postoperative breast; postradiation therapy change; ipsilateral breast tumor recurrence (IBTR) after lumpectomy; and the appearance of the breast after mastectomy with or without reconstruction. Suspicious palpable or image-detected breast abnormalities constitute the majority…

Magnetic Resonance Imaging of Breast Cancer and Magnetic Resonance Imaging–Guided Breast Biopsy

Magnetic resonance imaging (MRI) is more sensitive for breast cancer than standard x-ray mammography or ultrasound, when using dynamic contrast-enhancement (DCE) methods after administration of intravenous (IV) gadolinium-based contrast agents. Breast MRI both detects breast cancer and distinguishes it from benign breast with high-resolution scanning using breast lesion morphology and enhancement characteristics. Noncontrast MRI methods are in development, but currently they are not as sensitive for…

Mammographic and Ultrasound-Guided Breast Biopsy Procedures

Imaging-guided biopsy of nonpalpable breast lesions is an essential component of breast imaging services. Percutaneous biopsy provides a diagnosis with minimal patient trauma. If it is cancer, the patient and her team can decide on lumpectomy versus mastectomy, with definitive excision and axillary lymph node biopsy at the first surgery if breast conservation is chosen. This chapter describes percutaneous ultrasound (US)-guided and stereotactic-guided breast needle biopsy…

Breast Ultrasound Principles

Ultrasound (US) is a useful adjunct to mammography for diagnosis and management of benign and malignant breast disease. Technical advances have resulted in consistent, reproducible, high-resolution clinical US images. Although whole-breast automated scanners are now available and increasing in use, most practices rely on high-resolution handheld transducers. In women with dense breasts and additional risk factors, a screening breast US has been shown to detect additional…

Mammographic and Ultrasound Analysis of Breast Masses

A breast mass is one of the most frequent presenting features of breast carcinoma. Benign masses usually have round or oval shapes with pushing or circumscribed borders and do not invade normal surrounding tissue. Malignant masses are often irregularly shaped with indistinct or spiculated margins produced by the tumor infiltrating adjacent normal tissue. Thus radiologists look carefully at mass shapes and margins to determine whether the…

Mammographic Analysis of Breast Calcifications

Breast calcifications are commonly seen on mammograms, are usually composed of calcium carbonate, and are mostly seen in benign entities. However, breast calcifications also form in breast cancer and are sometimes the only sign that something is wrong on the mammogram. Fifty percent to eighty percent of breast cancers contain calcifications at pathology, but fewer cancers actually display calcifications on mammograms. This chapter will review a…

Mammogram Analysis and Interpretation

In the United States, statistics indicate that one in eight American women will develop breast cancer if women live a 90-year life span. The incidence of breast cancer in women in the United States is rising, and although the rate of increase has slowed recently, the rate of in situ breast cancer continues to increase. The United States breast cancer death rates have decreased since the…

Mammography Acquisition: Screen-Film, Digital Mammography and Tomosynthesis, the Mammography Quality Standards Act, and Computer-Aided Detection

Mammography is one of the most technically challenging areas of radiography, requiring high spatial resolution, excellent soft-tissue contrast, and low radiation dose. It is particularly challenging in denser breasts because of the similar attenuation coefficients of breast cancers and fibroglandular tissues. The Digital Mammographic Imaging Study Trial (DMIST) and other recent studies have shown that digital mammography offers improved cancer detection compared with screen-film mammography (SFM)…

Mammography Physics 101

Overview This chapter covers some of the basic physics of operation of a mammography system including the components of the mammography system, the effects of scatter, radiation dose requirements, magnification, and common artifacts in digital mammography . A mammography system is a dedicated radiography system designed and optimized specifically for imaging the breast. Some systems still employ a cassette with a fluorescent screen and x-ray film,…

Mammography Quality Standards Act (MQSA) and American College of Radiology (ACR) Accreditation Programs

Overview This chapter reviews the key components of the Mammography Quality Standards Act and American College of Radiology (ACR) accreditation programs, including personnel qualifications, imaging and equipment standards, reporting requirements, and the medical audit . Mammography Quality Standards Act Origins and Purpose The Mammography Quality Standards Act (MQSA) was established by the United States Congress as law on October 27, 1992. MQSA’s overall goal is to…

Special Populations in Breast Imaging

Overview This chapter covers breast imaging in special patient populations, including the young, pregnant, lactating, male, transgender, or combinations thereof. This includes management guidelines, common imaging findings, and pathologies that breast radiologists should be familiar with . The Breast Imaging Reporting and Data System (BI-RADS) Atlas comprises a thorough and evidence-based guide for accurate image interpretation and management of most common clinical scenarios encountered in women…

The Augmented and Reconstructed Breast

Overview This chapter reviews the normal and abnormal imaging appearances of the augmented and reconstructed breast. This includes implants and autologous flap reconstructions, as well as associated early, delayed, and rare complications. Breast surgeries, whether for cosmetic intent or for reconstruction, have evolved considerably over the last several decades. Advances in microsurgical techniques, increased use of autologous flaps, and availability of higher quality of implants have…

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…