Breast Imaging

·         SCREENING MAMMOGRAPHY:

1. Annual screening mammography should begin at age 40.
2. Mammography is still the best screening test to detect subclinical breast cancer.
3. The sensitivity of mammography is in the range of 83-95%.
4. An individual's risk of developing breast cancer increases with increasing age.
5. Most breast cancers occur in women with no family history of the disease.

·         DIAGNOSTIC MAMMOGRAPHY

1. The BIRADS categories are essential for reporting results of diagnostic mammography.
2. Diagnostic mammography is indicated for women with a specific breast-related problem that needs to be evaluated. Screening mammography is indicated for asymptomatic patients.
3. In patients who have had breast conservation, the postbiopsy changes may limit the sensitivity of mammography.
4. In a patient presenting with a palpable breast mass, if the mammogram results are negative, the imaging evaluation should not stop at that point. Directed sonographic evaluation is necessary to complete the evaluation.

·         MRI BREAST CANCER DETECTION

1. IV contrast is required for all breast cancer detection by MRI.
2. MRI is nearly 100% sensitive for invasive breast cancer but is less sensitive for DCIS. MRI can detect foci of cancer that are occult on mammography and physical examination.
3. Cancer detection requires identification of foci or regions of abnormal enhancement.
4. Differentiation of benign from malignant enhancement requires evaluation of both lesion morphology (e.g., borders) and enhancement kinetics.
5. MRI is most useful for evaluating indeterminate mammographic findings, staging known cancer, and identifying occult cancer in high-risk women.
6. Currently, MRI is not believed to be cost-effective as a screening modality for the general population.

·         IMPLANT EVALUATION

1. Breast implants can be saline-only, silicone-only, or a combination of saline and silicone (dual-lumen).
2. MRI is the most accurate imaging test for evaluating implant integrity.
3. Implant rupture is divided into three categories of increasing severity: gel bleed, intracapsular rupture, and extracapsular rupture.
4. Depiction of free silicone in the breast tissue is the hallmark of extracapsular rupture.