BREAST IMAGING

This post is for Basic understanding of the common modalities for imaging the breast.
Those most often used are-

- Mammography or

x-ray mammogram

- Ultrasound or sono-mammogram

- MRI Breast
Other modalities such as CT, nuclear scan, ductography, PET, etc are also used, but they are beyond the scope of this post.

WHY AND WHEN-

Patients are usually referred for an investigation for the following reasons:

-Feeling of a lump in breast or armpit

-Nipple discharge

-Breast pain

-Trauma to breast

- Screening

MAMMOGRAPHY

First line study;

It is basically a x-ray of the breast.

The radiation dose is low, however random use must be avoided.

It is highly sensitive to pickup very small findings, even before a lump is felt.

A special machine is required for carrying out this study, in which compression of breast is done and a x-ray is taken.

The density of the breast plays a role in good or poor visualisation of various lessons, with dense breasts image difficult to interpret.

ULTRASOUND OF THE BREAST

An ultrasound or sonography of the breast is used to investigate young / pregnant/ lactating women and also those with painful breast conditions.

It is also very good to further look at any abnormalities on the mammography.

It is also used to guide biopsies and other procedures.

Useful in looking at male breast conditions too.

MRI

This is a problem-solving modality, when mammography/ultrasound are inconclusive, or in checking spread of breast cancer preoperatively, when multiple lesions are suspected, postoperative screen etc

SCREENING for breast cancer-

There is increasing awareness to screen for breast cancer before any symptoms/ clinical signs appear.

Usually a mammogram is the first choice.
There are guidelines in place to screen for cancer, and random investigations, which will cause unnecessary worry, must be avoided. There are various studies about when to get a mammo- usually it's after 40 years. But various factors are involved and your doctor will be able to help you out.

So please talk to your primary care physician or gynecologist if you have any concerns.

You must inform your doctor if you have a family history of breast cancer. A detailed medical history is required to check for various other factors that can help assess risk for malignancy.


Other than cancer, there are various benign conditions such as cysts etc which maybe picked up on these studies.

Also, no single study has a diagnostic value of 100%.

When there is a doubt for malignancy a biopsy is needed to confirm it.

The aim of imaging the breast is to diagnose various benign breast conditions / distinguish cancer from non-malignant breast conditions and for early pickup of breast cancer, which is one of the commonest cancers in women.

Pic1- sono-mammogram showinga non-cancerous lesion.

Pic2- sonography machine at my workplace

Pic3- appearance of normal breast

Pic4- Mammography machine

Pic 5- x-ray mammo image.
#xraymom