Flat epithelial atypia is an entity that comprises any columnar cell lesion with low-grade cytologic atypia.
Flat epithelial atypia was introduced in the 3rd edition of WHO Classification of Breast Tumors in 2003, to substitute terms such as clinging carcinoma monomorphous type, at...
Columnar cell hyperplasia is part of the spectrum of columnar cell lesions of the breast characterized by enlarged terminal ductal lobular units lined by stratified (more than two layers) columnar epithelium, cellular crowding or overlapping without atypia.
It can also form tufts or mounds with...
Columnar cell change without atypia breast lesions are characterized by enlarged terminal ductal lobular units lined by columnar epithelial cells which substitute the normal cuboid epithelial layer.
They are also associated with prominent apical cytoplasmic snouts and intraluminal secretions. ...
Zuska disease, also known as Zuska-Atkins disease, is a rare pathology that is characterized by recurrent subareolar abscess formation, sometimes followed by fistula and pus drainage.
It is seen more commonly in females however, case reports of male disease have also been reported...
Inspissated secretions refers to thickened secretions with increased viscosity within ducts or body cavities (usually nasal, paranasal sinus, oral or ductal) that usually become thickened by dehydration (typically a chronic process). The secretions can then cause obstruction to respective airway...
Cyclin-dependent kinase 4 and 6 (CDK4/6) inhibitors which often go under the name palbociclib, ribociclib, and abemaciclib are used in patients with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative (HR+/HER2−) advanced breast cancer.
CDK 4 and C...
Skip metastases to the axillary lymph nodes in breast cancer refer to the uncommon phenomenon in which metastases do not follow the conventional stepwise pattern from level I to level II, to level III (infraclavicular), to the supraclavicular fossa, and or internal jugular chain 1-6,9.
Pleural silicone granulomas result from an extremely rare situation where there is leakage of silicone from an implant rupture into the thorax.
It is thought that scars from remote thoracotomy may provide a potential pathway for ruptured silicone to fistulise into the pleural space....
The mean glandular dose (MGD) is an estimate of the average absorbed dose to the glandular tissues of a breast during mammography. It is measured in Gray (Gy).
The most commonly accepted method of calculating the mean glandular dose is described by Dance et al (2000):
The K-absorption edge (K-edge) refers to the abrupt increase in the photoelectric absorption of x-ray photons observed at an energy level just beyond the binding energy of the k-shell electrons of the absorbing atom.
K-shell binding energies are specific to each element. As the atomic number (Z...
Leborgne's law in mammography represents a classic clinical observation where the clinical (palpable) size of a malignant breast mass commonly exceeds the radiographic one 1. The peritumoral edema and/or desmoplastic reaction are thought to be the cause of this phenomenon.
The law has been des...
Breast development occurs in two phases, one during fetal life and the second during puberty. In fetal life a rudimentary organ with simple ducts develop under maternal stimulus. During puberty, further complex branching of ducts and glandular tissue forms which is divided into five stages.
The keyhole sign may refer to:
keyhole sign (intracapsular breast implant rupture) 1
keyhole sign (posterior urethral valves) 2
keyhole sign (neural exit foramina)
Tamoxifen is an important anti-estrogen agent used for the treatment of hormone receptor-positive breast cancer and it may induce reversible hepatic steatosis. This is usually transient and may occasionally be associated with hepatic dysfunction. It only rarely leads to cirrhosis 1.
The Milky Way (disambiguation) has been used for two different radiological appearances:
Milky Way appearance on mammography
Milky Way sign in peripheral multifocal leukoencephalopathy
A non-mass finding on breast ultrasound refers to a discrete region of altered breast parenchymal echotexture that does make a mass shape (i.e. non-identifiable in two planes). "Non-mass finding" is not a current BI-RADS descriptor.
Non-mass findings are described in numerous ways...
A filling defect is a general term used to refer to any abnormality on an imaging study which disrupts the normal opacification (filling) of a cavity or lumen. The opacification maybe physiological, for example, bile in the gallbladder or blood in a dural venous sinus, or maybe due to the instal...
Lateral intercostal artery perforator (LICAP) flap is a technique performed in breast reconstruction. It is considered suitable for some patients who have breast cancer in the outer part of the breast. It aims to replace lost breast tissue, fat and occasionally skin that is removed at the time o...
Ultrasound elastography, also called as sono-elastography, is a modern evolutionary method of sonographic imaging. Techniques include shear wave elastography (also known as transient elastography) and strain elastography (also known as static or compression elastography). These techniques utiliz...
Lymphoscintigraphy is a nuclear medicine technique to visualize regional lymphatic drainage, especially for mapping sentinel lymph nodes, from a site of radiopharmaceutical injection.
Colloidal agents are used as these particles enter lymphatic channels and migrate to lymph...
Interpectoral lymph nodes, also known as Rotter lymph nodes, are located in the interpectoral fascia in Rotter space, between the pectoralis major and pectoralis minor muscles. Their number varies from one to four. They are usually considered to be a separate nodal group from the level I and II ...
Premature thelarche refers to the onset of female breast development before age 7–8 years. As with age-appropriate thelarche, premature thelarche may be asymmetric or unilateral.
Premature thelarche may occur as an isolated event or as part of precocious puberty. Isolated premature thelarche g...
A latissimus dorsi myocutaneous flap is a form of breast reconstruction that transplants the patient’s own latissimus dorsi muscle, fat, and skin from the middle back to the chest to form a breast mound.
This flap is more easily created and contains a robust vascular supply compared...
Mammary myofibroblastoma is a rare, benign, circumscribed mesenchymal breast tumor.
It is the only breast tumor that occurs more commonly in males than females 2. It also has a tendency to occur more often in elderly males and postmenopausal women.
It arises from the ...
Microinvasive carcinoma is a type of epithelial breast cancer in which microscopic foci of tumor cells infiltrate the breast stroma.
Microinvasive carcinoma is defined histologically as one or more clearly separate foci of tumor cells ≤1 mm in size infiltrating the mammary stroma 1. ...
Non-mass enhancement at breast MRI is defined in the BI-RADS lexicon as an area of enhancement that does not meet criteria for a mass, such as by having nonconvex borders or intervening fat or fibroglandular tissue between the enhancing components.
A wide variety of benign,...
A focus in the context of breast MRI using the BI-RADS lexicon refers to a unique enhancing dot that is too small to characterize further morphologically as a mass or nonmass enhancement. Usually, a focus is smaller than 5 mm.
T1 C-: no corresponding finding; possi...
Background parenchymal enhancement on breast MRI refers to the normal contrast enhancement of fibroglandular tissue.
Background parenchymal enhancement is more common in younger patients with dense breasts 1,8. Reflecting hormonal influence, background enhancement is decreased aft...
The World Health Organizatiοn classification of tumors of the breast is the most widely used pathologic classification system for such disorders. The current revision, part of the 4th edition of the WHO series, was published in 2012 and is reflected in the article below 1.
Round breast calcifications are a mammographic descriptor of typically benign breast calcifications characterized by a round shape. In the 5th edition BI-RADS lexicon, the morphologic descriptor encompasses punctate calcifications, but the latter term more specifically applies to such calcificat...
Granular cell tumors (GrCTs) are uncommon soft tissue tumors with the vast majority being benign (approximately 0.5-2.0% have been reported as malignant).
They have been reported in all organ systems, but most prominently are found in these sites 2,5:
breast (granular cell tumor of...
Clothing artifacts, like jewelry artifacts, are a regular feature on imaging examinations, especially plain radiographs, but in general are recognized for what they are, either at the time the image is taken by the radiographer, or later by the reporting radiologist. The radiographer will often ...
Radiation-induced breast cancers are a potential long-term complication of radiotherapy to the chest, in particular, in those patients receiving irradiation for breast cancer or Hodgkin lymphoma.
Besides breast cancer, sarcomas (breast angiosarcoma or osteosarcomas arising from the irradiated ...
Radiation-induced breast changes are a consequence of radiotherapy toxicity over the breast tissues either related to targeted breast cancer treatment or other thoracic malignancies (eg. lung cancer).
The radiation-induced breast changes may be seen in either dedicated b...
Breast masses are three-dimensional space-occupying lesions in the breasts. This article provides an overview of the standard BI-RADS terminology used to describe breast masses in radiology reports and other reporting suggestions.
Breast masses are described differently b...
CA 15-3 is a tumor marker used in monitoring breast cancer. The test detects levels of MUC-1, a mucin protein in the blood. MUC-1 is thought to be important in the invasiveness and metastasization of cancer cells.
Mucin-1 is a normal epithelial cellular glycoprotein localized to the...
Neonatal mastitis is rare and refers to infection of the breast tissue occurring in a neonate.
Patients may present with unilateral breast erythema and pain sometimes with associated nipple discharge and lymphadenopathy. It usually occurs in patients under five weeks of a...
The sentinel lymph nodes (SLNs) are defined as those lymph nodes that directly drain a malignancy, or alternatively can be considered as the first node(s) that a tumor metastasizes to.
History and etymology
"Sentinel node" as the initial draining node of a malignancy was first used in a paper ...
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare form of T-cell primary breast lymphoma that has primarily been associated with textured breast implants.
In BIA-ALCL, the peri-implant fluid is referred to as an effusion rather than seroma, as the latte...
A fistula (plural: fistulae or fistulas) is an abnormal connection between two epithelial surfaces such as between hollow organs, skin or vessels. Conventionally, the name of a specific fistula type is a combination of the two organs. For discussions of specific fistulae please refer to individu...
Breast filariasis describes filariasis, a parasitic infestation commonly caused by Wuchereria bancrofti and Brugia malayi, of the breast.
Lymphatic filariasis puts at risk more than a billion people in more than 80 countries who are seriously incapacitated or disfigured by the dis...
This article lists a series of labeled imaging anatomy cases by body region and modality.
CT head: non-contrast axial
CT head: non-contrast coronal
CT head: non-contrast sagittal
CT head: angiogram axial
CT head: angiogram coronal
CT head: angiogram sagittal
CT head: venogram axial...
The keyhole or noose sign indicates an uncollapsed intracapsular breast implant rupture seen as the focal invagination of the implant shell caused by a small concealed leak of silicone outside shell where the two membranes do not contact each other. It is best appreciated on breast MRI.
The teardrop sign indicates an uncollapsed intracapsular breast implant rupture and is seen as a small focal invagination of the implant shell caused by a minimal concealed leak of droplets of silicone outside the shell where the two membranes contact each other. It is best appreciated by MRI.
The subcapsular line sign is a small localized leak from a silicone implant that leads to the formation of a thin layer of silicone between the implant shell and the fibrous capsule. It represents a minimally collapsed intracapsular breast implant rupture. It is best appreciated by MRI.
Primary breast chondrosarcoma is a rare type of sarcoma that originates from the mammary stroma and not from the underlying bone or cartilage of the chest wall.
The prevalence of primary breast chondrosarcoma is reported to be 0.5-1%, they represent <5% of all sarcomas 1,14.
Perforating branches of the internal thoracic arteries arise from the paired internal thoracic arteries (also known as internal mammary arteries) and run in the superior six intercostal spaces. These arteries pierce the internal intercostal muscles and pectoralis major, contributing to the blood...
Breast tissue markers are a common finding in breast radiology. These are typically inserted following percutaneous biopsy, either under ultrasound or sterotactic guidance. They can be invaluable in identifying known benign areas or shrinking/treated malignant lesions on follow up imaging.
Complicated breast cysts are one of the cystic breast lesions that show intracystic debris which may imitate a solid mass appearance. They should be carefully differentiated from a complex cyst and may require alternative management 3.
thin wall with or withou...
Breast cysts are a common mammographic and sonographic finding, and can be of different types:
simple breast cyst: typically is a well-defined, anechoic lesion with imperceptible wall and posterior acoustic enhancement 1
complicated breast cyst: contains intracystic echoes or debris with other...
The British Society of Breast Radiologists (BSBR) publish with the Royal College of Radiologists a standardized classification for breast imaging in the United Kingdom. The first edition in 2009 was based on findings from the RCR Breast Group (RCRBG) 1 with the current fourth edition published i...
Many patients, particularly in developing countries, can present late with giant breast masses. They may be single or multiple and either benign or malignant. Many of these conditions are indistinguishable on physical examination alone. Some of these lesions require mastectomy while others can b...
The Kaiser score is an evidence-based clinical decision rule to distinguish benign from malignant lesions in breast MRI. It incorporates five BI-RADS descriptors:
suspicious protrusion from the lesion surface that has concave lateral aspects
this includes classical spiculations, ...
This is a basic article for medical students and other non-radiologists
Breast cancer is the commonest malignancy in female patients.
This is a summary article; read more in our article on breast cancer.
1 in 4 cancer deaths in women worldwide 1
Breast echotexture refers to the background tissue appearance on breast sonography, analogous to breast density/amount of fibroglandular tissue on mammography and MRI. There are three categories of tissue composition according to the BI-RADS lexicon 1:
homogeneous background echotexture – fat
Filariasis refers to infection with nematodes (roundworms) of the family Filarioidea. There are three species of these thread-like filarial worms:
Wuchereria bancrofti: responsible for 90% of cases
Brugia malayi: causes most of the remainder of cases
Brugia timori: an uncommon cause
It can a...
The anatomy curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core anatomy knowledge for radiologists and imaging specialists.
Head and neck anatomy
Abdominal and pelvic anatomy
Stepladder sign may refer to:
intracapsular breast implant rupture (ultrasound)
gas-fluid levels in obstructed small bowel (erect abdominal radiograph)
The salad oil sign, also referred to as the droplet sign, is an MRI sign of breast implant rupture.
It is characterized by small rounded high T2 signal foci within a breast implant and represents water droplets or small amounts of gas within the silicone. It also can be characterized as hypoint...
Snowstorm sign may refer to:
snowstorm sign: complete hydatiform mole (ultrasound)
snowstorm sign: extracapsular breast implant rupture (ultrasound)
snowstorm sign: thyroid pulmonary metastases (chest radiograph)
Snowstorm sign on breast ultrasound imaging represents the presence of free silicone droplets mixed with breast tissue giving a characteristic heterogeneous echogenic appearance with dispersion of the ultrasound beam. It is considered the most reliable sign of extracapsular breast implant ruptur...
Silicone injection into various parts of the body has been used in many countries to achieve what are perceived to be cosmetic improvements. Most common sites for such injections are the breasts, face, and buttocks, although anywhere can be targeted.
This article is a general discussion of the...
The causes of breast edema can be remembered using the mnemonic:
V: venous obstruction
I: inflammatory breast cancer
L: lymphatic obstruction
S: surgery (recent), secondaries 2
BI-RADS 5 lesions under the BI-RADS (breast imaging reporting and data system) refer to breast lesions that are highly suspicious for malignancy, requiring appropriate action to be taken (i.e. biopsy and management as appropriate). BI-RADS 5 lesions have the characteristic morphology of breast c...
The new pathological classification of DCIS (ductal carcinoma in situ) is based on cytonuclear atypia, degree of necrosis, size, and distance from margin/architecture. Low and intermediate grades DCIS require cytologic, architectural and size criteria to be met but high-grade DCIS requires only ...
Prostate specific antigen (PSA) is currently used as a tumor marker for prostate adenocarcinoma.
PSA is a 33 kilodalton glycoprotein produced in prostate epithelial cells. Its normal physiologic role is as a liquefying agent for seminal fluid; only a tiny amount leaks into the blood, therefore ...
Metaplasia is a general pathology term that refers to the process when one cell type is replaced by another. It usually occurs in the context of a changed cellular environment to which the new cell type is better adapted 1.
Examples include 2-5:
Barrett esophagus: normal squamous epithelium rep...
A handy mnemonic to recall the causes of a stellate breast lesion is:
S: summation shadow
T: tumor (i.e. invasive breast cancer)
R: radial scar
F: fibroadenoma / fat necrosis
A: adenosis (sclerosing)
CE: other causes, hematoma (e.g. postoperative, post biops...
Hereditary breast and ovarian cancer (HBOC) syndrome is caused by a mutation to either BRCA1 or BRCA2 genes. These patients have an increased risk of breast cancer, ovarian cancer, pancreatic cancer and prostate cancer. However, these gene mutations are not the only cause of hereditary breast ca...
The inframammary fold is the anatomical boundary formed at the inferior border of the breast, where it joins with the chest.
In mammography, it is an important landmark to identify on the mediolateral oblique view to assess image quality.
The Tabar 5-tier grading system is used to classify mammographic lesions. This should not be confused with the Tabar classification of parenchymal patterns in breast imaging. It is a separate but translatable system to the BI-RADS classification system (please note that Tabar grade 3 ≠ BI-RADS 3...
BI-RADS 0 is one of seven categories from the breast imaging-reporting and data system and is used when imaging is incomplete such as:
when further imaging or information is required, e.g. compression, magnification, special mammographic views, ultrasound
when requesting previous images not av...
Seromas are collections of serous fluid that usually occur as a complication of surgery, but can also be seen post-trauma. They are commonly seen as an early complication of breast surgery, where a potential space is left.
Seromas are distinct from hematoma as they contain almost n...
Lymphocytic mastitis, also known as lymphocytic mastopathy or sclerosing lymphocytic lobulitis, is a rare benign inflammatory disease of the breast that can mimic breast cancer.
Diabetic mastopathy is a closely-related entity although it is sometimes used synonymously in the litera...
Free silicone breast injections (silicone mastopathy) are an alternative form of breast augmentation to breast implants, although they have serious adverse effects and are banned in many countries.
There are similar features to that of free silicone from breast implant r...
This article lists examples of normal imaging of the breast and surrounding structures, divided by region and modality.
MLO and CC (standard mammographic views)
example (50 year old)
example 2 (35 year old)
example 3 (dense breasts, 45 year o...
Mnemonic for the causes of gynecomastia:
Deep inferior epigastric perforator flap (DIEP) reconstruction is a type of breast reconstruction surgery. It essentially involves the transfer of the patient's own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound.
The operation spare...
Albert Salomon (1883-1976), a German surgeon, was the first physician to study x-rays of breast tissue.
To be completed.
Development of mammography
Salomon worked at the Royal Surgical University Clinic in Berlin and from about 1913 x-rayed 3000 breast specimens obtained from the...
Breast cellulitis is an acute pyogenic inflammatory change involving the dermis and subcutaneous tissue. This can be secondary to any wound, surgery or radiation for breast carcinoma.
inflammatory changes such as edema, swelling and redness of the involved breast
Invasive ductal carcinoma not otherwise specified, also known as invasive carcinoma of no special type, is the most common type of breast cancer (70-80%) 5. It is an infiltrating, malignant and abnormal proliferation of neoplastic cells in the breast tissues.
The latest (4th) editi...
The tattoo sign is a feature given to describe dermal calcifications seen on mammography 1. The basis of this sign is that dermal calcifications maintain fixed relationships to one another that are reproducible with similar projections at different times. This is in contrast to intramammary calc...
Infiltrating syringomatous adenoma of the nipple is a relatively rare, benign dermal neoplasm of the areola and nipple.
Syringomatous adenomas of the nipple usually present as unilateral 1 to 3 cm firm lesion in the subareolar or nipple region of the breast. Tenderness, i...
Nipple adenoma is a rare, benign breast lesion which often mimics a malignancy
Patient presents with bloody discharge from an ulcerated and painful nipple in one breast. There is itching associated with this lesion. Symptoms may show variation with the menstrual cycle. T...
The percutaneous breast biopsy is one of the current choices for focal histopathological assessment of breast lesions. In contrast to fine needle aspiration, during a core needle biopsy, a hollow needle is used to withdraw small cores of tissue from the area of interest in the breast.
Ultrasound-guided percutaneous breast biopsy is a widely used technique for an accurate histopathological assessment of suspected breast pathology. It is a fast, safe and economical procedure.
Ultrasound guidance is limited to lesions visible on ultrasound study. The biopsy is gene...
Inferomedial superolateral oblique projection is useful for stereotactic biopsy positioning. This projection allows access to the inferior aspect of the breast to achieve shortest skin to abnormality distance. It is also useful in the nonconforming patient.
Rotate C arm to about 125°...
20° oblique projection is a troubleshooting projection used in mammography, especially in young women and in follow-up patients.
The C-arm is turned approximately 20° for a superomedial-inferolateral oblique. With the patient's feet pointing towards the unit and her torso turned slig...
Caudal cranial projection is an additional trouble shooting view.
invert the C arm as for a CC projection
step the patient forward and have her bend excessively forward at the waist to ensure that the abdomen does not encroach in the x ray field
place the image receptor above the b...
Elevated craniocaudal projection is an additional trouble shooting view.
direct beam superiorly to inferiroly
face patient towards unit, feet forward
lean patient inward, relaxing the shoulders
bring inferior aspect of breast onto the image receptor
pull breast outward and forwar...
Step-oblique mammography is an accurate technique for determining whether a mammographic finding visible on multiple images on only one projection (but not elucidated using standard additional mammographic projections) represents a summation artifact or a true mass and for precisely localizing t...
Triangulation is a technique for localizing lesions seen on at least two views on 2D mammography.
hang the CC, MLO, and 90° lateral films (in that order) on the view box
the nipple on each film must be at the same level
use a ruler and place one end over the lesion on the 90° later...
The lateral view is an additional view obtained at virtually every diagnostic evaluation. A lateral view may be obtained as a mediolateral view (ML) or lateromedial view (LM) view depending on where the imaging tube and detector are located.
for an ML view, the tube emitting the x-ra...