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Cutaneous calcifications in breast imaging

Cutaneous calcifications in breast imaging can form in dermal sweat glands after low grade folliculitis and inspissation of sebaceous material. Calcifications may also form in moles and other skin lesions. The vast majority of calcifications are coincidental findings on mammography. Radiographi...

Fat containing breast lesions

Fat containing breast lesions generally have some radiolucent component on mammography. Pathology They are generally classified at BIRADS II lesions. Common breast lipoma breast hamartoma fat necrosis within the breast/oil cyst intramammary lymph node: classically has a central fatty hilu...

Paget disease (breast)

Paget disease of the breast, which is also known as Paget disease of the nipple, has traditionally been described as a form of breast malignancy characterized by infiltration of the nipple epidermis by malignant cells. Although most cases have underlying focus or foci of in situ or invasive carc...

Breast venous malformation

Breast venous malformations (also known as breast hemangiomas) are benign vascular lesions occurring within breast tissue. Most breast venous malformations are so called cavernous malformations, which are found throughout the body. For a general discussion please refer to the general article on...

Juvenile papillomatosis of the breast

Juvenile papillomatosis (JP) of the breast is a relatively common benign localized proliferative lesion in the breast. Epidemiology As the name implies, it is mainly seen in young women (mean age ~19-23 years 4,6) and is unusual in women over 30 years old. Clinical presentation Patients pres...

Breast curriculum

The breast curriculum is one of our curriculum articles and aims to be a collection of articles that represent core breast knowledge. Definitions Topics pertaining to the breast. Anatomy An understanding of the anatomy of relevant structures is essential. Core anatomical topics include: du...

Invasive lobular carcinoma of the breast

Invasive lobular carcinoma is the most common special type of invasive breast cancer after invasive breast carcinoma of no special type (invasive ductal carcinoma not otherwise specified). Epidemiology They represent 5-10% of all breast cancer. Associations There is a greater rate of contral...

Intraductal papilloma of breast

Intraductal papillomas are the most common masses within the milk ducts of the breast. They are benign tumors but may contain areas of atypia or carcinoma. The most common symptom is nipple discharge. Epidemiology sex almost exclusively in women extremely rare in males 9 ag...

Breast sebaceous cyst

Breast sebaceous cyst, also sometimes known as an epidermal inclusion cyst or simply epidermoid cyst, is a benign breast lesion (BIRADS II). For a general discussion of this entity outside the breast, please refer to epidermal inclusion cysts. Terminology The two terms, breast sebaceous cys...

Breast implant rupture

Breast implant ruptures are a recognized complication of a breast implant. It can be intracapsular, when confined by the surrounding fibrous capsule, or extracapsular, when silicone freely extravasates. Pathology After implantation of a silicone or saline breast implant, a fibrous capsule (sc...

Diabetic mastopathy

Diabetic mastopathy is a condition characterized by the presence of a benign tumor like breast masses in women with long-standing type 1 or type 2 insulin-dependent diabetes mellitus. The condition has also been reported in men. A similar condition is lymphocytic mastitis but this occurs in non-...

Breast hematoma

Breast hematoma can result from preceding direct trauma, surgery, biopsy (rare) or contusion and can be easily misinterpreted as other lesions such as breast malignancy if the correct clinical context is not taken into account. They can rarely occur spontaneously, especially in those with coagul...

Intramammary lymph nodes

The intramammary lymph nodes (IMLN) (a.k.a. intramammary nodes) are lymph nodes within the breast tissue. In breast imaging, they generally fall into BIRADS II lesions 7. They can be solitary or multiple. This article discusses normal (physiological) intramammary lymph nodes. Epidemiology Intr...

History of breast augmentation

Breast augmentation (also known as augmentation mammaplasty) for cosmetic enlargement has been performed for well over a century. Below is a brief summary of its history. Breast augmentation was first attempted in the 19th century, when in 1895, Czerny transplanted a patient’s lipoma to her br...

Complex fibroadenoma

Complex fibroadenoma is a sub type of fibroadenoma harboring one or more of the following features: epithelial calcifications papillary apocrine metaplasia sclerosing adenosis and cysts larger than 3 mm Epidemiology Complex fibroadenomas tend to occur in older patients (median age, 47 yea...

Breast density

Breast density refers to the amount of fibroglandular tissue in a breast relative to fat. It can significantly vary between individuals and within individuals over a lifetime. Classification There are four descriptors for breast density on mammography in the 5th edition of BI-RADS 1,2: a...

Papillary carcinoma of the breast

Papillary carcinoma of the breast is a rare ductal breast malignancy. Epidemiology They are thought to account for 1-2% of breast carcinomas 2. They typically present in postmenopausal patients with the mean age being 63-67 years. Clinical presentation Papillary carcinomas may manifest clini...

Mucinous carcinoma of the breast

Mucinous carcinoma of the breast, also known as colloid breast carcinoma, is a subtype of invasive ductal carcinoma (IDC). They account for about ~2% (range 1-7% 4) of breast cancers. Epidemiology It tends to occur in older women where a prevalence of as much as 7% is found among women 75 yea...

Tubular carcinoma of the breast

Tubular carcinoma of the breast is a subtype of invasive ductal carcinoma (IDC). Epidemiology These account for ~1% of breast cancers. The peak age at presentation may be comparatively younger than with other types of breast cancer 7. Clinical presentation The vast majority of tubular carci...

Sclerosing adenosis

Sclerosing adenosis is a benign proliferative condition of the terminal duct lobular units characterized by an increased number of acini and their glands. It manifests as multiple small, firm, tender nodules, fibrous tissue, and variable microcysts within the breast. It is sometimes placed under...

Sternalis muscle

The sternalis muscle (TA: musculus sternalis 8), also known as rectus sternalis or parasternalis 7, is an uncommon chest wall accessory muscle and is of uncertain etiology and function. Its importance lies in that it should not be mistaken for a pathological lesion. Epidemiology Cadaveric stu...

Steatocystoma multiplex of the breast

Steatocystoma multiplex is a rare familial hamartomatous malformation that is characterized by the presence of multiple intradermal cysts, and can result in abnormal breast examinations. Epidemiology They usually appear during adolescence and progress with age. Clinical presentation The dis...

Lobular carcinoma in situ

Lobular carcinoma in situ (LCIS) represents the next step up from atypical lobular hyperplasia (ALH) along the malignant spectrum of lobular breast carcinoma. Epidemiology Lobular carcinoma in situ occurs predominantly in premenopausal women with a mean age of 45 years old, approximately 10-15...

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS) refers to a breast carcinoma limited to the ducts with no extension beyond the basement membrane, as a result of which the disease has not infiltrated the parenchyma of the breast and the lymphatics and cannot therefore metastasize. Epidemiology The detection of...

Atypical ductal hyperplasia

Atypical ductal hyperplasia is a histologically borderline lesion that has some, but not all, of the features of ductal carcinoma in situ. Sometimes the distinction between Atypical ductal hyperplasia and ductal carcinoma in situ are simply defined on the number of ducts involved. Pathology A...

Atypical lobular hyperplasia

Atypical lobular hyperplasia (ALH) is a pre-malignant lesion of the breast which falls at the milder end of the spectrum of lobular neoplasia. It is therefore considered a part of borderline breast disease. Clinical presentation It is usually asymptomatic and mammographically occult and is in...

Pseudoangiomatous stromal hyperplasia

Pseudoangiomatous stromal hyperplasia (PASH) is a benign, relatively uncommon form of stromal (mesenchymal) overgrowth within breast tissue that derives from a possible hormonal etiology. Epidemiology Typically affects women of reproductive age. It rarely affects males. Clinical presentation...

Lactating adenoma

Lactating adenomas are benign breast tumors that typically occur in the peri-partum period, and are one of the most prevalent breast lesions during puerperium 4. Clinical presentation Lactating adenomas commonly present as painless breast masses late in pregnancy or in the postpartum period. T...

Galactocele

Galactoceles, also referred as lactoceles, are the most common benign breast lesion typically occurring in young lactating women; however, they mostly happen on cessation of lactation 1. Clinical presentation Patients usually present with a painless breast lump occurring over weeks to months....

Plasma cell mastitis

Plasma cell mastitis is a benign breast condition that represents calcification of inspissated secretions in or immediately adjacent to ectatic benign ducts. It is clinically relevant since it shares some clinical, microscopical and macroscopical similarities with breast cancer 5. Epidemiology...

Inflammatory carcinoma of the breast

Inflammatory carcinoma of the breast, also referred to as inflammatory breast cancer, is a relatively uncommon but aggressive form of invasive breast carcinoma with a characteristic clinical presentation and unique radiographic appearances. Epidemiology Inflammatory carcinomas account for 1...

Nipple inversion

Nipple inversion is an important finding on mammography and correlation with patient history is essential. When nipple abnormalities such as inversion are identified, it is important for the technologist to document them in the medical record / mammography worksheet so that the radiologist will ...

Common calcifying metastases (mnemonic)

A simple mnemonic to recall a list of commonly calcifying metastases is: BOTOM Mnemonic B: breast cancer O: osteosarcoma T: papillary thyroid cancer O: ovarian cancer (especially mucinous) M: mucinous adenocarcinoma (especially colorectal carcinoma)

Mondor disease (breast)

Mondor disease is a rare benign breast condition characterized by thrombophlebitis of the subcutaneous veins of the breast and anterior chest wall. It can also occur in the axilla, when it is called axillary web syndrome, or the penis. Epidemiology Although Mondor disease is rarely reported i...

Breast MRI

Breast MRI is the most sensitive method (>90%) for the detection of breast cancer, its role in diagnosis and management continues to evolve 13. Terminology Dynamic contrast-enhanced (DCE)-MRI provides information about the morphology and function of a lesion with high sensitivity but moderate ...

Breast lesion localization (mnemonic)

A mnemonic to help remember breast lesion localization when given a set of mammograms in mediolateral oblique (MLO) and 90-degree/true lateral (mediolateral [ML] or lateromedial [LM]) views to predict laterality is: muffins rise and lead falls This can help localize a finding on MLO during dia...

Adenoid cystic carcinoma

Adenoid cystic carcinomas are a rare histological subtype of adenocarcinoma. Pathology Adenoid cystic carcinomas are generally considered low grade 4. The tumors have a notable tendency for perineural spread. Location They have a wide distribution and mainly occur in relation to the airways,...

Accessory breast tissue

Accessory breast tissue, also known as polymastia, is a relatively common congenital condition in which abnormal accessory breast tissue is seen in addition to the presence of normal breast tissue. This normal variant can present as a mass anywhere along the course of the embryologic mammary str...

Breast hamartoma

Breast hamartomas, also known as fibroadenolipomas, are benign breast lesions. They are typified by a "breast within a breast" appearance on mammogram. Epidemiology They typically occur in women older than 35 years of age. Clinical presentation Breast hamartomas most commonly are asymptomat...

Breast implants

Breast implants are increasingly common in general breast radiology practice. Classification Location Breast implants may be placed behind the glandular tissue but in front of the pectoral muscle: subglandular submammary retroglandular retromammary The second position of b...

Breast imaging-reporting and data system (BI-RADS)

BI-RADS (Breast Imaging-Reporting and Data System) is a risk assessment and quality assurance tool developed by American College of Radiology that provides a widely accepted lexicon and reporting schema for imaging of the breast. It applies to mammography, ultrasound, and MRI. This article refle...

Bilateral axillary lymphadenopathy (differential)

Bilateral axillary lymphadenopathy can result from a number of causes and generally implies a systemic process. They include: autoimmune diseases, e.g.: rheumatoid arthritis scleroderma dermatomyositis 5 systemic lupus erythematosus (SLE) psoriasis Sjögren syndrome lymphoma leukemia di...

Gynecomastia

Gynecomastia refers to a benign excess of the male breast tissue, that is usually reversible. It is not a risk factor per se for developing male breast cancer. Epidemiology While it can occur at any age, it tends to have greater prevalence in two groups: adolescent boys and older men (some pub...

Ultrasound evaluation of breast cysts

Ultrasound evaluation of breast cysts is the modality of choice. Obstruction of the ducts, often appearing as the result of epithelial hyperplastic processes or stromal fibrosis, or both processes lead to the formation of cysts, disabling the drainage of the terminal ducts of the lobules. In al...

Fibrocystic change (breast)

Fibrocystic change of the breast (also known as diffuse cystic mastopathy) is a benign alteration in the terminal ductal lobular unit of the breast with or without associated fibrosis. It is seen as a wide spectrum of altered morphology in the female breast from innocuous to those associated wit...

Male breast cancer

Male breast cancer is exceptionally rare and only accounts for less than 0.25% of male malignancies and ~0.5-1% of all breast cancer (both genders). The diagnosis is sometimes delayed due to the patient's hesitancy to seek advice. Workup from a radiological point of view is the same as for women...

Breast cancer metastases

Metastases from breast cancer can be a frequent finding in routine oncoradiological practice. Clinical presentation With the universal use and acceptance of screening mammography, the isolated clinical presentation from metastases from breast carcinoma has become rare in clinical practice. His...

Fat necrosis (breast)

Fat necrosis within the breast is a pathological process that occurs when there is saponification of local fat. It is a benign inflammatory process and is becoming increasingly common with the greater use of breast-conserving surgery and mammoplasty procedures. Epidemiology Most at risk are mi...

Radial scar

Radial scar, or complex sclerosing lesion, is a rosette-like proliferative breast lesion. It is not related to surgical scarring. Some authors, however, reserve the latter term to lesions over 1 cm 5. It is an idiopathic process with sclerosing ductal hyperplasia. Its significance is that it...

Fibroadenoma (breast)

Fibroadenoma is a common benign breast lesion and results from the excess proliferation of connective tissue. Fibroadenomas characteristically contain both stromal and epithelial cells. Epidemiology They usually occur in women between the ages of 10 and 40 years. It is the most common solid b...

Simple breast cyst

Simple breast cysts are a common benign cause of a breast lump in women. Clinical presentation Patients may be asymptomatic or present with a breast lump. Some patients may have associated pain or tenderness. Pathology Breast cysts are caused by blockage of the terminal acini with resultant ...

Breast lump

Breast lumps have different characteristics that allow simplification of differential diagnosis by breaking down the vast list into sections. Consider whether the lump fits into one of these categories. Spiculated lesion Spiculation is a feature of neoplasms and all masses that display spicula...

Poland syndrome

Poland syndrome refers to a congenital unilateral absence of the pectoralis major and minor muscles and is a recognized cause of unilateral hyperlucent hemithorax. Epidemiology Poland syndrome is usually sporadic, although rare familial cases have been described 1. It is rare, with an estimat...

Cowden syndrome

Cowden syndrome, also known as multiple hamartoma syndrome, is characterized by multiple hamartomas throughout the body and increased risk of several cancers. Terminology Type 2 segmental Cowden syndrome is the association of Cowden syndrome with a Cowden nevus when it is considered a type of ...

Breast ductography

Breast ductography (a.k.a. galactography) is an imaging technique which is used to evaluate lesions causing nipple discharge. It helps in precisely locating the mass within breast tissue and gives useful information for surgical approach and planning. Technique A blunt-tipped sialogram needle ...

Brachytherapy

Brachytherapy, also known as sealed source radiotherapy or endocurietherapy, is a form of radiotherapy where a radioactive source is placed, under the guidance of imaging, within or next to the area requiring treatment. This provides localized targeted internal radiation. Brachytherapy has been...

Breast imaging-reporting and data system (BI-RADS) assessment category 6

BI-RADS 6 is one of seven categories of the ACR (American College of Radiology) BI-RADS system and is defined as known biopsy-proven malignancy. This category is used when: imaging is performed post percutaneous biopsy that demonstrated a malignancy but prior to definitive therapy1 imaging dem...

Abscess

Abscesses are focal confined collections of suppurative inflammatory material and can be thought of as having three components 1: a central core consisting of necrotic inflammatory cells and local tissue peripheral halo of viable neutrophils surrounded by a 'capsule' with dilated blood...

Popcorn calcification (disambiguation)

Popcorn calcification refers to amorphous calcifications often with rings and arcs that resemble popped corn kernels. This type of calcification may be seen in many radiological settings including 1: chondroid lesions (e.g. enchondroma, chondrosarcoma) fibrous dysplasia pulmonary hamartomas ...

Non-palpable breast lesions

With increasing use of screening mammography and ultrasound for various indications, a large number of non-palpable breast lesions are being detected. Among this large number of non-palpable masses, not all are malignant. The incidence of malignancy among these non-palpable lesions varies betwe...

Breast ultrasound

Breast ultrasound is an important modality in breast imaging. It is the usual initial breast imaging modality in those under 30 years of age in many countries ref. In assessing for malignancy, it is important to remember that one must use the most suspicious feature of three modalities (patholo...

Stewart-Treves syndrome

Stewart-Treves syndrome refers to an angiosarcoma seen in the setting of lymphedema 1. It was classically attributed to lymphedemas induced by radical mastectomy to treat breast cancer. Nowadays, we know that it can arise in chronically lymphedematous regions of any cause 2. The incidence is ...

Phyllodes tumor

Phyllodes tumor, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumor of the breast which has some resemblance to a fibroadenoma. It is typically a large, fast growing mass that forms from the periductal stroma of the breast 13. Epidemiology Phyllodes tumors account for less t...

Nottingham classification

The Nottingham classification is used at the end of work up of a breast lesion to help guide management. A = malignant lesion needs surgical excision regardless of biopsy result B = indeterminate will accept a benign biopsy result, but only if it is congruent with imaging, i.e. a well circum...

Metastases to the breast

Metastases to the breast from non-mammary primary tumors are uncommon and account for 0.5-2.0% of all breast malignancies. Clinical presentation Metastases do not tend to cause retraction of the skin or nipple. Metastatic lesions are much more likely to be multiple or bilateral than primary c...

Mastitis

Mastitis (rare plural: mastitides) refers to inflammation of the breast parenchyma, of which there are a number of subtypes: acute mastitis puerperal mastitis: occurs usually from infection with Staphylococcus spp. during lactation non-puerperal mastitis: not related to lactation, and occurs ...

Mammography

Mammography is a dedicated radiographic technique for imaging the breast, and the resultant images are known as mammograms. Types of mammography In general terms, there are two types of mammography: screening and diagnostic. Mammography differs significantly in many respects from the rest of ...

Linguine sign (breast)

Linguine sign, also known as the wavy line sign, is one of the imaging signs of intracapsular rupture of a breast implant 4. Pathology After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell. In an intracapsular rupture, the contents o...

Breast neoplasms

Breast neoplasms consist of a wide spectrum of pathologies from benign proliferations, high-risk lesions, precursor lesions, to invasive malignancies. This article provides an overview for radiologists, with a focus on breast cancer. For a summary article for medical students and non-radiologis...

Breast lymphoma

Breast lymphoma refers to the involvement of the breast with lymphoma and may be primary or secondary. Epidemiology Both primary and secondary breast lymphomas are rare. Breast lymphoma accounts for <1% of all breast malignancies and <2% of all extranodal non-Hodgkin lymphoma 11. Secondary lym...

Benign and malignant characteristics of breast lesions at ultrasound

Benign and malignant characteristics of breast lesions at ultrasound allow the classification as either malignant, intermediate or benign based on work published by Stavros et al. in 1995. Radiographic features Ultrasound Malignant characteristics (with positive predictive values) sonog...

Breast cancer (staging)

Breast cancer staging refers to TNM classification of breast carcinomas. The system applies to epithelial malignancies and does not apply to breast sarcomas, phyllodes tumor, or breast lymphomas. The following article reflects the 8th edition manual published by the American Joint Committee on C...

5-tier ACR system of radiologic breast findings

The 5-tier ACR system was a previously used system for classification of radiologic breast findings, proposed by the American College of Radiology (ACR). It is no longer in widespread use, having been gradually superseded by the 6-tier BI-RADS classification system first published in 1992. Inter...

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