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...
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 It is no longer in widespread use, having been gradually superseded by the 6-tier BI-RADS classification system first published in 1992.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...
Aberrations in the Normal Development and Involution of the breast (ANDI) is an all-encompassing term that is used to describe a wide spectrum of the benign breast diseases. As the name suggests, it is based on the theory that most of the encountered benign breast disorders are essentially minor...
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 vessel...
Accessory breast tissue 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 streak (axilla to the inguinal...
Adenoid cystic carcinomas are a rare histological subtype of adenocarcinoma.
Adenoid cystic carcinomas are generally considered low grade 4. The tumours have a notable tendency for perineural spread.
They have a wide distribution and mainly occur in relation to the airways...
Adenoid cystic carcinoma (ACC) of the breast is a rare subtype of breast cancer.
They account for only 0.1-0.4% of all breast cancers.
The tumour demonstrates a strikingly characteristic microscopic pattern similar to that of adenoid cystic carcinoma of the salivary gl...
Adenomatous breast lesions are benign tumours which grow from glandular parenchyma. The breast is a conglomeration of various glandular tissues, hence they can be of several types.
apocrine adenoma of breast
pleomorphic adenoma of breast
Adenosis of the breast is a benign lobulocentric proliferative process in which lobules are enlarged and increased in number in addition to an increased number of glands within each lobule.
Pathologically subclassified into three main subtypes which include:
sclerosing adenosis of the breast
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...
Mammographic screening detects early breast cancers and thereby reduces potential mortality. However, its sensitivity is inversely related to breast density 1.
Altered density between two mammograms can arise in a number of situations:
Affecting both breasts:
interval commencement/cessation ...
Amastia is a rare congenital condition characterised by the absence of breast tissue, nipple and areola. This may occur unilaterally or bilaterally.
During embryological development, breasts first appear as ectoderm ridges during the 6th week of gestation. This ridge grows thicker an...
Amazia is a rare congenital condition defined by the absence of glandular parenchyma in either one or both of the breasts and a normal nipple and areola complex.
This is a very rare entity and the true prevalence is not known. Although there are strict definition criteria, the di...
Amorphous calcifications, previously known as indistinct calcifications, are a morphological descriptor for breast calcifications that are small and/or hazy such that no clearly defined shape/form can be ascribed.
Many benign and malignant conditions may be seen in association with ...
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
Breast angiosarcomas are a rare vascular breast malignancy.
As primary tumours of the breast, they account for ~0.04% 2 of all breast cancers and tend to occur in younger women, in their 3rd to 4th decades.
Secondary angiosarcoma, related to prior therapy of breast cancer, has an...
Apocrine carcinoma of the breast is a rare variant of breast cancer. The diagnosis is mainly pathological as it is difficult to differentiate from other forms of breast cancer on imaging.
It accounts for about 4% of all cases. It is seen most often in females in the age group of 5...
Apocrine metaplasia of the breast is a benign breast condition and is sometimes considered part of or associated with fibrocystic change. It is a common finding in the female breast, particularly after the age of 25, and many regard it as a normal component of the breast.
Artifacts that mimic breast calcification can arise from a number of external sources of radiopaque material that leave particulate residue on or within the skin. These include:
deodorants/antiperspirants, particularly solid applicator products 1
powders, such as those containing talc 2,3
Asymmetry in breast size can arise from a number of factors.
Breasts are rarely absolutely the same size or volume. Normal variation is common. Most females have slight discrepancies in breast size. Asymmetric progressive breast enlargement is unusual but known. The role of the breas...
Asymmetries in mammography represents a spectrum of morphological descriptors for a unilateral fibroglandular-density finding seen on one or more mammographic projections that does not meet criteria for a mass. The term refers to a density finding and should not be confused with asymmetry in bre...
Atypical ductal hyperplasia (ADH) is a histologically borderline lesion that has some, but not all the features of ductal carcinoma in situ (DCIS). Sometimes the distinction between ADH and DCIS is simply on the basis of the number of ducts involved.
Atypical ductal hyperplasia is a...
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.
It is usually asymptomatic and mammographically occult and is in...
An automatic full-field volumetric breast ultrasound scanner (AFFBUS) is a developing technology which was initiated to overcome the drawback of dense breast and to get a three-dimensional view of the breast.
Automatic ultrasound imaging ac...
The axillary lymph nodes (LN), also known commonly as axillary nodes, are a group of lymph nodes in the axilla and receive lymph from vessels that drain the arm, the walls of the thorax, the breast and the upper walls of the abdomen.
There are five axillary lymph node groups, nam...
An axillary view (also known as a "Cleopatra view“) is a type of supplementary mammographic view. It is an exaggerated craniocaudal view for better imaging of the lateral portion of the breast to the axillary tail. This projection is performed whenever we want to show a lesion seen only in the a...
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...
Balloon breast brachytherapy (BBB) is a technique for delivering radiation treatment in women with early-stage breast cancer. It is given after lumpectomy, or surgical removal of a small breast neoplasm, and is a shorter alternative to the more traditional method of external beam radiation for s...
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.
Malignant characteristics (with positive predictive values)
Bilateral axillary lymphadenopathy can result from a number of causes and generally implies a systemic process. They include:
autoimmune diseases, e.g.:
systemic lupus erythematosus (SLE)
Borderline breast disease (BBD) refers to a group of conditions while being not completely malignant are still concerning. Usually an excision biopsy is recommended if entities falling into borderline breast disease is detected on core biopsy.
These entities include:
atypical ductal hyperplasi...
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.
Brachytherapy has been used to treat:
breast cancer (ofte...
The breast is an apocrine gland seen in both males and females. However, in females it has a specific function which is the production of milk.
The breast has an inhomogeneous structure which is predominantly composed of adipose tissue and glandular tissue. In additi...
A breast abscess is a relatively rare but significant complication of mastitis that may occur during breastfeeding, particularly in primiparous women. The clinical context is a key to diagnosis as imaging appearances (particularly ultrasound) can mimic many other entities such as breast carcinom...
Amyloid deposition in the breast occurs predominantly in two forms
breast involvement in primary amyloidosis - commoner
in association with other conditions like multiple myeloma, plasmacytosis and rheumatoid arthritis and another in the localised form which is rarer.
Breast aneurysms are a rarely seen cause of a breast mass.
true aneurysm: occurs post trauma and is seen as a slowly enlarging pulsatile mass
false aneurysm / pseudoaneurysm: occurs in acute trauma, post percutaneous biopsy, due to spontaneous haemorrhage secondary to coagulo...
Breast architectural distortion is a descriptive term in breast imaging (mammography, ultrasound, and MRI) to indicate that the breast parenchyma is tethered or indented. The finding per se is not a mass.
Architectural distortion is often due to a desmoplastic reaction in which there...
Breast calcifications are deposits of calcium salts in the breast, which are radio-opaque on mammography. The majority are benign, but they can be associated with cancer. The ability to diagnose and appropriately manage the significant microcalcifications and differentiate them from innocuous fi...
An approach to breast calcifications in terms of imaging evaluation and biopsy aims to distinguish benign from malignant aetiologies. This article overviews a general approach to the evaluation of breast calcifications. The types and descriptors of calcifications are detailed separately: breast ...
Metastases from breast cancer can be a frequent finding in routine oncoradiological practice.
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...
Breast cancer staging refers to TNM classification of breast carcinomas. The system applies to epithelial malignancies and does not apply to breast sarcomas, phyllodes tumour, or breast lymphomas. The following article reflects the 8th edition manual published by the American Joint Committee on ...
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 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 oedema, swelling and redness of the involved breast
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.
The breast curriculum is one of our curriculum articles and aims to be a collection of articles that represent core breast knowledge.
Topics pertaining to the breast.
An understanding of the anatomy of relevant structures is essential. Core anatomical topics include:
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...
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.
There are four descriptors for breast density on mammography in the 5th edition of BI-RADS 1,2:
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.
A blunt-tipped sialogram needle ...
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
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...
Breast haematoma can result from preceding direct trauma, surgery, biopsy (rare) or contusion and can be easily misinterpreted as other lesions such has breast malignancy if the correct clinical context is not taken into account. They can rarely occur spontaneously, especially in those with coag...
Breast hamartomas, also known as fibroadenolipomas, are benign breast lesions. They are typified by a "breast within a breast" appearance on mammogram.
They typically occur in women older than 35 years of age.
Breast hamartomas most commonly are asymptomat...
Breast hypoplasia is a condition which is characterised by underdevelopment of the breast. Breast hypoplasia can be congenital or acquired.
congenital adrenal hyperplasia
Breast screening and diagnostic programmes cannot exist without the technologists. They play an indispensable role in the acquisition of mammogram and ultrasound images in both screening and diagnostic settings.
The mammogram technologist: the primary responsibility of the "mammo tech" is the ...
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...
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...
A BI-RADS 1 category under the breast imaging reporting and data system is when no finding is present in an imaging modality (not even a benign finding).
BI-RADS 2 is a benign category in the breast imaging reporting and data system. A finding placed in this category should have a 100% chance of being benign.
Examples of such lesions or findings include:
multiple secretory calcifications
fat-containing lesions such as...
BI-RADS 3 is an intermediate category in the breast imaging reporting and data system. A finding placed in this category is considered probably benign, with a risk of malignancy between 0% and 2%.
BI-RADS 3 should not be utilised in the screening setting. It should be reserved for ...
A BI-RADS 4 lesion under the breast imaging-reporting and data system refers to a suspicious abnormality. BI-RADS 4 lesions may not have the characteristic morphology of breast cancer but have a definite probability of being malignant. A biopsy is recommended for these lesions. If possible, the ...
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...
BI-RADS 6 is an assessment category of the ACR (American College of Radiology) BI-RADS system.
Patients with biopsy-proven cancer prior to definitive therapy would be category 6.
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.
The entity is rare, with a reported prevalence of between 0.3 in 100,000 to 1 in 1,000 women with...
Breast implant ruptures are a recognised complication of a breast implant. It can be intracapsular, when confined by the surrounding fibrous capsule, or extracapsular, when silicone freely extravasates.
After implantation of a silicone or saline breast implant, a fibrous capsule (sc...
Breast implants are increasingly common in general breast radiology practice.
Breast implants may be placed behind the glandular tissue but in front of the pectoral muscle:
The second position of breast implants ...
A mnemonic to help remember breast lesion localisation 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 localise a finding on MLO during dia...
Breast lipomas are a benign breast lesion and is classified as a BIRADS II lesion.
Lipomas are mostly asymptomatic and coincidentally discovered on routine mammography. Patients may present with a painless palpable breast lump which is soft and mobile. In these cases the ...
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.
Spiculation is a feature of neoplasms and all masses that display spicula...
Breast lymphoma refers to the involvement of the breast with lymphoma and may be primary or secondary.
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...
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...
Breast MRI is the most sensitive method for detection of breast cancer. Depending on international health regulations, it is either applied for screening of women at high risk for developing breast cancer (e.g. BRCA1 and BRCA2 carriers), as an additional diagnostic test in pretherapeutic breast ...
Following administration of Gadolinium there can be three possible enhancement kinetic curves for a lesion on breast MRI (these are also applied in other organs such as prostate MRI). These are sometimes termed the Kuhl enhancement curves.
type I curve: progressive enhancement pattern
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 nonradiologist...
Breast sarcoma refers to a relatively heterogenous group of rare breast tumours which can include:
angiosarcoma of the breast
pleomorphic sarcoma of the breast
fibrosarcoma of the breast
myxofibrosarcoma of the breast
leiomyosarcoma of the breast
primary osteosarcoma of the breast
Breast screening programs are programs where mammography or other screening methods are carried out in populations of asymptomatic women for the improved detection of breast cancer.
Such programs vary widely from country to country. The WHO recommends implementing different programs based on th...
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.
The two terms, breast sebaceous cys...
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.
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...
Breast varix is, as the name suggests, varices in the breast that are focally dilated veins in the breast.
If varices are seen bilaterally then a cause for central venous obstruction (superior vena cava syndrome) could be the underlying aetiology with the varices being a part of the...
Breast venous malformations (also known as breast haemangiomas) 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 o...
The breast within a breast sign refers to the common mammographic appearance of breast hamartomas (fibroadenolipomas). Since these benign lesions are well-circumscribed and contain a mixture of fibrous, glandular and fatty tissue (just like normal breast), it is not surprising that they appear v...
The bullseye view is designed for better evaluation of lesion located in retroareolar area. In this view, the nipple-areola complex are directed upward or downward on the detector surface to visualise the areolar and periareolar region en face, allowing characterisation of lesions in this area.
Carcinoma antigen 15-3, usually shortened to CA 15-3 is a tumour 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 metastasisation of cancer cells.
MUC-1 is a normal epith...
Calcific axillary lymphadenopathy is in general, more concerning than axillary lymphadenopathy alone and is particularly so if it contains microcalcifications. While this is concerning for malignancy, it can also occur from occasional nonmalignant causes
metastatic axillary lymp...
Capsular contractures are a potential complication of a breast implant and refers to a tightening and hardening of the capsule that surrounds a breast implant. It is a condition that can distort the shape and cause pain in the augmented breast. It seems to be the commonest complication post-brea...
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...
The causes of breast oedema can be remembered using the mnemonic:
V: venous obstruction
I: inflammatory breast cancer
L: lymphatic obstruction
S: surgery (recent), secondaries 2
Cavernous venous malformation, also traditionally referred to as a cavernous haemangioma (despite it not being a tumour) or cavernomas, are non-neoplastic slow flow venous malformations found in many parts of the body.
Despite the ubiquity of use of the traditional terms cavernoma...
Chassaignac bursa (also known as the retromammary bursa, submammary serous bursa or occasionally Chassaignac bag) is the space behind the breast, lying between the pectoralis fascia posteriorly and deep layer of superficial fascia anteriorly.
It contains loose connective tissue and aids in mobi...
The new pathological classification of DCIS 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 cytologic criteria; this is...
A cleavage view (also called "valley view") is a mammogram view that depict the posteromedial portion of both breasts (the “valley” between the two breasts) by placing them on the cassette at the same time and pulling them anteriorly.
Manual technical factors should be used.
A cleavage view m...
Clothing artifacts, like jewellery artifacts, are a regular feature on imaging examinations, especially plain radiographs, but in general are recognised for what they are, either at the time the image is taken by the radiographer, or later by the reporting radiologist. The radiographer will ofte...
Clustered microcysts, or a microcystic cluster, refer to part of the spectrum of cystic change in the breast on ultrasound. They are part of aberrations in development and involution of the breast.
These lesions have no malignant potential 1,2.
These lesions a...