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 metastasise.
The detection of...
A ductal adenoma of the breast is a benign glandular tumour of the breast that usually fills and distends the ductal lumen.
They may occur in women of all ages, although the majority of patients are 60 years of age or greater 3.
Ductal adenomas usually pres...
Diabetic mastopathy is a condition characterised by the presence of a benign tumour like breast masses in women with long-standing type 1 or type 2 insulin-dependent diabetes. The condition has also been reported in men.
Diabetic mastopathy manifests clinically as a large...
Vascular calcifications in the breast are calcifications associated with blood vessels.
They are most often seen in post menopausal women with arteriosclerotic heart disease.
Results due to calcified atherosclerotic plaques in the arterial walls.
A comedo-type ductal carcinoma in situ, also known as comedocarcinoma in situ is the high grade subtype of ductal carcinoma in situ (DCIS). It completely fills and dilates the ducts and lobules in TDLU with plugs of high grade tumour cells with central necrosis "comedonecrosis".
It is the mos...
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...
Complex fibroadenoma is a sub type of fibroadenoma harbouring one or more of the following features:
papillary apocrine metaplasia
sclerosing adenosis and
cysts larger than 3 mm
Complex fibroadenomas tend to occur in older patients (median age, 47 ye...
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...
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...
Pseudoangiomatous stromal hyperplasia (PASH) is a benign, relatively uncommon form of stromal (mesenchymal) overgrowth within breast tissue that derives from a possible hormonal aetiology.
Typically affects women of reproductive age. It rarely affects males.
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 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 lymphoma refers to involvement of the breast with lymphoma and may be primary or secondary.
Both primary and secondary breast lymphoma are rare accounting for ~ 0.5% (range 0.3-1.1%) of all breast malignancies.
Breast lymphoma may present either as a...
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 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 hamartoma (also known as a fibroadenolipoma) is a benign breast lesion.
They typically occur in women older than 35 years of age.
While it can present as a painless soft lump, it may also present as unilateral breast enlargement without a palpable l...
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 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
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...
Amyloid deposition in the breast is predominantly of 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.
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...
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...
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...
The tent sign is a term referring to a characteristic appearance of the posterior edge of the breast parenchyma when a mass (usually an infiltrating lesion) causes its retraction and forms an inverted "V" that resembles the tip of a circus tent.
The detection of a "tent sign" is facilitated by ...
The stepladder sign is a sonographic sign indicating an intracapsular breast implant rupture. It is considered the most reliable ultrasonographic finding in silicone gel breast implant intracapsular rupture. It is identified as multiple, discontinuous, parallel, linear echoes in the lumen, and i...
Stepladder sign may refer to:
intracapsular breast implant rupture (ultrasound)
gas-fluid levels in obstructed small bowel (erect abdominal radiograph)
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, such as:
Invasive ductal carcinoma is a subset of ductal carcinoma. It is an infiltrating, malignant and abnormal proliferation of neoplastic cells in the breast tissues. It is the most frequently seen breast malignancy.
Peak age of presentation is about 50 to 60 years.
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)
Albert Salomon (1883-1976) was the first physician to study x-rays of breast tissue.
Salomon worked at the Royal Surgical University Clinic in Berlin and from about 1913 x-rayed 3000 breast specimens obtained from the morgue in an attempt to identify breast pathology. He demonstrated tumour sp...
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.
Montgomery glands are large sebaceous glands in the breast, representing a transition between a mammary gland and a sweat gland.
Located within the nipple-areolar complex, Montgomery glands open onto the skin surface via protrusions on the skin known as Montgomery tubercles. They...
In breast imaging, forbidden, check or review areas are zones that, according to Tabár, require special attention in mammographic interpretation.
on a mediolateral oblique (MLO) view
the "milky way" (retromammary fat): a 3-4 cm wide band parallel to the edge of the pectoral muscle...
Salad oil sign, also referred to as the droplet sign, is characterised by small rounded high T2 signal foci within a breast implant on MRI studies and represents water droplets or small amounts of air within the silicone. It also can be characterised as hypointense foci on the water-suppressed s...
Gynaecomastia 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.
While it can occur at any age, it tends to have greater prevalence in two groups: adolescent boys and older men (some pu...
Stewart-Treves syndrome refers to an angiosarcoma seen in the setting of lymphoedema 1.
It was classically attributed to lymphoedemas induced by radical mastectomy to treat breast cancer. Nowadays, we know that it can arise in any chronically lymphoedematous region due to any cause2.
The posterior nipple line (PNL) refers to a line drawn posteriorly and perpendicularly from the nipple towards the pectoral muscle (or the posterior image edge in CC) on the mammograms. In an adequately positioned breast, the measurement difference of this line between a CC view and MLO view sho...
A complex breast cyst is a morphological type of breast cyst along with simple breast cysts and complicated breast cysts. The current preferred term for complex breast cysts is solid and cystic mass to avoid confusion with a complicated cyst.
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...
Ultrasound evaluation of breast cysts is the modality of choice. Obstruction of the ducts, often appearing as the result of epithelial hyperplastic processes or the stromal fibrosis, or both processes lead to the formation of cysts, disabling the drainage of the terminal ducts of the lobules.
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.
In assessing for malignancy, is important to remember that one must use most suspicious feature of 3 modalities (pathology, ultrasound,...
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 cysts are a relatively common cause of a breast lump in perimenopausal women, and usually causing wage pain or discomfort and slightly tender on palpation. They are a benign (BIRADS II) entity.
Breast cysts are caused by blockage of the terminal acini with resultant dilatation...
A simple mnemonic to recall a list of commonly calcifying metastases is:
B: breast cancer
T: papillary thyroid cancer
O: ovarian cancer (especially mucinous)
M: mucinous adenocarcinoma (especially colorectal carcinoma)
Feel free to edit this page however you want, if you want to just play and see how editing works.
words after bullets should not be capitalised unless they represent a name, e.g. Churg-Strauss syndrome will have "C" and "S" as ...
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...
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...
Oil cysts in breast imaging refer to benign breast lesions where an area of focal fat necrosis becomes walled off by fibrous tissue.
Occurs across all age and ethnic groups with a female predilection. Usually associated with blunt trauma if present in males.
A metastatic intramammary lymph node refers to an intramammary lymph node involved with metastatic or malignant disease.
Sonographic features that suggest metastatic involvement include 4:
disappearance or loss of central echogenic hilar region
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc. may also be visible
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)
work in progress - Fran/Derek
UK interpretation/system to guide investigation (2008)
Paget disease can refer to either:
Paget disease of bone
Paget disease of breast
History and etymology
Both conditions are named after Sir James Paget (1814-1899), British surgeon and physiologist.
The breast MRI classification flowchart (or Tree algorithm) is an evidence-based clinical decision rule to distinguish benign from malignant lesions in breast MRI. It incorporates five diagnostic criteria that are mainly consistent with BI-RADS though assigning diagnostic weights.
Breast echotexture according to the BI-RADS lexicon is usually classified into three categories 1:
PGMI (Perfect, Good, Moderate, Inadequate) is a method of evaluation of clinical image quality in mammography developed by the United Kingdom Mammography Trainers Group with the support of the Royal College of Radiographers, aimed to ensure the maintenance of a high standard of mammography in Br...
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...
There are many types of breast neoplasms, which can be divided into the following broad oversimplified categories as a starting point.
intra-lobular (epithelial and stromal)
metastasis to breast
Intralobular and interlobular refer to the terminal duct lobular ...
BIRADS V lesions under the BIRADS (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). BIRADS V lesions have the characteristic morphology of breast canc...
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...
Inflammatory carcinomas of the breast also referred as inflammatory breast cancers, are a relatively uncommon but aggressive form of invasive breast carcinoma which has a characteristic clinical presentation and unique radiographic appearances.
Inflammatory carcinomas account f...
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.
Patients usually present with a painless breast lump occurring over weeks to months....
Medullary carcinoma of the breast (MCB) is an uncommon subtype of breast cancer and accounts for ~5% 1,4 of all breast cancers.
They tend to occur more frequently in younger women than other breast cancer types 7. The mean age of presentation varies from 46-54 years but in 10% of ...
Architectural distortion is a mammographic descriptive term in breast imaging. It may be visualised as tethering or indentation of breast tissue.
Architectural distortion per se is not a mass. It is often due to a desmoplastic reaction in which there is focal disruption of the normal...
Asymmetrical mammographic density is a mammographic morphological descriptor. It is given when there is increased density in one of the breasts, on either one or both standard mammographic views but without evidence of a discrete mass. An asymmetrical density can be further characterised as:
Milk of calcium (MOC) is a term given to dependent, sedimented calcification within a cystic structure or hollow organ. This sort of colloidal calcium suspension layering can occur in various regions:
renal cysts: milk of calcium in renal cyst (most common)
breast cysts: milk of calcium in bre...
The pectoralis major muscle is a muscle of the pectoral region, overlying the anterior chest wall but is considered an upper limb muscle due to its function.
sternal part: sternum and superior six costal cartilages
clavicular part: medial half of the clavicle
A handy mnemonic to recall the causes of a stellate breast lesion is:
S: summation shadow
T: tumour (i.e. invasive breast cancer)
R: radial scar
F: fibroadenoma / fat necrosis
A: adenosis (sclerosing)
CE: other causes, haematoma (e.g. postoperative, post bio...
The causes of breast oedema can be remembered using the mnemonic:
V: venous obstruction
I: inflammatory breast cancer
L: lymphatic obstruction
S: surgery (recent)
A mnemonic to help remember breast lesion localisation when given a set of mammograms (MLO and CC) is:
muffins rise and lead falls
This can help localise the lesion into the quadrant (e.g. upper, outer) to make ultrasound correlation easier.
muffins rise: if the lesion is located me...
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...
Breast cancer staging uses the TNM staging system and then into stage groupings.
Primary tumour (T)
Tx: primary tumour cannot be assessed
T0: no evidence of primary tumour
Tis: carcinoma in situ
T1a: 0.1-0.5 cm
T1b: 0.5-1.0 cm
T1c: 1.0- 2.0 cm
T2: 2-5 cm
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.
Mammography is a dedicated radiographic technique for imaging the breast.
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 diagnostic imaging.
Phyllodes tumour, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumour 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.
Phyllodes tumours account for less t...
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
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.
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 has an estimated incidence of ~0.09-0.16% and occur...
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...
The presence of skin thickening on mammography is variably defined, usually being more than 2mm in thickness. It can result from a number of both benign and malignant causes. They include:
inflammatory breast cancer: one of the most concerning causes of skin thickening: this usually ...
Punctate microcalcifications in the breast are defined as calcific opacities <0.5 mm in diameter seen within the acini of a terminal duct lobular unit.
rarely in DCIS: punctate, clustered, segmentally distributed
Seromas are collections of serous fluid that usually occur as a complication of surgery, but can also be seen post-trauma. It is most commonly associated with post-breast surgery, where a potential space is left.
Seromas are distinct from a haematoma as it contains almost no red bl...
Popcorn calcification in the breast is the classical description for the calcification seen in involuting fibroadenomas which, as the name suggests, has a popcorn-like appearance.
A fibroadenoma in the long run may degenerate and calcify. Initially there are a few punctate periphera...
Eggshell calcifications in the breast are benign peripheral rim like calcifications
They are typically secondary to fat necrosis or calcification of oil cysts.
thin rim-like calcification (<1 mm in thickness)
small to several centimetres in di...
Intraductal papillomas, or more specifically solitary intraductal papillomas of the breast, are benign breast lesions. Papillomas are the most common intraductal mass lesions of the breast.
Typically present in women in their late reproductive or postmenopausal years (with an aver...
Each breast lobe is drained by a collecting duct terminating in the nipple. The collecting duct has several branches, which ends in a terminal ductal-lobular unit (TDLU), the basic functional and histopathological unit of the breast. The TDLU is composed of a small segment of the terminal duct a...
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...
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 artefact or a true mass and for precisely localizing t...
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.
Most at risk are mi...
Triangulation is a technique for determining if a questionable structure is genuine or superimposition of structures.
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 les...
The nipple areolar complex is a major anatomic landmark of the breast. It may be affected by variation in its embryological development, breast maturation and also by other benign and malignant conditions.
nipple retraction or inversion
Artifacts that mimic breast calcification can arise from a number of sources. These include:
deodorants on skin: most practices recommend that clients for mammography do not use deodorant or perfume on the day of the study for this reason. The residue from deodorant is a very fine, dense, misty...
Breast density on mammography can significantly vary between individuals. The density is a function of the relationship between radiolucent fat and radiodense glandular tissue.
Breast density varies with age and generally younger women have denser breasts (i.e. more glandular tissue relative to...