The subcapsular line sign is a small localised 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.
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...
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.
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 haematoma as they contain almost ...
There are many types of breast neoplasms, which can be divided into the following broad oversimplified categories as a starting point.
intralobular (epithelial and stromal)
metastasis to breast
Intralobular and interlobular refer to the terminal duct lobular un...
Male breast disease includes a wide spectrum of conditions. Many conditions and entities that affect the female breast may also affect the male breast.
male breast cancer
pseudogynaecomastia: fat deposition within the...
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...
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...
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 ...
Cowden syndrome, also known as multiple hamartoma syndrome, is characterised by multiple hamartomas throughout the body and increased risk of several cancers.
Type 2 segmental Cowden syndrome is the association of Cowden syndrome with a Cowden naevus, when it is considered a type o...
Metastases from breast cancer can be a frequent finding in routine onco-radiological 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. Hi...
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...
Metastases to the breast from non-mammary primary tumours are uncommon and account for 0.5-2.0% of all breast malignancies.
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 ...
The term milk of calcium (MOC) is 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: milk of calcium in renal cyst (most common)
breast: milk of calcium in breast cyst
This article lists examples of normal imaging of the breast and surrounding structures, divided by region and modality.
MLO and CC (standard mammographic views)
lateral: example needed
compression: example needed
cleavage view: example
axillary lymph n...
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 could be targeted.
This article is general discussion of the...
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 impla...
Eklund modified compression technique is a technique which can be used for patients with augmented or reconstructed breasts post mastectomy.
It consists of posterosuperior displacement of the implants simultaneously to an anterior traction of the breast, pushing the implants towards...
Mammographic density is considered a risk factor for breast cancer, and parenchymal patterns in breast imaging are important in the way in which the effects mammographic screening sensitivity. Women with high-risk density patterns should be screened more frequently and/or with additional views p...
BI-RADS classification is proposed by the American College of Radiology (ACR), last updated in November 2015, and is a widely used classification system at the time of writing this article (July 2016).
The BI-RADS acronym stands for Breast Imaging-Reporting and Data System which is a widely acc...
BI-RADS VI is a new addition to the ACR (American College of Radiology) BI-RAD system. The prior classification system was a 5-tier system. The current system is a 6-tier system.
According to the current BI-RADS tier, patients with biopsy proven cancer prior to definitive therapy would be categ...
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.
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...
Breast calcifications are relatively frequent on mammograms and are indicative of focally active process, however about 80% of these processes are benign. Thus the ability to distinguish these calcifications based on their morphological characteristics, size, number and distribution is important...
Granulomatous mastitis is a very rare breast inflammatory disease of unknown origin that can clinically mimic carcinoma of the breast.
The condition generally manifests as a distinct, firm to hard mass that may involve any part of the breast. The subareolar regions may be...
Sclerosing adenosis (SA) is a benign proliferative condition of the terminal duct lobular units characterised 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 ...
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...
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 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 ...
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...
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
Inflammatory carcinomas of the breast also referred as inflammatory breast cancers, are a relatively uncommon but aggressive form of invasive breast carcinoma with a characteristic clinical presentation and unique radiographic appearances.
Inflammatory carcinomas account for 1-...
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.
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...
Gigantomastia (also known as macromastia or mammomegaly) is the term employed when there is massive breast enlargement. It is often associated with pregnancy. It may be rarely unilateral.
Gigantomastia is a very common condition characterised by proliferation of either breast fatty tissue or gl...
The sternalis muscle is an uncommon anatomic variant of the chest wall musculature and is of uncertain aetiology and function. Its importance lies in that it should not be mistaken for a pathological lesion.
Cadaveric studies have shown that the muscle is present in ~5% (range 1-...
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...
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...
Triple receptor-negative (TRN) breast cancer is a subtype of breast cancer characterised by a relative absence of immunohistochemical staining for the following hormone receptors/protein:
oestrogen receptor (OR)
progesterone receptor (PR)
human epidermal growth factor receptor 2 (HER2/neu)
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 ...
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 ...
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...
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. A similar condition is lymphocytic mastitis but this occurs in non-diabetic...
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.
Skin calcifications in the breast usually form in dermal sweat glands after low grade folliculitis and inspissation of sebaceous material. Calcifications may also form in moles and other skin lesions. Often, these calcifications are in groups as they extend into small glands in the skin. Occasi...
Sclerosing papillomas of the breast are a sub type of intraductal papilloma of breast. It is termed when a papillary lesion form well-defined solid masses with a dominant sclerosed architecture 2. It is usually a histological diagnosis and usually cannot be differentiated from a non sclerosing p...
Sclerosing lobular hyperplasia (SLH) of the breast, also known as fibro-adenomatoid mastopathy, is an uncommon benign proliferative breast lesion.
It tends to occur more often in adolescent and young adult patients (peak age in the thirties). In the United States, there may be a g...
Scirrhous carcinoma of the breast is a pathological subtype of breast cancer. It is a subtype of invasive ductal carcinoma not otherwise specified and presents as a hard lump. The proportion of pathologic lymph node metastasis among scirrhous carcinomas is significantly higher than that among ca...
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
Subareolar breast abscess are relatively uncommon and tend to occur mostly in young women.
Mastalgia, signs of inflammation, lump formation in the subareolar region and nipple discharge. In chronic cases fistula formation and nipple deformity may be seen.
Primary osteosarcoma of the breast is an uncommon breast malignancy and is a sub type extraskeletal osteosarcoma.
While it can present in a wide are group, the peak age at presentation is around the 6th decade 7.
The presence of bone in breast lesions is not diagnosti...
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...
Puerperal mastitis refers to mastitis occurring during pregnancy and lactation.
It occurs most often during breast feeding and is rarely encountered during pregnancy.
The source of infection is the nursing infants nose and throat; the organisms being Staphylococcus aur...
Plasma cell mastitis is a benign breast condition which represents calcification of inspissated secretions in or immediately adjacent to ectatic benign ducts.
It is typically seen in older women (e.g. >60 years of age).
It is thought to represent aseptic inflammation ...
Snowstorm sign on breast ultrasound imaging represents the presence of free silicone droplets mixed with breast tissue giving a characteristic heterogeneous echogenic appearance with the dispersion of the ultrasound beam. It is considered the most reliable sign of extracapsular breast implant ru...
Suture calcification in breast can be seen after a lumpectomy and/or radiation therapy. It is theorised that tissue damage from radiation therapy delays the resorption of the suture. The residual suture material is thought to act as a nidus for calcification.
Synchronous breast cancers are two (or more) primary breast cancers that occur in either breast at the same time.
Up to 10% of all breast cancers may be synchronous (particularly found with the use of breast MRI). The occurrence of bilaterality is greatest with invasive lobular c...
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...
Dystrophic calcifications within the breast are usually seen as small macrocalcifications with relatively smooth margins.
They are generally considered benign and can occur in a number of situations which include:
evolving mammary fat necrosis
post reduction mammoplasty 2
Lactating adenomas are a benign breast tumour that typically occur in the peri-partum period, and are one of the most prevalent breast lesions during puerperium 4.
Lactating adenomas commonly present as painless breast masses late in pregnancy or in the postpartum period....
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...
Papillary carcinoma of the breast is a rare ductal breast malignancy.
They are thought to account for 1-2% of breast carcinomas 2. They typically present in postmenopausal patients with the mean age at being ~63-67 years.
A papillary carcinoma may manifest ...
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 characterised by infiltration of the nipple epidermis by malignant cells. Although most cases have underlying focus or foci of in situ or invasive carc...
Lobular carcinoma in situ (LCIS) represents the next step up from atypical lobular hyperplasia (ALH) along the malignant spectrum of lobular breast carcinoma.
LCIS occurs predominantly in premenopausal women with a mean age of 45 years old, approximately 10-15 years younger than t...
Lobular breast carcinoma is a subtype of breast cancer can range from lobular carcinoma in situ (LCIS) to invasive lobular carcinoma.
Multicentricity and bilaterality tend to be quite common with lobular breast carcinomas.
The supraclavicular lymph nodes are a paired group of lymph nodes located on either side in the hollow of clavicle close to the sternoclavicular joint. It is the final common pathway of the lymphatic system as it joins the central venous system. They oversee the transport of lymph from the thora...
The term recurrent breast cancer in medical imaging is given to recurrence of malignancy within the same breast at or close to the resection bed more than two years following surgical excision.
The rate of local recurrence may be as high as 19% in 10 years. The maximum for recurre...
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...
Infiltrating or invasive lobular carcinoma (ILC) of the breast is the second most common type of invasive breast cancer after invasive ductal carcinoma (IDC) "not otherwise specified" (NOS).
They represent 5-10% of all breast cancer. The mean age at presentation may be higher than...
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.
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...
An intracystic papillary carcinoma of the breast is a type of papillary carcinoma of the breast. It accounts for a significant proportion of intracystic breast cancers.
As with papillary carcinomas in general, it tends to occur in postmenopausal women.
Intracystic carcinoma of the breast refers to a breast cancer located within a cyst.
They represent ~0.2-1.3% of all breast cancers.
Often they tend to represent papillary breast cancer 2:
intracystic papillary breast carcinoma (ICPC)
cystic degeneration of ductal c...
Juvenile papillomatosis (JP) of the breast is a relatively common benign localised proliferative lesion in the breast.
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.
A juvenile fibroadenoma of the breast is a term given to a fibroadenoma presenting in children or adolescents. These may account for ~0.5-2% of all fibroadenomas, and are rapidly-growing masses that cause asymmetry of the breast, distortion of the overlying skin, and stretching of the nipple.
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...
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.
Non-comedo type ductal carcinoma in situ is a subgroup of ductal carcinoma in situ (DCIS). This group comprises of relatively less aggressive types with low nuclear grade. It can have has multiple patterns which are often mixed:
cribriform type non-comedo DCIS
micropapillary type non-comedo D...
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...
Nevoid hyperkeratosis of the nipple and the areola (NHNA) is a rare, idiopathic and benign dermatological condition.
Most often seen in females of reproductive age, especially during 2nd and 3rd decades of life. Less than 70 cases have been reported till now.
Pseudogynaecomastia refers to breast enlargement in men primarily due to fatty tissue but with no associated glandular or stromal tissue.
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.
It tends to occur in older women where a prevalence of as much as 7% is found among women 75 ye...
Mondor disease is a rare benign breast condition characterised by thrombophlebitis of the subcutaneous veins of the breast and anterior chest wall.
Although Mondor disease is rarely reported in the literature, this is likely in part due to lack of awareness of the entity. It tends...
Breast involvement in granulomatosis with polyangiitis is seen in patients with avid systemic manifestations.
Clinically they can mimic carcinoma as a palpable, tender mass.
Granulomatosis with polyangiitis (or formerly known as Wegeners granulomatosis) is a ...
Microglandular adenosis (MGA) of the breast is a pathological subtype of mammary adenosis. It is benign breast condition although can mimic a breast cancer (particularly tubular breast carcinoma 3,5) both clinically, radiology and pathologically.
It is considered the only benign brea...
Metaplastic breast carcinoma (MBC), also known as spindle cell carcinoma of the breast (SpCC), is a rare form of primary breast malignancy and accounts < 5% of breast carcinomas.
These are scarce lesions, rarely seen in general radiology practice. The lesions usually present as a mass in postme...
A granular cell tumour (GCT) of the breast is an uncommon, usually benign tumour which is possibly of neural origin.
They tend to occur at a younger age than other types of breast cancer 4. The age range of presentation, however, can be very variable although they occur more commo...
Giant fibroadenomas are fibroadenomas weighing more than 500 grams or measuring >5 cm in size 2. They are usually encountered in pregnant or lactating women.
Gel bleed is a phenomenon associated with silicone breast implants.
Gel bleed refers to microscopic diffusion of silicone gel through the breast implant elastomer shell. The implant shell, made of silicone, is a semipermeable membrane that allows for the egress or bleed of silicone n...
Extensive intraductal component (EIC) in breast imaging evaluation is the pathological description where an invasive ductal carcinoma has a prominent intraductal component within it or if there is intraductal carcinoma, DCIS is present within sections of normal adjacent tissue. It is sometimes c...
Mammary duct ectasia is characterised by chronic inflammatory and fibrotic changes leading to clogging of debris within the duct. It is of primary importance because of its features mimicking to that of malignancy.
Some publications use this term synonymously with periductal mastit...
Malignant phyllodes tumour of the breast accounts for up to a quarter of the phyllodes tumours.
Please, refer to the main article on phyllodes tumours for a general discussion.
It is generally thought that it is the stromal component that becomes malignant 4. This may account for t...
Fibrosarcoma of the breast is a type of malignant stromal sarcoma that rarely occurs as a primary tumour within the breast.
A fibrosarcoma is composed of immature mesenchymal elements surrounded by a collagenous substance. It is a type of breast sarcoma with a predominant “herringbo...