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...
Inflammatory carcinomas of the breast, also referred to 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 fo...
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...
Li-Fraumeni syndrome is a hereditary cancer syndrome due to mutations in the tumour suppressor gene TP53. Approximately half of affected individuals are thought to develop invasive cancer by 30 years of age 1.
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...
Multifocal breast cancer refers to two or more individual breast cancers diagnosed at the same time within the same quadrant of the same breast 1.
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 ...
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...
Poland syndrome refers to a congenital unilateral absence of the pectoralis major and minor muscles and is a recognised cause of unilateral hyperlucent hemithorax.
Poland syndrome is usually sporadic, although rare familial cases have been described 1. It is rare, with an estimat...
A mnemonic to help remember breast lesion localisation when given a set of mammograms in medio-lateral oblique (MLO) and 90-degree/true lateral (medio-lateral [ML] or latero-medial [LM]) views to predict laterality is:
muffins rise and lead falls
This can help localise a finding on MLO during ...
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...
Columnar cell lesions of the breast comprise a wide range of breast lesions which are commonly characterised by columnar cells lining the terminal ductal and lobular unit. These range from lesions that show little or no cytologic or architectural atypia to those that show sufficient cytologic an...
There are a number of lesions that appear hyperechoic on ultrasound. Such lesions can be either completely or partly hyperechoic and include both benign and malignant entities.
fat containing breast lesions
lipoma of the breast
fibroadenolipoma (hamartoma) of the breast
Papillary lesions of the breast comprise a wide group and range from benign to malignant.
They develop as tufts of epithelium with a ﬁbrovascular core that arborize into branching papillae and protrude into the duct lumen.
papilloma of breast / intraductal papilloma of the b...
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
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 ...
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.
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...
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...
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...
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
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 ...
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...
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...
In breast imaging, forbidden, check or review areas are zones that, according to Tabár, require special attention in mammographic interpretation. These are:
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
The tattoo sign is a feature given to describe dermal calcifications seen on mammography 1. The basis of this sign is that dermal calcifications maintain fixed relationships to one another which are reproducible with similar projections at different times. This is in contrast to intramammary cal...
Filariasis refers to infection with nematodes (roundworms) of the family Filarioidea. There are three species of these thread-like filarial worms:
Wuchereria bancrofti: responsible for 90% of cases
Brugia malayi: causes most of the remainder of cases
Brugia timori: an uncommon cause
It can a...
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 has multiple patterns which are often mixed:
cribriform type non-comedo DCIS
micropapillary type non-comedo DCIS
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 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...
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 gas within the silicone. It also can be characterised as hypointense foci on the water-suppressed s...
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 ...
The keyhole or noose sign indicates an uncollapsed intracapsular breast implant rupture seen as the focal invagination of the implant shell caused by a small concealed leak of silicone outside shell where the two membranes do not contact each other. It is best appreciated by MRI.
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) 1, British surgeon and pathologist.
Stereotactic mammotome is method of biopsing breast lesions, particularly if they are occult on ultrasound.
A vacuum-assisted core biopsy (VACB)-stereotactic breast biopsy is performed as a diagnostic approach when mammography shows irregularities with micro-calcifications, parenchymal distorti...
Breast biopsy is performed whenever it becomes necessary to characterise a breast lesion. This consists of the withdrawal and collection of cells (cytologic exam) or tissue fragments (histologic exam) and in the anatomical-pathological analysis of the sample tissue.
There are many different wa...
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:
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...
The teardrop sign indicates an uncollapsed intracapsular breast implant rupture and is seen as a small focal invagination of the implant shell caused by a minimal concealed leak of droplets of silicone outside the shell where the two membranes contact each other. It is best appreciated by MRI.
The subcapsular line sign is a small 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.
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 ...
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...
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...
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...
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...
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...
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...
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...