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...
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.
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...
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...
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
Contrast enhanced mammography (CEM) is a complementary breast imaging modality. A finite number of sequential images are obtained with X-ray beam produced at a high energy, above the K-edge of Iodine, and with an intravenous non-ionic Iodine contrast agent injected between pre and post contrast...
Cooper ligaments are the fibrous connections between the inner side of the breast skin and the pectoral muscles. Working in conjunction with the fatty tissues and the more fibrous lobular tissues, they are largely responsible for maintaining the shape and configuration of the breast. They play a...
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...
The craniocaudal view (CC view), along with the MLO view, is one of the two standard projections in a screening mammography. It must show the medial part as well the external lateral portion of the breast as much as possible.
A correctly performed CC projection may show the pectoral muscle on t...
The crests of Duret attach the most numerous superficial breast lobes by their summit to the superficial layer of fascia. The deepest crests connect the anterior lobes to the deep layer through the Cooper's ligament.
Breast lobe groups about one hundred lobules separated by interlobular connect...
Cutaneous calcifications in breast imaging can form in dermal sweat glands after low grade folliculitis and inspissation of sebaceous material. Calcifications may also form in moles and other skin lesions. The vast majority of calcifications are coincidental findings on mammography.
A cystic breast mass is a mass that contains both solid and fluid components. This can occur from both benign and malignant causes.
complex breast haematoma
complex breast abscess
breast cyst with associated inflammation and haemorrhage
fibrocystic changes and oil cysts...
Cystic hyperplasia of the breast is a benign breast condition which is considered part of fibrocystic changes.
There is usually greater unfolding and enlargement of ductules with formation of microcysts.
If associated with secretion of calcium s...
Deep inferior epigastric perforator flap (DIEP) reconstruction is a type of breast reconstruction surgery. It essentially involves the transfer of the patient's own skin and subcutaneous tissues from the lower abdominal wall to the chest to form the breast mound.
The operation spare...
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...
Digital breast tomosynthesis (DBT) is an imaging technique that allows a volumetric reconstruction of the whole breast from a finite number of low-dose two-dimensional projections obtained by different X-ray tube angles, with a geometric principle very similar to that applied in stratigraphic te...
Dilated ducts on breast imaging may be seen on many breast imaging modalities and can arise from a number of causes which can be both benign or malignant.
physiological lactational changes
mammary duct ectasia
breast neoplasm 2-3
Dilated mammary veins can result from many pathologies. These include:
as a secondary but non specific sign of breast malignancy 1
ipsilateral subclavian venous obstruction
Mondor disease: can be dilated as well as being thrombosed
A double spot compression view is obtained by focal compression of both sides of the breast to produce higher spatial and contrast resolution. This is made possible due to the increased amount of breast thinning and a significant decreased incidence of blurring because of decreased exposure time...
Dual-energy digital mammography is a complementary breast imaging modality.
The technique consists of high-energy and low-energy digital mammograms after administration of iodinated contrast agent.
Breast is exposed to low- and high-energy X-ray beams during a single breast compression in MLO ...
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...
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...
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
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...
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...
Elevated craniocaudal projection is an additional trouble shooting view.
direct beam superiorly to inferiroly
face patient towards unit, feet forward
lean patient inward, relaxing the shoulders
bring inferior aspect of breast onto the image receptor
pull breast outward and forwar...
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...
Fat containing breast lesions generally have some radiolucent component on mammography.
They are generally classified at BIRADS II lesions.
fat necrosis within the breast/oil cyst
intramammary lymph node: classically has a central fatty hilu...
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...
Fibroadenoma is a common benign breast lesion and results from the excess proliferation of connective tissue. Fibroadenomas characteristically contain both stromal and epithelial cells.
They usually occur in women between the ages of 10 and 40 years. It is the most common breast ...
Fibrocystic change of the breast (also known as diffuse cystic mastopathy) is a benign alteration in the terminal ductal lobular unit of the breast with or without associated fibrosis. It is seen as a wide spectrum of altered morphology in the female breast from innocuous to those associated wit...
Fibromatosis of the breast (also known as an extra-abdominal desmoid tumour of the breast or mammary fibromatosis 4) is considered as a type of rare breast tumour. It is a non-metastasising benign but locally invasive stromal tumour 4. However, it can mimic more sinister types of breast cancer o...
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...
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...
Flying focus is a technology of image acquisition in digital breast tomosynthesis characterized by a continuous sweep during shooting.
Sharpness in digital systems is determined by the modulation transfer function (MTF), which determine contrast transfer as a function of spatial frequency.
Focal fibrosis of the breast (FFB) is a benign entity characterized by abundant connective tissue separating intervening ducts and lobules, which are often atrophic. There is obliteration of the mammary acini and ducts by hypocellular fibrous tissue which results in a localized area of fibrous t...
The foramen of Langer is a defect in the deep pectoralis fascia. It is a defect at the level of the third intercostal space, through which the upper lateral portion of the breast extends into the axilla forming the axillary tail of Spence.
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
Free silicone breast injections (silicone mastopathy) are an alternative form of breast augmentation to breast implants, although they have serious adverse effects and are banned in many countries.
There are similar features to that of free silicone from breast implant r...
Mammographic technique is very important to obtain diagnostic mammograms, to reduce the number of false negatives and to increase the sensitivity of the procedure. As widely noted in literature, most breast pathology occurs in the upper outer quadrant and is very important that this ...
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....
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...
Gestational and secretory hyperplasia are pregnancy and lactation related physiological changes occurring in breast tissues.
The normal physiology of pregnancy causes a lobular enlargement of terminal duct lobular units along with formation of new ones during the second month of gest...
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...
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.
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...
Global asymmetry in breast tissue is a form of asymmetrical breast density where the entire breast is either larger, denser or has increased trabecular markings than the opposite breast.
This can occur from a number of causes which include:
surgery +/- breast reduction to the...
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...
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 ...
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...
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...
Mnemonic for the causes of gynaecomastia:
Halo sign in mammography refers to a radiolucent rim (halo) around a lesion and is generally but not always indicative of a benign breast lesion. Exceptions include intracystic carcinoma, papillary carcinoma, and carcinoma arising within a fibroadenoma.
halo sign (chest)
halo sign (u...
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...
The term high-risk breast lesion is given to a breast lesion that carries an increased risk for the future development of breast cancer or carries suspicion of a more sinister pathology around or in association with the lesion. The term has some overlap with borderline breast disease. Many radio...
Breast augmentation (also known as augmentation mammaplasty) for cosmetic enlargement has been performed for well over a century. Below is a brief summary of its history.
Breast augmentation was first attempted in the 19th century, when in 1895, Czerny transplanted a patient’s lipoma to her br...
There are a number of lesions that appear hyperechoic on ultrasound. Such lesions can be either completely or partly hyperechoic and comprise of both benign and malignant entities.
fat containing breast lesions
lipoma of the breast
fibroadenolipoma (hamartoma) of the breast
Inferomedial superolateral oblique projection is useful for stereotactic biopsy positioning. This projection allows access to the inferior aspect of the breast to achieve shortest skin to abnormality distance. It is also useful in the nonconforming patient.
Rotate C arm to about 125°...
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...
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 for...
The inframammary fold is the anatomical boundary formed at the inferior border of the breast, where it joins with the chest.
In mammography, it is an important landmark to identify on the mediolateral oblique view to assess image quality.
Interval breast cancer is a term given to cancers detected/presenting within 12 months after a mammographic screening in which findings are considered normal 2. The term is a statistical benchmark used in conjunction with other parameters to assess the efficacy of breast imaging programmes and t...
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...
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.
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...
Intramammary lymph nodes (IMLN) are lymph nodes within the breast tissue. In breast imaging, they generally fall into BIRADS II lesions 7. They can be solitary or multiple. This article discusses normal (physiological) intramammary lymph nodes.
Intramammary lymph nodes are seen in...
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.
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...
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.
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.
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.
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....
Large rod like calcifications are benign calcifications seen within ectatic ducts.
plasma cell mastitis
>1 mm in diameter
may have lucent centres (if calcium is only in walls of ducts)
branching pattern may be seen
radiation towards the nipple...
A late mediolateral projection is an additional view that can be used whenever,in the presence of rounded calcifications of probable intracystic nature, the standard ML view does not allow the recognition of the characteristic tea cups appearance due to the density of milk of calcium.
A second ...
The lateral view is an additional view obtained at virtually every diagnostic evaluation. A lateral view may be obtained as a mediolateral view (ML) or lateromedial view (LM) view depending on where the imaging tube and detector are located.
for an ML view, the tube emitting the x-ra...
A lateral-medial oblique (LMO) view is a type of supplementary mammographic view.
The advantage of performing the lateromedial view is to depict lesions located far medio-posteriorly visible on the CC view only, or to depict palpable lesions in the inner quadrant not seen on mammography.
The lateromedial view (or LM view) is a supplementary mammographic view where the bucky is placed up against the sternum and the and film is taken in a true lateral projection. This view allows the medial breast to be closest to the film. This view allows the medial breast to be more carefully e...
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.
Linguine sign is one of the imaging signs of intracapsular rupture of a breast implant.
After implantation of a silicone or saline breast implant, a fibrous capsule (scar) forms around the implant shell. In an intracapsular rupture, the contents of the implant are contained by the fibrous scar,...
Liponecrosis in breast refers to areas of mammary fat necrosis with associated dystrophic calcification. It is further divided into:
liponecrosis microcystica calcificans: <3 mm
liponecrosis macrocystica calcificans: >3 mm
Mammographic features are radioluc...
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.
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...
Lymphatic drainage of breast originates from breast lobules and flows into a subareolar plexus, called Sappey’s plexus. From this plexus, lymphatic drainage takes place through three main routes:
axillary or lateral pathway
fed by Sappey’s Plexus, as well as by ducts satellite lymphatics and b...
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...
A magnification view in mammography is performed to evaluate and count microcalcifications and its extension (as well the assessment of the borders and the tissue structures of a suspicious area or a mass) by using a magnification device which brings the breast away from the film plate and close...
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...
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...
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...
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...
The mammary glands
develop in close association with a depot of adipose tissue that is commonly
referred to as the mammary fat pad.
The mammary fat pad is a matrix of adipose
and connective tissue capable of mediating hormone action and synthesizing an
array of growth regulatory molecules.
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.
There are numerous mammography views that can broadly be split into two groups
supplementary views - additional information or problem solving
Standard views are those that are performed on routine screening mammograms. The views are usually used for all routine...
Mastitis refers to inflammation of the breast parenchyma, of which there are a number of subtypes:
puerperal mastitis: occurs usually from infection with Staphylococcus during lactation
non-puerperal mastitis: not related to lactation, and occurs usually in older women