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...
Adenosis of the breast is a benign lobulocentric proliferative process in which lobules are enlarged and increased in number in addition to an increased number of glands within each lobule.
Pathologically subclassified into three main subtypes which include:
sclerosing adenosis of the breast
Mammographic screening detects early breast cancers and thereby reduces potential mortality. However, its sensitivity is inversely related to breast density 1.
Altered density between two mammograms can arise in a number of situations:
Affecting both breasts:
interval commencement/cessation ...
Amorphous or indistinct calcifications are a morphological descriptive term for breast calcification and are defined as having small, hazy, faint calcifications with no clearly defined shape or form.
80-200 micrometer in diameter
small, hazy calcification
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:
Asymmetry in breast size can arise from a number of factors.
Breasts are rarely absolutely the same size or volume. Normal variation is common. Most females have slight discrepancies in breast size. Asymmetric progressive breast enlargement is unusual but known. The role of the breas...
Bilateral axillary lymphadenopathy can result from a number of causes and generally implies a systemic process. They include:
autoimmune diseases, e.g.:
systemic lupus erythematosus (SLE)
Borderline breast disease (BBD) refers to a group of conditions while being not completely malignant are still concerning. Usually an excision biopsy is recommended if entities falling into borderline breast disease is detected on core biopsy.
These entities include:
atypical ductal hyperplasi...
Brachytherapy, also known as sealed source radiotherapy or endocurietherapy, is a form of radiotherapy where a radioactive source is placed, under the guidance of imaging, within or next to the area requiring treatment.
Brachytherapy is commonly used to treat localised prostate cancer, breast c...
Breast calcifications can arise from a vast number of aetiologies.
They are extremely common and can be present in ~85% of mammograms 8. Their frequency increases with age. Up to 50% of breast cancers can be associated with calcification while 15-30% of calcifications biopsied fo...
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 have become rare in clinical practice. H...
Breast cysts are a common mammographic and sonographic finding, and can be of different types:
simple breast cyst: typically is a well-defined, anechoic lesion with imperceptible wall and posterior acoustic enhancement 1
complicated breast cyst: contains intracystic echoes or debris with other...
Breast density 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 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...
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...
Calcific axillary lymphadenopathy is in general, more concerning than axillary lymphadenopathy alone and is particularly so if it contains microcalcifications. While this is concerning for malignancy, it can also occur from occasional nonmalignant causes
metastatic axillary lymp...
In mammography, the term calcific cluster is usually given to where at least five microcalcifications in one cubic centimetre (that is 1 square cm) on two projections on a non-magnified contact view 1.
Homogeneous, smooth clustered microcalcifications can be due to 2:
Serum carcinoembryonic antigen (CEA) is a cell-adhesive glycoprotein that was discovered in colorectal cancer in 1965, and is hence one of the oldest and most used tumour markers. Its name derives from its normal expression in fetoembryonic liver, gut and pancreas tissue.
Normal range of CEA is...
Coarse macrocalcifications within the breast are a morphological descriptive term for a type of breast calcification.
involuting fibroadenomas ( classical popcorn calcification )
chronic renal disease with hypercalcaemia 1
rarely seen in malignancy 2
invasive breast carci...
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...
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
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...
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...
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...
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...
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
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 th...
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
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
Metachronous breast cancers are two breast cancers that occur in either breast in two different time periods.
Treatment and prognosis
The survival rate of women with metachronous breast cancers diagnosed within 2 years of the original primary is worse than those with unilateral disease 4.
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 ...
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
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
Milk of calcium within a breast cyst is a mammographic feature observed when there is dependent calcium layering within breast cysts. It is typically observed as "tea cup" or "crescent shaped" calcifications on a true lateral (LM or ML) view on occasionally on a MLO view. On a CC view, these cal...
A multicentric breast cancer is a term given to a breast cancer where there are two or more breast cancers separated by normal breast tissue (often taken as 5 cm of separation 4). It is related to but distinct from the term multifocal breast cancer.
At a pathological level It can also mean 2
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.
Nipple markers can be a useful technique in the evaluation of densities overlying the expected position of the nipple on a chest radiograph. Not uncommonly a small round opacity projects over the lower thorax on a chest radiograph (see: solitary pulmonary nodule).
Often, especially in women, th...
Papillary lesions of the breast comprise of a wide group and can range from being 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 papil...
Post surgical breast scar is a benign complication that usually occurs following surgical intervention to breast tissue. It can however be a strong and potentially very confusing mimicker of breast malignancy.
Review of the patient's past history and previous mammography...
Pregnancy associated breast cancer (PABC) is usually defined as a breast breast cancer diagnosed during pregnancy or one year following delivery. PABC occurs in one out of every 1500-10,000 pregnancies 5-6 and represents up to 3% of all breast malignancies. The incidence may be increasing due to...
A residual breast cancer is a remaining portion of the original primary breast cancer after an incomplete resection or following radiotherapy or chemotherapy. The term is particularly used in assessing patients who have had neo-adjuvant chemo +/- radiotherapy.
There are few areas in imaging specifically and in medicine in general, fraught with more controversy than screening for breast cancer. Due to the emotive issues surrounding the diagnosis, the scientific literature on breast screening and its issues reaches the lay press quickly and is sometimes...
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...
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 ...
Spontaneous nipple discharge in a non lactating breast can result from many causes which include:
papillary lesions of breast: present in ~35-50% of cases with spontaneous nipple discharge
ductal carcinoma in situ: 5-21%
Suspicious breast calcifications are calcifications within the breast that are not benign. These calcification need further work up and biopsy. These can be divided as
suspicious calcification of intermediate concern
suspicious calcification raising high probability of malignancy
Unilateral axillary lymphadenopathy while being more concerning than bilateral axillary lymphadenopathy can still arise from a various benign as well as malignant causes.
other regional infective causes
ipsilateral arm infection, e.g. cellulitis
Certain well-defined breast cancers tend lack the characteristic spiculation and can give false reassurance of more benign entities on both ultrasound and mammography. These include:
certain high grade invasive ductal carcinomas: not enough time for a desmoplastic reaction to form spiculation