Focusing on high-yield information, Breast Imaging: The Core Requisites, 4th Edition emphasizes the basics to help you establish a foundational understanding of breast imaging during rotations, prepare for the core and certifying exams, refresh your knowledge of key concepts, and learn strategies to provide “value-added reports to referring clinicians. This completely rewritten and reorganized edition emphasizes the essential knowledge you need in an easy-to-read format, with thorough updates that cover new imaging modalities, the latest guidelines, and integration of physics information throughout.Emphasizes the essentials in a templated, quick-reference format that includes numerous outlines, tables, pearls, boxed material, and bulleted content for easy reading, reference, and recall.
Prioritizes and explains the key information that you will be tested on to help you efficiently and effectively prepare for board exams.
Helps you build and solidify core knowledge to prepare you for clinical practice with critical, up-to-date information on mammography, breast ultrasound, digital breast tomosynthesis, and breast MRIs, as well as special chapters on lymph node evaluation in breast imaging, augmented and reconstructed breast, and special populations in breast imaging.
Features hundreds of high-quality images, including correlations of ultrasound, mammography, digital breast tomosynthesis and MRI.
Published as part of the newly reimagined Core Requisites series, an update to the popular Requisites series aimed at radiology trainees and today’s busy clinicians.
Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.
Author(s): Bonnie N. Joe, Amie Y. Lee
Edition: 4
Publisher: Elsevier
Year: 2022
Language: English
Pages: 321
City: Philadelphia
Front Cover
Breast Imaging
Copyright Page
Contributors
Foreword
Preface
Contents
1 Introduction to Mammography: The Basics
How Is a Mammogram Performed?
Compression
Standard Views
Standardized Labeling
What Is Acceptable Quality?
Image Quality
Appropriate Positioning
Special Views and Additional Views
Spot Compression View
Magnification View
Additional Views
The Normal Mammogram
Anatomy
Radiologic Anatomy of the Breast
Image Contrast
Screening Versus Diagnostic Mammograms
Suggested Readings
2 Why BI-RADS?: Overview of Breast Imaging Reporting and Data System (BI-RADS)
Introduction
History of BI-RADS
The BI-RADS Lexicon
Special Considerations for Other Imaging Modalities
BI-RADS Final Assessment Categories
The Structured Breast Imaging Report
BI-RADS FAQs
Quality Assurance Tool
BI-RADS and Beyond/Conclusion
Implications for Research
Beyond BI-RADS
The Art of Breast Imaging
Suggested Readings
References
3 Mammographic Masses, Asymmetries, and Distortion
Overview
Breast Masses
Breast Mass Descriptors Specific to Ultrasound
Asymmetries
Asymmetry
Global Asymmetry
Focal Asymmetry
Developing Asymmetry
Assessment of Asymmetry at Screening Mammography
Assessment of Asymmetry at Diagnostic Mammography
Architectural Distortion
Assessment of Architectural Distortion on Diagnostic Mammography Workup
References
Suggested Readings
4 Mammographic Analysis of Breast Calcifications
Pathogenesis
Screening and Diagnostic Assessment
Typically Benign Calcifications
Skin Calcifications
Vascular
Coarse “Popcorn-Like”
Large Rod-Like
Rim
Dystrophic
Milk of Calcium
Suture
Round
Probably Benign Calcifications (BI-RADS 3) and Their Management
Suspicious Calcifications
Distribution
Diffuse
Regional
Grouped
Linear
Segmental
Morphology
Coarse Heterogeneous
Amorphous
Fine Pleomorphic
Fine Linear/Linear Branching
Management of Suspicious Calcifications
Summary
Suggested Reading
5 Breast Ultrasound Indications and Interpretation
Indications
Supplemental Screening in Addition to Mammography
Technique
Diagnostic Evaluation
Ultrasound Evaluation of Mammographic Finding
Targeted Ultrasound After MRI and Other Imaging
Postsurgical Breast
Neoadjuvant Treatment
Breast Implants
Interventional Procedures
Technical Parameters
Image Quality
Artifacts
Image Optimization
Image Resolution
Tissue Harmonics
Compound Imaging
Doppler Imaging
Additional Ultrasound Techniques
Strain Elastography
Shear Wave Elastography
Breast Anatomy
Female Hormonal Phases
Male Breast
Ultrasound BI-RADS and Interpretation
Tissue Composition
Masses
Shape
Orientation
Margin
Echo Pattern
Posterior Features
Calcifications
Associated Features
Special Cases
Cysts: Simple versus Complicated versus Complex Cystic and Solid Mass
Benign versus Probably Benign Masses
Round Mass
Additional Features of Malignancy
BI-RADS Final Assessment for Ultrasound
Suggested Reading
6 Basics of Digital Breast Tomosynthesis
Acquisition of Images
Methods of Acquiring DBT Images
Dose of DBT Compared With DM
Imaging With DBT in One View Only
Synthetic Imaging
Images Available for Interpretation
DBT Terminology
DBT Display
Advantages of DBT
Reasons for Increase in Cancer Detection
Reasons for Decrease in Recall
Vessel Turns
Lymph Nodes
Superimposed Tissue
Decrease in Technical Recalls
Grouped Skin Calcifications
Incident Versus Prevalent Screening With DBT
Special Considerations
Suggested Readings
7 Mammographic and Ultrasound-Guided Breast Biopsy Procedures
Image-Guided Breast Biopsy
Prebiopsy Patient Workup
Breast Lesion Labeling
Informed Consent and Procedural Risks
Complications—Specific Scenarios
Skin Sterilization, Local Anesthesia, and Skin Nicks
Fine-Needle Aspiration and Core Biopsy Techniques
Fine Needle Aspiration
Automated Core Biopsy
Vacuum-Assisted Core Biopsy
Cyst Aspiration
Palpation-Guided Percutaneous Needle Biopsy
Ultrasound-Guided Percutaneous Needle Biopsy
Stereotactic and Tomosynthesis-Guided Percutaneous Needle Biopsy
Core Specimen Radiography
Placement of Biopsy Site Markers
Carbon Breast Tissue Marking and Tattoo Ink Marking of Axillary Lymph Nodes
Patient Safety and Comfort after Biopsy
Radiologic-Pathologic Correlation after Breast Biopsy
Preoperative Needle Localization With Hookwire or Wireless Methods
2D Mammographic–Guided Needle/Hookwire or Wireless Localization
Tomosynthesis-Guided Needle/Hookwire or Wireless Localization
Stereotactic-Guided Needle/Hookwire or Wireless Localization
Ultrasound-Guided Needle/Hookwire or Wireless Localization
Types of Wireless Fiducial Devices
Specimen Radiography
References
8 Breast MRI Indications, Interpretation, and Interventions
Indications
Screening
Diagnostic Imaging in Women With Known Breast Cancer
Evaluation of Response to Neoadjuvant Therapy
Problem Solving: Evaluation of Suspicious Nipple Discharge
Evaluation of Silicone Implant Integrity
Technical Considerations and MRI Artifacts
Technical Considerations
Key Pulse Sequences
Artifacts
Breast MRI Interpretation and Reporting
Approach to MRI Interpretation
MRI BI-RADS Lexicon
Amount of Fibroglandular Tissue
Amount of Background Parenchymal Enhancement
Lesion Type, Morphology, and Internal Enhancement Characteristics
Contrast Kinetic Features
Assigning BI-RADS Assessments on MRI
Malignant MRI Findings
Invasive Carcinoma
Ductal Carcinoma in Situ
Features Associated with Malignancy
Benign MRI Findings
MRI-Guided Breast Interventions
Pulse Sequences for MRI-Guided Biopsy
Approach Planning
Basic Steps of MRI-Guided Biopsy
Radiology-Pathology Concordance and Follow-Up
Suggested Reading
9 Breast Pathology and Radiologic–Pathologic Correlation
Overview of Normal Breast Anatomy
Anatomy
Breast Embryology and Development
Menstrual Cycle and Menopause
Radiologic–Pathologic Correlation and Recommendations
Appearance and Management of Benign Lesions
Benign Breast Masses Generally Not Requiring Additional Management
Fibroadenoma
Lipoma
Hamartoma
Pseudoangiomatous Stromal Hyperplasia
Intramammary Lymph Node
Fat Necrosis
Fibrocystic Change
Benign Masses That May Warrant Surgical Consultation
Phyllodes Tumor
Stromal Fibrosis
Granular Cell Tumor
Granulomatous Mastitis
Diabetic Mastopathy
Desmoid Tumor
Benign Calcifications
Usual Ductal Hyperplasia
Adenosis and Sclerosing Adenosis
Columnar Cell Change and Columnar Cell Hyperplasia
High-Risk Lesions
Atypical Ductal Hyperplasia
Lobular Neoplasia (Atypical Lobular Hyperplasia and Classic Lobular Carcinoma In Situ)
Pleomorphic LCIS
Flat Epithelial Atypia
Complex Sclerosing Lesion/Radial Scar
Papillary Lesions
Mucocele-Like Lesion
Breast Malignancies
Ductal Carcinoma In Situ
Molecular Subtypes of Breast Cancer
Invasive Ductal Carcinoma Not Otherwise Specified (IDC NOS)
Tubular Carcinoma
Medullary Carcinoma
Mucinous/Colloid Carcinoma
Invasive Papillary Carcinoma
Invasive Lobular Carcinoma
Adenoid Cystic Carcinoma
Metaplastic Carcinoma
Other Malignancies
Lymphoma
Metastasis
Sarcoma
Suggested Readings
10 Breast Cancer Risk Assessment
Definitions: Average Versus Higher-Than-Average Risk
Population Subgroups at Higher Risk
Genetic Mutation Carriers and Hereditary Syndromes
Chest/Mantle Radiation Before Age 30
Family History of Breast Cancer
Personal History of Breast Cancer
Additional Risk Factors for Breast Cancer
General Risk Factors
Lobular Neoplasia and Atypical Ductal Hyperplasia
Breast Density
Background Parenchymal Enhancement
Models for Risk Assessment
Gail Model
BRCAPRO
IBIS (Tyrer-Cuzick)
Claus
BOADICEA
Breast Cancer Surveillance Consortium
Suggested Readings
References
11 Breast Cancer Screening Guidelines and Supplemental Screening
Breast Cancer Screening Guidelines
Screening Guidelines for Average-Risk Women
ACR, SBI, ASBrS, NCCN, and NCBC
American Cancer Society
USPSTF, AAFP, and ACP
Screening Guidelines for Higher-Than-Average-Risk Women
Supplemental Screening
Incremental Cancer Detection Rate Per Modality
Digital Breast Tomosynthesis
Screening Breast Ultrasound
Breast Magnetic Resonance Imaging
Supplemental Breast MRI Screening in High-Risk Women
Supplemental Breast MRI Screening in Average-Risk Women
Molecular Breast Imaging
Contrast-Enhanced Mammography
References
Suggested Readings
12 Organized Approach to Screening Mammography
Why Perform Screening Mammography? (Screening Evidence)
Historical Perspective
Screening Mammography Reduces Breast Cancer Mortality
Screening Guidelines
Screening Controversies: Commonly Cited Screening “Harms” (Risks)
Radiation
Benign-Outcome Recalls and Biopsies (False Positives)
Patient Anxiety
Overdiagnosis
Additional Benefits of Screening Mammography
Risk-Based Screening
Breast Cancer Incidence by Race
How to Interpret Screening Mammography by Following a Systematic Approach
General Approach
Perform “Overview” and “Close-In” Visual Searches
Look for a Second Lesion
Annotate and Describe Location of Findings to Help the Next Radiologist
Perception Aids for Screening Mammography Interpretation
View Right and Left Images “Back-to-Back” as if They Were Mirror Images
Concentrate on the Whitest Areas of the Image
Search for One Calcification or Tiny Artifact
Compare With Two Prior Examinations
Interpret in Batches Without Distractions
Suggested Readings
13 Organized Approach to Diagnostic Imaging
Triangulation
Describing the Location of Findings in the Breast
Triangulation with Two-Dimensional Mammography
Lesion Localization with Tomosynthesis
Supplemental Mammographic Views
Diagnostic Workup of Masses
Workup of Asymmetries
Asymmetry (One-View) Workup
Shallow Obliques
Rolled Views
Tomosynthesis
Focal Asymmetry workup
Developing Asymmetry workup
Suggested Reading
14 The Symptomatic Breast
Palpable Breast Lump
Palpable Lump ≥40 Years Old
Palpable Lump in Women 30 to 39 Years Old
Palpable Lump in Women <30 Years Old
The Probably Benign Mass
Palpable Lump: Special Scenarios
Nipple Changes
Nipple Discharge
Other Nipple Symptoms
Diffuse Breast Swelling and Edema
Pain
Suggested Readings
15 Breast Cancer Staging: What the Surgeon and Oncologist Want To Know
Background
Eighth Edition of AJCC Cancer Staging Manual
Principles and Rules of Staging
Clinical Versus Pathologic Staging
(Table 15.2)
Clinical Staging
Pathology Staging
Restaging
Imaging Modalities Used to Stage Breast Cancer
TNM
Assessment of the T (Tumor) Parameter
Assessment of the N (Lymph Node) Parameter
Assessment of the M (Metastases) Parameter
Multifocal and Multicentric Disease
Putting It All Together
Suggested Reading
16 After Breast Conservation Therapy
Breast Conservation Therapy
Definition and History
Oncoplastic BCS
Surgical Management of the Axilla
Patient Selection for BCT
Contraindications to BCT
Preoperative Tumor Localization for BCT and Specimen Radiography
Preoperative Tumor Localization
Intraoperative Specimen Radiography
Posttreatment Surveillance
Mammography
Breast Ultrasound and Breast MRI
Imaging Features of Benign Posttreatment Findings
Seroma
Postradiation Skin and Trabecular Thickening
Postsurgical Scar and Architectural Distortion
Fat Necrosis
Suture and Other Benign Calcifications
Imaging Assessment of Residual Disease
Imaging Features of Recurrent Disease
Mammography
Breast Ultrasound
Breast MRI
Suggested Readings
17 Lymph Node Evaluation in Breast Imaging
Basic Anatomy
Normal Versus Abnormal Appearance
Diagnostic Approach
Bilateral Axillary Lymphadenopathy
Unilateral Axillary Lymphadenopathy
Axillary Nodal Calcifications
Axillary Lymph Node Management in Breast Cancer Patients
Suggested Readings
18 The Augmented and Reconstructed Breast
Breast Implants
Implant Risks and Complications
Early Implant Complications
Late Implant Complications
Breast Reconstruction After Mastectomy
Breast Reconstruction Risks and Complications
Breast Cancer Recurrence After Mastectomy
Reduction Mammoplasty
Explantation
References
Suggested Readings
19 Special Populations in Breast Imaging
Young
Young: Differential Considerations
Young: Imaging Management
Young: Management of Breast Masses
Young: Probably Benign
Young: Management of the Pathologic Nipple
Young: Special Considerations for Patients Under 18
Young: Summary
Pregnant or Lactating
Pregnant or Lactating: Imaging Safety and Expected Imaging Appearances
Pregnant or Lactating: Benign Masses
Pregnant or Lactating: Mastitis and Breast Abscesses
Pregnancy-Associated Breast Cancer
Percutaneous Procedures in Lactating Patients
Pregnant or Lactating: Summary
Male
Male: Imaging Management
Male: Gynecomastia
Male: Male Breast Cancer
Male: Summary
Transgender
Transgender: Expected Imaging Appearances
Transgender: Breast Cancer Risk
Transgender: Screening Considerations
Transgender: Diagnostic Considerations
Transgender: Summary
Suggested Readings
20 Mammography Quality Standards Act (MQSA) and American College of Radiology (ACR) Accreditation Programs
Mammography Quality Standards Act Origins and Purpose
Personnel Qualifications
Equipment Requirements and Quality Assurance
American College of Radiology (ACR) Accreditation
Mammography Reporting and Medical Records Requirements
Medical Audit
Suggested Readings
21 Mammography Physics 101
Image Acquisition
Target/Filter Combinations
Imaging Receptors
Scatter and Grid
Heel Effect
Focal Spot and Magnification Views
MQSA Dose Requirements
Radiation Dose
Image Processing
Image Quality
Image Unsharpness
Contrast
Signal-to-Noise
Artifacts
Detector-Based Artifacts
Machine-Based Artifacts
Patient-Based Artifacts
Suggested Reading
Index
