MAMMOGRAPHY

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MAMMOGRAPHY

• PATHOLOGIES
• PT 3

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PATHOLOGY BIOPSIES

• ADVANCED
• PROCEDURES

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ADVANCED IMAGING PROCEDURES
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INVASIVE BREAST PROCEDURES

• When a problem is discovered advanced, invasive
  procedures may be necessary to help lead to a
  diagnosis.
• BREAST BIOPSIES To check tissue samples
• GALACTOGRAPHY to check the patency of the ducts
  - discharge present (ductogram)

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GALACTOGRAPHY

• Nipple Discharge
• White / Yellow/ Green / Brown / Red
• Can be considered benign or malignant
• Approx 2-5 bloody discharges cancer
• Other causes can be a blocked duct due to a
  papiloma (shows as a filling defect on film)
• Spontaneous discharge more worrisome than if
  discharge must be expressed manually

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GALACTOGRAPHY

• Small catheter (31 g) sialogram
• Inserted into duct with discharge
• Iodinated contrast injected (2-5ml) sinograph
  

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DUCTOGRAM
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Breast Biopsies

• Treatment Options on Breast Health

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Types of lumps

• Fibrocystic Changes
• Cyst
• Lipoma
• Fibroadenoma
• Cancer

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LUMPS AND BUMPS

• FIBROADENOMAS
• CYSTS
• DCIS DUCTAL CARCINOMA IN SITU
• IDC INFLITRATING DUCTAL CA
• DISCHARGE FROM NIPPLE

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• Breast profile
• A ducts
• B lobules
• C dilated section of duct to hold milk
• D nipple
• E fat
• F pectoralis major muscle
• G chest wall/rib cage
• Enlargement
• A normal duct cells
• B basement membrane
• C lumen (center of duct)

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Fibrocystic Breasts

• Fibrocystic changes are the most common cause of
  breast lumps in women ages 30 to 50.
• AKA fibrocystic disease - not a disease, but a
  condition.
• It can be known as cystic disease, chronic cystic
  mastitis or mammary dysplasia.
• This condition is not cancerous.
• At least 60 of the women in their reproductive
  years have "lumpy" breasts as a result of these
  non-cancerous conditions.

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Abnormal Mammogram

• Abnormal Density An irregular, oblong, or
  starry shape. Highly white in contrast compared
  to surrounding tissue.
• Usually tissue of both breasts are similar. When
  one appears different to the other, or changes
  from year to year, follow-up is recommended.

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Abnormal Density
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Abnormal Mammogram

• Calcifications Tiny white specks of calcium,
  sometimes in clusters.
• Can be benign or malignant.
• Magnification views of clusters sometimes
  required.
• Biopsy sometimes necessary to rule out malignancy.

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Calcifications
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Breast Biopsy

• The removal of breast tissue for microscopic
  evaluation by a pathologist.

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Breast Biopsy Info

• Breast abnormalities can occur at any age
• 80 of Breast lumps are benign
• Mammograms can identify non-palpable breast lumps
  earlier than they can be felt
• But mammography is not perfect, a Breast biopsy
  is needed to determine if the lesion is benign or
  malignant.

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Breast Biopsy Methods

• Surgical Excisional Biopsy
• Fine Needle Aspiration Biopsy
• Core Needle Biopsy
• Ultrasound Guided Biopsy
• Stereotactic Biopsy

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Needle wire localization
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Surgical Biopsy

• ADVANTAGES
• Usually entire lesion is removed.
• 97-99 accurate diagnosis.

• DISADVANTAGES
• Out-Patient surgery
• General anesthesia
• 1-2 inch incision
• Sutures required
• Moderate discomfort and bruising
• Disfigurement, scarring and infection possible.

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Open Surgical Excisional Biopsy
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Ultrasound Guided Biopsy
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Stereotactic Breast Biopsy
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Advantages for Stereotactic Biopsy

• Procedure done in office setting
• Approx. 1 hour long
• 1/4 inch long incision
• No sutures needed
• No general anesthesia
• Less internal and external scarring
• No recovery time

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Contraindications for Stereotactic Biopsy

• Major blood vessels near area of biopsy.
• Breast lesion too close to chest wall.
• Patient is on blood thinners such as aspirin,
  heparin, coumadin, which can result in
  hemorrhage.
• Patient has medical condition in which they
  cannot lie prone for an hour or so.

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Mammotome Probe
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Breast Tissue Specimens
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Tissue Sent to Pathology Cancerous Cells
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• Woman with lumpectomy.
• A dark area indicates tumor
• B light pink highlighted area indicates tissue
  removed at lumpectomy

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• A pink highlighted area indicates tissue removed
  at mastectomy
• B axillary lymph nodes levels I
• C axillary lymph nodes levels II
• D axillary lymph nodes levels III

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• Lymph node areas adjacent to breast area.
• A pectoralis major muscle
• B axillary lymph nodes levels
• C axillary lymph nodes levels
• D axillary lymph nodes levels
• E supraclavicular lymph nodes
• F internal mammary lymph nodes

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PATHOLOGIC CONDITIONS

• BREAST CA
• FIBROADENOMAS
• FIBROCYSTIC DISEASE
• CYSTS FLUID FILLED BENIGN
• PAGETS DISEASE OF THE NIPPLE

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FIBROADENOMA
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Fibroadenoma are the most common benign solid
lesion
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CYSTS
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PHYLLOIDES TUMOR-GIANT FIBROADENOMA
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INFILTRATING DUCTAL CA
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DCIS
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DCIS CELLS HAVENT BROKEN OUT SO WONT SPREAD
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CLUSTER CALCIFICATIONS
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61 year old woman with normal post-op mammogram
MRI shows 5mm invasive ductal carcinoma    
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Spot compression
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POSITONING COUNTS!
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PATHOLOGYLOOKING OUTSIDE

• HOW CAN IT GO THIS FAR?

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Pagets disease of the nipple
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47 yo breast cancer
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Abnormal axillary lymph nodes Breast Breast
Cancer
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normal
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Male breast cancer and gynecomastia
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MRI for dense breast tissye
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Surgical scars can mimic characteristics of
breast cancer.
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bilateral, benign calcifications.
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Left breast (L) contains an irregular carcinoma
that is producing considerable spiculation,
nipple retraction (arrow), and skin thickening.
Right breast (R) contains fibroadenoma.
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27-year-old woman who stopped breast-feeding 2
months before having this mammogram.
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42-year-old woman with fibrocystic condition
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28-year-old woman 4 months postpartum and not
breast-feeding. The right breast contains a
large mass (arrow) palpable on physical
examination. The left breast contains two smaller
nonpalpable masses (arrows) with
microcalcifications. All three lesions were
breast cancers.
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fibroadenomas may calcify.
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diffusely distributed calcifications. (benign)
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FIBROCYSTIC WITH DILATED DUCTS
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1. Abnormal axillary lymph nodes 2. Breast 3.
Breast Cancer
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importance of high-quality mammograms is evident
in the two images of the same breast
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FINAL THOUGHTS