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MAMMOGRAPHY

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Approx 2-5% bloody discharges = cancer. Other causes can be a blocked duct due to a papiloma (shows as a filling defect on film) ... – PowerPoint PPT presentation

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Title: MAMMOGRAPHY


1
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)

6
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

10
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)

14
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.

17
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
20
Breast Biopsy
  • The removal of breast tissue for microscopic
    evaluation by a pathologist.

21
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.

22
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

44
  • 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

45
  • 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
59
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
63
CLUSTER CALCIFICATIONS
64
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.
101
27-year-old woman who stopped breast-feeding 2
months before having this mammogram.
102
42-year-old woman with fibrocystic condition
103
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.
104
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
112
FINAL THOUGHTS

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