Mammography

Front 1

Well-circumscribed Mass: Benign

Back 1

Cyst
Fibroadenoma (and variants)
Lipoma
Fibroadenolipoma (hamartoma)
Phylloides tum (usu lobulated)
Oil cyst
Galactocoele
Hematoma (can be ill-defined)
Intramammary lymph node
Papilloma
Hemangioma
Skin mole (nevus)
Sebaceous cyst (usually dense and superficial, axilla most common)
Accessory nipple
Silicone granuloma or nodule (in patients with/post implants)
Pseudotumor

Front 2

Well-circumscribed Mass: Cancer

Back 2

Papillary CA
Intracystic CA (often papillary)
Mucinous CA (usually fuzzy on mag views) [= colloid CA]
Medullary CA
NOS Ductal CA (even intraductal can be large, to 6 cm)
Mets (from anywhere, includes sarcoma & lymphoma, latter are rare breast primaries)

Front 3

Spiculated mass

Back 3

Breast CA (usu invasive; includes ductal +variants such as tubular, and invasive lobular)

Radial scar (sclerosing ductal hyperplasia = benign sclerosing lesion of breast; central elastosis; “black star”; assoc. with or marker for possible CA; EXCISE)

Post-surgical scar

Previous trauma/resolving
hematoma

Sclerosing adenosis

Fibrocystic changes

Granular cell myoblastoma (probably from Schwann cells)

Desmoid

Front 4

Axillary LAD: Bilateral

Back 4

Breast CA with contralat spread (rare unless CA is bilateral)

Lymphoma/CLL

Mets (melanoma, lung, head and neck CA)

Drug reaction (Dilantin, pseudolymphoma)

Rheumatoid arthritis
SLE
Granulomatous disease
Mixed Connective Tissue Dz
AIDS

Front 5

Axillary LAD: Unilateral

Back 5

Primary breast cancer with ipsilateral spread (primary may be occult; Tx for adeno presumptive, go to mastectomy)
Sinus histiocytosis (reactive to breast cancer in same breast)
Infection (mastitis, or occasionally an upper extremity infection such as paronchyial)
Primary breast cancer arising in node (rare)
Any of above bilateral, seen only on one side
Silicone LAD (leaky implants, include gel bleed)

Front 6

Skin thickening

Back 6

Inflammatory CA
Post surgical
Keloids
Focal mastitis
Thyroid acropachy
Dermatomyositis
Normal variant for medial and inferior skin to be >2 mm, <5mm
Fungal infection

Front 7

Types of Invasive Breast CA

Back 7

Ductal (80-90%)

Lobular (~10%, usu older [50s-60s], often missed, infiltration of cells, often no mass, never has microcalcs)

Medullary (<5%, lobulated, most are not pure, actually no sign difference in prognosis, usu younger pts[40s])

Tubular (2%, very well-diff, mc spiculated small mass, prognosis excellent <1 cm)

Papillary (1-2%, very good prognosis even when large)

Mucinous (Good prognosis, rare cells in PAS+ mucin)

Minor rare variants

Front 8

Types of DCIS

Back 8

COMEDO (=high nuclear grade; dangerous; linear branching calcs; calcs map the cancer reasonably well); ? Does LUMP/RT work?

Low nuclear grade: papillary, micropapillary, cribriform, solid (calcs do not map the cancer well; look for multiple clusters for multifocality [= cancer in same quadrant at multiple sites])

Front 9

Benign appearing microcalcifications

Back 9

Skin (you have to think of them; clusters/rosettes, classic ones have lucent centers; sites in axillary regions and cleavage; skin study with low exposure tangential view)
Milk of calcium in microcysts (need 90 degree and CC views = smiles vs smudges)
Lobular calcifications (round)

Front 10

Linear Calcifications

Back 10

Comedo type DCIS or intraductal extension from invasive primary
Secretory Dz (=benign ductal dz, plasma cell mastitis; can be tubular periductal calcifications or intraductal; classically bilateral and behind nipples)
Single wall arterial calcification
Suture calcifications (most often seen post RT)
Milk of calcium (look for concavity superiorly)
Fat necrosis (dangerous to call if not peripheral around a central lucency)

Front 11

Increased Breast Densities

Back 11

Estrogen replacement (usually global, can be patchy, maybe 15% of patients on ERT have some effect, including cysts, soreness)
Weight loss (homogeneous putty look)
Change in mammo technique (e.g., higher contrast processing, undercompression/under-exposure)

Front 12

2 major categories of mammo findings that are interpreted as probably benign with recommendation for periodic surveillance:

Back 12

Localized findings: focal distribution and are found in one segment of one breast

Multiple similar lesions (usually three or more lesions, either tiny calcifications or circumscribed masses), randomly distributed in both breasts

Front 13

WORK-UP FOR AND PERIODIC SURVEILLANCE OF PROBABLY BENIGN LESIONS

Back 13

US is performed for the nonpalpable, apparently circumscribed, noncalcified mass to establish or exclude a diagnosis of simple cyst
Solid masses, focal asymmetric densities, and lesions involving microcalcifications necessitate spot compression magnification mammography to clearly portray the shapes and marginal characteristics of the lesions and also to serve as a fine-detail source for comparison when additional fine-detail images are obtained later, during mammographic surveillance

Front 14

Things to follow 6 months:

Back 14

Masses that are 75% well circumscribed, oval or round, without calcifications, non-palpable, not new, without worrisome findings or strictly benign findings (ie. cyst on u/s) on spot mags or ultrasound
Asymmetric densities (seen on two views and though to represent breast tissue)
Clusters of rounded or oval calcifications similar in size or density (specifically not malignant looking)