31. Imaging of the breast. Mammography, clinical mammography, ultrasound.

Breast cancer screening
- Modality
  - Main modality for examination of breast: Mammography
    - Uses low-energy, soft X-rays
      - 20 – 30/40 kV
      - Soft rays are better at differentiating soft tissues of the breast
    - Molybdenum anode (instead of tungsten)
      - Produces more characteristic x-rays
    - Standard views
      - Cranocaudal (CC)
      - Mediolateral oblique (MLO)
    - Breast prosthesis (silicone/saline) behind the pectoral muscle is the best for mammography
    - Breast is compressed
      - Reduces blurring from motion
      - Reduces scattered radiation
      - Reduces radiation dose
  - Complementary roles:
    - US
      - High-frequency (7 – 12 MHz)
      - Linear probe
      - Most used in women < 30 years
      - For dense breasts
      - Axilla must also be scanned
    - MRI
      - Dynamic MRi
      - Native + contrast-enhanced
- In Hungary
  - Normal population
    - From 45 – 65 years
    - Every 2nd year
  - High-risk patients
    - From 30 years
    - Annually
Benign breast tumors
- Circumscribed on imaging
- Fibroadenoma
  - Most common in young women
Breast cancer
- Most commonly in the outer upper quadrant
- Star-shape (stellate) on imaging
- Invasive ductal cc = most common cancer
- Precancerous lesion:
  - Atypical ductal hyperplasia