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PICTORIAL ESSAY Table of Contents   
Year : 2001  |  Volume : 11  |  Issue : 4  |  Page : 175-179
Pictorial essay : Mammographic features of breast cancer


Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Lucknow Road, Delhi-10054, India

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Keywords: Microcalcification, malignancy

How to cite this article:
Popli M B. Pictorial essay : Mammographic features of breast cancer. Indian J Radiol Imaging 2001;11:175-9

How to cite this URL:
Popli M B. Pictorial essay : Mammographic features of breast cancer. Indian J Radiol Imaging [serial online] 2001 [cited 2019 Aug 24];11:175-9. Available from: http://www.ijri.org/text.asp?2001/11/4/175/28397
Mammography is unchallenged as a screening test for the early detection of breast cancer [1],[2] . No other imaging technique matches its ability to find small cancers [3],[4],[5] . Some of these criteria are extensively accurate. They are divided into major signs of malignancy (conventional signs) and supporting signs of malignancy (indirect signs).

Major Signs:

1. Spiculated Margins:

Spiculated margins are a true diagnostic feature of malignancy. Strands of tissue are seen radiating out from an ill-defined mass, producing a stellate appearance [Figure - 1]a,b. This appearance is pathognomonic of breast cancer. Spiculation represent retraction of tissue strands towards the tumor due to fibrosis - as a result of desmoplastic response. Sometimes, only the spiculation are seen [Figure - 1]c.

2. Clustered Microcalcifications:

Mammography is the only technique capable of detecting microcalcification [Figure - 2]a. Microcalcification, even when found in isolation herald the presence of early stage breast cancer. Five or more calcifications, measuring less than 1mm, in a volume of one cubic centimeter, define a 'cluster'. The possibility of malignancy increases as the size of individual calcification decreases, the total number of calcification per limit area increases [Figure - 2]b,c. It is the distribution and morphology of the calcifications, which defines their significance.

Supporting Signs of Malignancy

These indirect signs, though non-specific, signify enough risk to warrant intervention.

1) Poorly Defined Mass

Most breast cancers are seen as poorly defined masses, without any mammographic features more suggestive of malignancy [Figure - 3]a. Circumscribed masses with margins that are mostly well defined with only a portion ill-defined, are also managed as other ill-defined masses [Figure - 3]b. There are a sizable number of benign breast masses whose margin appears to be poorly defined, and therefore are difficult to differentiate from malignancy resulting in the need to biopsy in order to detect early cancer.

2) Microlobulation

Lobulations are usually associated with fibroadenomas. Increased number of lobulations, measuring few millimeters should be suspected for malignancy [Figure - 4]a,b.

3) Architectural Distortion

Breast cancer does not always produce a mammographically visible mass. Sometimes it produces just a localized cicatrization [Figure - 5]a,b. If previous surgery and trauma to the breast can be excluded, there is high likelihood that the distortion is because of malignancy. Invasive carcinoma distorts the interface between breast and normal parenchyma due to desmoplastic response of host tissue to the malignancy.

4) Asymmetric Density

Asymmetric density is the three dimensional area in which the density is greatest at the centre and fades towards the periphery trying to form a mass [Figure - 6]a,b. In this situation, it is helpful to to view the mammograms of both breasts side by side [Figure - 6]a1,b1.

5) Nipple Retraction

Nipple retraction "over a short period of time " is suspicious of an underlying cancer [Figure - 7]a,b .

6) Enlarged Axillary Lymph nodes

Demonstration of large nodes is non-specific sign of malignancy. Involvement of the nodes(s) indicates worsening of prognosis [Figure - 8].

Acknowledgement

We thank Mr. Sharma for the photographs.

 
   References Top

1.Kopans DB. Mammographic screening for breast cancer. Cancer 1993; 72: 1809 - 1812.  Back to cited text no. 1  [PUBMED]  
2.Skrabanek P. Breast cancer screening with mammography. Lancet 1993; 341: 1531- 39.  Back to cited text no. 2  [PUBMED]  
3.Sickles EA. Mammograhic features of 300 consecutive non - palpable breast cancers. AJR 1986; 146: 661-676.  Back to cited text no. 3  [PUBMED]  
4.Sickles EA. The subtle and atypical mammographic features of invasive lobular carcinoma. Radiology 1991; 178:25-26.   Back to cited text no. 4  [PUBMED]  
5.Mendelson EB, Harris KM, Doshi N, Tabon H. Infiltrating lobular carcinoma: mammographic pattern with pathological correlation. AJR 1989; 153: 265-271.  Back to cited text no. 5    

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Correspondence Address:
M B Popli
127-B/AC-II, Shalimar Bagh, Delhi-110052
India
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    Figures

[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8]

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