MAMMOGRAPHY

Male breast anatomy

Rudimentary breast composed mainly of skin

Male breast mammographic appearance

Predominantly radiolucent due to fat with possible thin retroareolar linear density

Gynecomastia

Benign proliferation of ducts in male breast producing flame-shaped retroareolar density

Male breast key principle

Any male breast abnormality is uncommon and considered suspicious until proven otherwise

Female breast anatomy

Fully developed breast containing lobes

Female breast mammographic appearance

Mixed radiolucent fat and radiodense fibroglandular tissue with variable density

Hormonal influence on female breast

Estrogen and progesterone regulate glandular development and density changes

Fetal breast development

Initiation of mammary ridges at approximately six weeks gestation without functional tissue

Mammography in fetal stage

Not applicable because no developed breast tissue is present

Pubertal breast changes

Estrogen-driven ductal growth and lobule formation with increased fibroglandular tissue

Pubertal mammographic appearance

Extremely dense breast predominantly white on mammography

Dense breast implication

High fibroglandular density reduces mammographic sensitivity and masks lesions

Reproductive breast physiology

Cyclic hormonal changes causing periodic engorgement and tenderness

Reproductive mammographic density

Fluctuating density with increased glandular prominence pre-menstruation

Optimal timing for mammography

Post-menstrual phase for reduced discomfort and improved image clarity

Menopausal breast changes

Declining estrogen leads to glandular regression and increased fat

Menopausal mammographic effect

Decreasing density improves visualization of masses and calcifications

Postmenopausal breast anatomy

Predominantly fatty breast due to glandular atrophy

Postmenopausal mammographic advantage

High contrast imaging improves lesion detection

Hormone replacement therapy effect

Exogenous hormones may increase breast density post-menopause

Breast quadrants

Anatomical division into upper outer

Upper outer quadrant significance

Most common site of breast cancer due to higher glandular concentration

Axillary tail of Spence

Extension of upper outer quadrant tissue toward the axilla

Clockface localization system

Lesion localization method using nipple as center reference

Clockface reporting importance

Enables precise communication for surgery

Breast skin anatomy

Thin elastic covering containing hair follicles and sweat glands

Skin thickening on mammography

May indicate inflammation or malignancy

Nipple anatomy

Central projection containing openings of lactiferous ducts

Nipple retraction significance

Suggests malignancy when new or unilateral

Areola anatomy

Pigmented skin surrounding nipple containing Montgomery glands

Clinical significance of areolar changes

Retraction or dimpling implies Cooper’s ligament involvement

Superficial fascia of breast

Fascial layer enveloping breast tissue beneath the skin

Deep fascia of breast

Fascial layer covering the pectoralis major muscle

Fascial plane importance

Allows breast mobility over the chest wall

Retromammary space

Fatty connective tissue between breast and pectoralis major

Loss of retromammary fat plane

Suggests chest wall invasion by malignancy

Fibrous breast tissue

Structural framework providing firmness and appearing radiodense on mammography

Glandular breast tissue

Milk-producing tissue composed of lobes and lobules

Glandular lobes

Fifteen to twenty lobes arranged radially around the nipple

Lobules

Subdivisions of lobes containing acini

Terminal ductal lobular unit (TDLU)

Functional unit composed of terminal duct and lobules

TDLU clinical importance

Origin of most breast cancers and benign proliferative disease

TDLU mammographic changes

Manifest as masses

Adipose tissue of breast

Fat surrounding glandular tissue increasing with age

Fat mammographic appearance

Radiolucent background improving lesion conspicuity

Cooper’s ligaments

Fibrous bands extending from skin to deep fascia maintaining breast contour

Cooper’s ligament infiltration

Causes skin dimpling or retraction in malignancy

Extralobular stroma

Dense fibrous supportive tissue between lobules

Intralobular stroma

Loose hormone-sensitive connective tissue within lobules

Breast lymphatic drainage

Primarily to axillary lymph nodes

Lymph node involvement

Determines staging and prognosis in breast cancer

Breast arterial supply

Internal mammary

Breast venous drainage

Parallels arteries draining into axillary and internal thoracic veins

Pectoralis major relevance

Must be visualized to nipple level on MLO view

Absent pectoralis major on MLO

Indicates positioning error rather than pathology

Epithelial cells of breast

Line ducts and lobules forming inner layer of TDLU

Epithelial pathology

Source of hyperplasia

Basement membrane breach

Defines invasive breast carcinoma

Myoepithelial cells

Contractile cells between epithelium and basement membrane

Myoepithelial cell significance

Presence indicates non-invasive lesion

Stromal cells

Fibroblasts

Tumor–stroma interaction

Influences tumor aggressiveness and spread

Adipocytes in breast

Fat cells involved in padding and estrogen conversion

Breast asymmetry

Difference in size or density between breasts

Developing asymmetry

Suspicious finding requiring further evaluation

Inverted nipple evaluation

New unilateral inversion raises concern for malignancy

Accessory breast tissue

Ectopic hormonally responsive tissue commonly in axilla

Accessory tissue pathology

Can develop fibroadenoma or carcinoma

Breast lump characteristics

Benign masses are mobile and smooth while malignant masses are hard and fixed

Palpable lump protocol

Requires imaging correlation regardless of clinical impression

Skin dimpling mechanism

Tumor traction on Cooper’s ligaments

Peau d’orange appearance

Lymphatic obstruction causing skin edema in inflammatory carcinoma

Pathologic nipple discharge

Unilateral single-duct bloody or serous discharge

Bloody nipple discharge rule

Consider malignancy until proven otherwise

Breast implant imaging

Requires implant-displaced Eklund views

Implants and cancer risk

Breast implants do not increase cancer risk

Post-surgical breast changes

Scarring and fat necrosis may mimic malignancy

Radiation therapy effects

Early edema followed by late fibrosis and density increase

Breast imaging golden rule

Compare both breasts and prior studies before interpretation

Mammo-

Breast

Mast-

Breast

Galacto-

Milk

Gyneco-

Female

Hyper-

Excessive or increased

Hypo-

Decreased or deficient

Neo-

New or abnormal growth

Dys-

Abnormal or difficult

Lact-

Milk production

Duct-

Channel or tube

Lob-

Lobe or rounded structure

Aden-

Gland

Onco-

Tumor or mass

Carcin-

Cancer

Fibro-

Fibrous tissue

Steato-

Fat

-oma

Tumor or mass

-itis

Inflammation

-osis

Abnormal condition

-plasia

Formation or growth

-ectomy

Surgical removal