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things to know before surgery of mammogram

             things to know before surgery of mammogram

An introduction to the basics of mammography first we will discuss what is mammography a mammogram is an imaging study that uses x-rays to evaluate the breast for boobs cancer.

Types of Mammograms:

There are two types of mammograms that are performed.

1.In the screening setting.
2.In the diagnostic setting.


mammogram behind the machine


In general screening, mammograms are performed in all women every 1 to 2 years after the age of 40 with the goal of identifying a boobs cancer screening mammography.

Recommendations are a current hot topic both in the medical community as well as the media with varying recommendations related to the age of initiating and concluding the screening imaging as well as the frequency to perform it.

Diagnostic mammography is when the patient has additional mammographic images above and beyond the routine views that are performed one scenario is when an abnormality is seen on the screening study and the patient returns for additional views to further evaluate that finding another scenario is when the patient has a symptom related to their breasts such as a lump pain or nipple discharge.

How is Mammogram done:

There are four standard views performed in every mammogram with two views of each breast this image here and this image here are two images of the right breast and this image here are two views of the left breast.

As you can see rights and left's are reversed as is the case with other imaging studies the name of the image comes from the location and the direction of the x-ray beam, for example, a CC view stands for cranial cado which means that the x-ray extends from the cranial or the superior aspect of the breast and extends through the Brass towards the patient's feet this is an image that shows how the CC view is performed.

The breast is placed in compression and the x-ray beam extends from above the boob through the boob to hit the image receptor below what you get are these two images here the upper aspect of both of these images represent the outer portion of the breast.

The lower aspect of both of these images represent the inner aspect of the breast so just to restate this is the outer left breast this is the outer right breast this is the inner right breast and this is the inner left breast the MLS view stands for medial-lateral oblique which is the direction that the x-ray beam travels when the image is acquired in the MLS projection the breast is placed in compression at a 45-degree angle and the x-ray beam travels from the medial aspect of the breast which is here through to the lateral aspect of the breast.

The result are these two images over here where this is the superior aspect of the breast and this is the inferior aspect of the breast so just to restate this is the left upper breast the left lower breast the right upper breast and the right lower breast we use these images to help us triangulate we're finding.

If we see a mass here and here in the left breast, we can say that the mass is in the upper inner left boob alternatively if we see calcifications here and here in the right boob we can say that the calcifications are in the lower outer right boob.

Now we'll review patient positioning correct positioning of the breast within the mammal unit is very important and there are certain requirements of all studies the breath needs to be pulled out far enough from the chest wall to make sure that all of the boobs is being imaged the way that we evaluate this is by making sure that we see the pectoralis muscle on the MLL view.

 To the level of the mid nipple line and we also want to see the pectoralis muscle on the CC view and the pectoralis is representing the chest wall so we know we have all of the breast tissue anterior or superficial to that along these lines the distance from the nipple to the chest wall this measurement here should not differ between the MLL and the CC view.

It should not be more than one centimeter if they do then it suggests that one of the images captured more of the breast tissue than the other image and that we might be missing some of the breasts on one of those pictures.

The nipple should be in profile on at least one of these pictures to make sure that we've adequately imaged the retro areola region and haven't missed this area or confuse the nipple with a potential underlying mass the nipple should also be angled slightly up on the MLL view.

What happens after a Mammogram?

To make sure that the entire boobs is being lifted and that you're able to evaluate this lower inferior portion of the boob and lastly each MLS image should adequately capture this portion here which is referred to as the inframammary fold and this again is to make sure that you've sufficiently captured the inferior and the posterior aspect of the boobs now that we've acquired our technically adequate study.

We have to interpret the imaging and the first thing that we evaluate is what the tissue density is this refers to the percentage of glandular tissue relative to breast fat within the breast glandular tissue is the portion of the breast that has ducks and lobules and produces milk.

If a woman were to be lactating it typically is white whereas boob fat is typically gray on a mammogram so there's a spectrum of proportions that we typically see this image on the Left represents what we call a predominantly fatty boob where there really is no white glandular tissue within this breast that might potentially hide a boob cancer you can see that boob is predominantly gray/black the next level is something that we call scattered fiber glandular densities.

What if I have an abnormal mammogram?


 You can see that there are these little white areas within it that represent little areas of fiber glandular tissue and then we get into the next category which is called heterogeneous lis dense breast tissue and you can see that there's far more light glandular tissue here scattered throughout the boobs.

The last category is dense which is here where the breast is predominantly that dense fiber glandular tissue categorize it because we know that as a woman's breast has increasing fiber glandular densities there's an increasing chance that we'll miss an underlying breast cancer the reason for that is that glandular tissue is white and breast cancer is white.

So the fiber glandular tissue can mask an underlying malignancy when interpreting the mammogram or looking predominantly at three things masses calcifications and architectural distortion a mass is a space-occupying lesion that we can see on two of the projections both the CC and the MLL view an example of a mass.

 I'm going to circle it this lesion here in the lower left breast and this lesion here in the central left breast this is one and the same and it's a breast mass when you see a finding on two views but it doesn't have as discreet borders as you would find with a mass we call it a focal asymmetry.

When you only see a finding on one view we call it an asymmetry alone when looking at a mammogram we also look for calcifications this is an example of a woman with very dense breast tissue you can see this very white fiberglass jeweler tissue.

In all four views however within here the upper central to inner right breast we see these little white dots that seemed to be extending from the chest wall towards the nipple and these are called calcifications these are calcium deposits that lie within the breast and calcification within the breast can happen for a number of different reasons that are both benign and malignant.

We use the imaging characterization of the calcifications to help us decide how worried we are about these calcifications potentially being cancer these are schematics of the breast courtesy of radiology assistant to help you better understand where calcifications and masses form within the breast so here on the right you have a schematic of the breast that shows ducts that branch into smaller ducks and duck rules and here.

 At the end, they branch into these little buds like structures called a Sanae and it's within these Asuna that milk is formed which then extends through the ducts towards the nipple when a woman is lactating this unit here is called the terminal duct lobular unit and this is the location where a predominant number of breast cancers form it is also a common location for calcifications to develop calcifications can form within the acid I as in this example here this is an example of banal benign calcifications called milk of calcium fluid within the acid.

I may be present even when a woman is not lactating and this fluid can calcify these calcifications layer within the fluid and can form a teacup configuration as you see here this feature tells us with certainty that these are not cancer and are in fact benign calcifications to the right.

 Here is an example of a different type of calcifications and these are associated with malignancy these classifications are linear and branching within the small terminal duct jewels and our classic for cancer so ultimately we use the imaging features that we see to help us determine the likelihood that these findings are benign or malignant.

We look for architectural distortion which is really a secondary sign that there might be a boobs cancer within the breast and all that we're seeing and is the pulling in of the tissues around the breast cancer.

How to diagnose mammograms?

In the right central upper breast where there's almost like a sunburst pulling in appearance here and here and this is typically what we see and it's a very subtle finding when we see it we have to make sure that there's an underlying explanation for this area of pulling in does this represent a new breast cancer with associated changes of the surrounding breast tissue or could this be related to a person's prior history of surgery or trauma to the breast in this location for this reason we often put scar markers over the area.

Where a person has had prior breast cancer surgery so that we know that any architectural distortion that we see in this location is related to that intervention we don't typically put markers for surgeries for benign disease but there is an indication for this in the tech notes that we have lastly we are going to talk about how we report these imaging studies and we use something called the breast imaging reporting and data system is otherwise known as byroads.

To guide how we dictate our reports and how we code each exam the byroads provides recommended words to use to describe the finding that we see on mammography so that everybody who's reading our reports understands whether we're worried or not worried about a finding for example if we see a mass that does not look like cancer and is round or circumscribed and doesn't have vascularity to it if we see a speculated irregular mass we use these words to suggest that this might be cancer the bioroids also provides a coding scheme that is required for each report that we dictate the coding system is as follows.

 If we have a finding that we think we need additional imaging in order to better evaluate that finding we will code this study as a by reg 0 which means that the assessment is incomplete once we state this means we either need to bring the patient back for additional pictures or we need to get prior imaging in order to compare the current study to old exams this happens most frequently at the time of the screening mammogram interpretation we use this code when there is absolutely no finding on the mammogram study we use byroads.

When we see a finding but we know with certainty that it's not cancer and this might be for example an intra memory lymph node which really is just lymph in that's living in the breasts but not cancerous or not cancerous looking by Reds.

When we see a finding and we're not really sure if it's cancer but we think it's probably not cancer, in fact, we think with 98% certainty that it's not a cancer and in cases like this would typically recommend a short interval follow-up ranging from one month to 6 months when we code something as a by Red's for we are saying that we are worried about this finding and we think it needs to be biopsied within the by Reds for category we have three subcategories by Reds for a by Red's for B and by Reds for C which indicate how worried we are about that finding a buyer ads for C.

It means that we are very concerned that the finding is a cancer a buyer ads5 is one step up which by definition the finding is highly suggestive of malignancy the recommendation for buyer adds five lesions is often biopsy as well however the patient may go to surgical excision or have additional imaging performed at that time a by red six lesion or rather we code reports as by red six.

When the patient has a recent diagnosis of cancer that has yet to be treated and so we're saying that there is a biopsy-proven malignancy present in the breast at the current time again every report that we dictate has a code assigned to it.


mammogram love


We are therefore telling everybody who reads our reports how worried we are about the findings that we see and what our recommendation is what we think should happen next so in conclusion we have reviewed.

What a mammogram is what the different types of mammograms are what the for routine views are of the mammogram how to properly position for mammogram what the basics are for image interpretation and how we use the by Reds code this information should serve as a foundation for the remaining rotation that you have through the breast service.

things to know before surgery of mammogram things to know before surgery of mammogram Reviewed by Technical Vishwadeep on Wednesday, January 22, 2020 Rating: 5

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