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Treza12
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all_dataset2

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Screening
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Diagnosis
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Staging
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Treatment
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800
Breast Cancer Screening
CONCLUSION
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nan nan
Jonsson H, Johansson R, Lenner P. Increased incidence of invasive breast cancer after the introduction of service screening with mammography in Sweden. Int J Cancer 2005;117(5):842–847.
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0.3
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0.3
0.3
0.3
0.3
0.3
1
801
Breast Cancer Screening
CONCLUSION
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nan nan
White E, Lee CY, Kristal AR. Evaluation of the increase in breast can- cer incidence in relation to mammography use. J Natl Cancer Inst 1990; 82(19):1546–1552.
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0.3
0.3
0.3
0.3
0.3
0.3
0.3
1
802
Breast Cancer Screening
CONCLUSION
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Feuer EJ, Wun LM. How much of the recent rise in breast cancer inci- dence can be explained by increases in mammography utilization? A dynamic population model approach. Am J Epidemiol 1992;136(12): 1423–1436.
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0.05
0.07
0.08
0.09
0.06
0.08
0.09
4
803
Breast Cancer Screening
CONCLUSION
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Zahl PH, Strand BH, Maehlen J. Incidence of breast cancer in Norway and Sweden during introduction of nationwide screening: prospective cohort study. BMJ 2004;328(7445):921–924.
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0.09
0.09
0.08
0.08
0.09
3
804
Breast Cancer Screening
CONCLUSION
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Gotzsche PC, Nielsen M. Screening for breast cancer with mammogra- phy. Cochrane Database Syst Rev. 2006(4):CD001877.
6
0.005
0.09
0.03
0.09
0.005
0.01
0.09
2
805
Breast Cancer Screening
CONCLUSION
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nan nan
Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med 2012;367(21):1998–2005.
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0.4
0.3
0.3
0.3
0.3
0.3
0.4
1
806
Breast Cancer Screening
CONCLUSION
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nan nan
Mandelblatt J, Saha S, Teutsch S, et al. The cost-effectiveness of screen- ing mammography beyond age 65 years: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2003;139(10):835–842.
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0.07
0.08
0.09
0.1
0.09
0.08
0.1
4
807
Breast Cancer Screening
CONCLUSION
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nan nan
Walter LC, Lindquist K, Covinsky KE. Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med 2004;140(9):681–688.
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0.005
0.003
0.001
0.001
0.001
0.001
0.005
1
808
Breast Cancer Screening
CONCLUSION
null
nan nan
Lee CH, Dershaw DD, Kopans D, et al. Breast cancer screening with imag- ing: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 2010;7(1):18–27.
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0.005
0.09
0.06
0.04
0.03
0.07
0.09
2
809
Breast Cancer Screening
CONCLUSION
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nan nan
Chen S, Parmigiani G. Meta-analysis of BRCA1 and BRCA2 penetrance.
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0.07
0.08
0.09
0.06
0.04
0.09
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810
Breast Cancer Screening
CONCLUSION
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Tilanus-Linthorst M, Verhoog L, Obdeijn IM, et al. A BRCA1/2 mutation, high breast density and prominent pushing margins of a tumor indepen- dently contribute to a frequent false-negative mammography. Int J Cancer 2002;102(1):91–95.
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0.08
0.07
0.06
0.04
0.03
0.02
0.08
1
811
Breast Cancer Screening
CONCLUSION
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nan nan
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 2 ed. Jenkintown, PA: National Comprehensive Cancer Network, 2011.
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0.005
0.003
0.007
0.004
0.008
0.006
0.008
5
812
Breast Cancer Screening
CONCLUSION
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nan nan
Andrieu N, Easton DF, Chang-Claude J, et al. Effect of chest X-rays on the risk of breast cancer among BRCA1/2 mutation carriers in the inter- national BRCA1/2 carrier cohort study: a report from the EMBRACE, GENEPSO, GEO-HEBON, and IBCCS Collaborators’ Group. J Clin Oncol 2006;24(21):3361–3366.
6
0.005
0.09
0.08
0.07
0.08
0.08
0.09
2
813
Breast Cancer Screening
CONCLUSION
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nan nan
Narod SA, Lubinski J, Ghadirian P, et al. Screening mammography and risk of breast cancer in BRCA1 and BRCA2 mutation carriers: a case- control study. Lancet Oncol 2006;7(5):402–406.
6
0.098
0.093
0.098
0.098
0.098
0.098
0.098
1
814
Breast Cancer Screening
CONCLUSION
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nan nan
Goldfrank D, Chuai S, Bernstein JL, et al. Effect of mammography on breast cancer risk in women with mutations in BRCA1 or BRCA2. Cancer Epidemiol Biomarkers Prev 2006;15(11):2311–2313.
6
0.098
0.074
0.088
0.098
0.098
0.098
0.098
1
815
Breast Cancer Screening
CONCLUSION
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nan nan
Berrington de Gonzalez A, Berg CD, Visvanathan K, et al. Estimated risk of radiation-induced breast cancer from mammographic screening for young BRCA mutation carriers. J Natl Cancer Inst 2009;101(3):205–209.
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0.4
0.3
0.3
0.3
0.3
0.3
0.4
1
816
Breast Cancer Screening
CONCLUSION
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nan nan
Lehman CD, Blume JD, Weatherall P, et al. Screening women at high risk for breast cancer with mammography and magnetic resonance imaging. Cancer 2005;103(9):1898–1905.
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0.7
0.5
0.6
0.5
0.7
3
817
Breast Cancer Screening
CONCLUSION
null
nan nan
Lehman CD, Isaacs C, Schnall MD, et al. Cancer yield of mammography, MR, and US in high-risk women: prospective multi-institution breast can- cer screening study. Radiology 2007;244(2):381–388.
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0.005
0.09
0.06
0.09
0.08
0.08
0.09
2
818
Breast Cancer Screening
CONCLUSION
null
nan nan
Sardanelli F, Podo F, D’Agnolo G, et al. Multicenter comparative mul- timodality surveillance of women at genetic-familial high risk for breast cancer (HIBCRIT study): interim results. Radiology 2007;242(3): 698–715.
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0.1
0.1
0.1
0.1
0.1
0.1
0.1
1
819
Breast Cancer Screening
CONCLUSION
null
nan nan
Kuhl C, Weigel S, Schrading S, et al. Prospective multicenter cohort study to refine management recommendations for women at elevated familial risk of breast cancer: the EVA trial. J Clin Oncol 2010;28(9): 1450–1457.
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0.06
0.03
0.03
0.03
0.03
0.03
0.06
1
820
Breast Cancer Screening
CONCLUSION
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nan nan
Shah P, Rosen M, Stopfer J, et al. Prospective study of breast MRI in BRCA1 and BRCA2 mutation carriers: effect of mutation status on cancer incidence. Breast Cancer Res Treat 2009;118(3):539–546.
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0.07
0.08
0.09
0.1
0.08
0.09
0.1
4
821
Breast Cancer Screening
CONCLUSION
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nan nan
Rijnsburger AJ, Obdeijn IM, Kaas R, et al. BRCA1-associated breast cancers present differently from BRCA2-associated and familial cases: long-term follow-up of the Dutch MRISC Screening Study. J Clin Oncol 2010;28(36):5265–5273.
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0.09
0.09
0.09
0.09
0.09
0.09
0.09
1
822
Breast Cancer Screening
CONCLUSION
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nan nan
Weinstein SP, Localio AR, Conant EF, et al. Multimodality screening of high-risk women: a prospective cohort study. J Clin Oncol 2009;27(36): 6124–6128.
6
0.005
0.01
0.01
0.01
0.01
0.01
0.01
2
823
Breast Cancer Screening
CONCLUSION
null
nan nan
Sardanelli F, Podo F, Santoro F, et al. Multicenter surveillance of women at high genetic breast cancer risk using mammography, ultrasonog- raphy, and contrast-enhanced magnetic resonance imaging (the high breast cancer risk italian 1 study): final results. Invest Radiol 2011;46(2): 94–105.
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0.08
0.07
0.08
0.08
0.08
0.08
0.08
1
824
Breast Cancer Screening
CONCLUSION
null
nan nan
Lee JM, McMahon PM, Kong CY, et al. Cost-effectiveness of breast MR imaging and screen-film mammography for screening BRCA1 gene muta- tion carriers. Radiology 2010;254(3):793–800.
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0.06
0.08
0.09
0.09
0.09
0.09
0.09
3
825
Breast Cancer Screening
CONCLUSION
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nan nan
Cott Chubiz JE, Lee JM, Gilmore ME, et al. Cost-effectiveness of alternat- ing magnetic resonance imaging and digital mammography screening in BRCA1 and BRCA2 gene mutation carriers. Cancer November 26 2012.
6
0.005
0.09
0.08
0.07
0.04
0.03
0.09
2
826
Breast Cancer Screening
CONCLUSION
null
nan nan
American Cancer Society. What are the key statistics about breast can- cer in men? Breast Cancer in Men, 2012; http://www.cancer.org/cancer/ breastcancerinmen/detailedguide/breast-cancer-in-men-key-statistics. Accessed December 14, 2012.
6
0.005
0.003
0.007
0.008
0.006
0.009
0.009
6
827
Breast Cancer Screening
CONCLUSION
null
nan nan
U.S. Food and Drug Administration. Consumer Information (MQSA). Radiation-Emitting Products, 2011; http://www.fda.gov/Radiation- EmittingProducts/MammographyQualityStandardsActandProgram/ ConsumerInformation/default.htm. Accessed December 3, 2012.
6
0.005
0.09
0.08
0.07
0.06
0.04
0.09
2
828
Breast Cancer Screening
CONCLUSION
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United States General Accounting Office. Mammography Services: Impact of Federal Legislation on Quality, Access, and Health Outcomes. Report to Congressional Committees, 1997; http://www.fda.gov/downloads/Radiation- EmittingProducts%20/MammographyQualityStandardsActandProgram/ Reports/ucm124388.pdf. Accessed Dec 3, 201...
6
0.005
0.06
0.01
0.01
0.01
0.01
0.06
2
829
Breast Cancer Screening
CONCLUSION
null
nan nan
American College of Radiology. Ultrasound Accreditation. 2012; http://www. acr.org/Quality-Safety/Accreditation/Ultrasound. Accessed December 3, 2012.
6
0.005
0.09
0.08
0.07
0.06
0.04
0.09
2
830
Breast Cancer Screening
CONCLUSION
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nan nan
Agency for Healthcare Research and Quality. National Guidelines Clearinghouse. 2012; http://www.guidelines.gov/. Accessed November 21, 2012.
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0.005
0.003
0.007
0.004
0.008
0.006
0.008
5
831
Breast Cancer Screening
CONCLUSION
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nan nan
C H A P T E R 11
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0.05
0.075
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4
832
Imaging Analysis: Mammography
null
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Mark A. Helvie and Stephanie K. Patterson
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0.09
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0.065
0.1
0.095
0.1
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833
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Screening versus Diagnostic Mammography
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834
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Digital Breast Tomosynthesis
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835
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Mammographic Interpretation Radiologists’ Performance Double Reading
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836
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Computer-Aided Detection (CAD)
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0.095
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837
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Calcifications
6
0.015
0.023
0.046
0.078
0.091
0.099
0.099
6
838
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Architectural Distortion Unusual Findings
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0
0.015
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839
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Skin Changes or Inflammatory Breast Findings Axillary Lymph Node Presentation of Breast Cancer Symptomatic Pregnant and Lactating Women
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0.08
0.07
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0.09
2
840
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Mammographic Assessment of Breast Density as a Risk Factor
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841
Imaging Analysis: Mammography
CHAPTER CONTENTS
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Factors Affecting Mammographic Sensitivity 1
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0.07
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Imaging Analysis: Mammography
CHAPTER CONTENTS
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Hormone Therapy Biologic Subtypes Patient Factors
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843
Imaging Analysis: Mammography
CHAPTER CONTENTS
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and eventually led to screening trials, primarily in northern European countries and North America. These showed mor- tality reduction in screened women which formed the basis for the current recommendation for mammographic screen- ing (1). While some controversy exists regarding frequency and age to begin screening, m...
6
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0.03
0.04
0.07
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0.02
0.07
4
844
Imaging Analysis: Mammography
CHAPTER CONTENTS
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106
6
0.095
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1
845
Imaging Analysis: Mammography
TECHNIQUE
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Basic understanding of radiologic physics is necessary for mammographic interpretation. A typical mammographic machine generates low energy (25–32 kVp) x-rays utilizing a small (0.3-mm) focal spot source, such as molybdenum, rho- dium, or tungsten. The breast is compressed between an image receptor (film or digital det...
6
0.097
0.1
0.096
0.094
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0.1
2
846
Imaging Analysis: Mammography
TECHNIQUE
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Image quality is affected by a host of factors including
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0.09
0.085
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0.1
0.1
0.1
5
847
Imaging Analysis: Mammography
TECHNIQUE
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breast tissue “density,” compressed thickness, positioning, motion, focal spot size, detector performance, and radiation dose. Manufacturers attempt to maximize multiple factors to achieve optimum image quality at the lowest possible radiation dose. The FDA limits dose to 3 mGy (300 mrad) for an average thickness breas...
6
0.095
0.087
0.062
0.041
0.038
0.035
0.095
1
848
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
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Screening mammography refers to obtaining routine mam- mographic images of asymptomatic women in order to detect cancer at a preclinical stage. This is the primary role of mammography. The goal of screening is high sensitivity for early cancer detection. Diagnostic mammography refers to mammography used to evaluate abn...
6
0.095
0.087
0.063
0.045
0.032
0.021
0.095
1
849
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
null
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thickness in an area of concern. Unfortunately, the distinc- tions between screening and diagnostic mammography have been confused by definitions utilized for insurance billing purposes. An insurer may consider a woman with a prior biopsy of “fibrocystic disease” as “diagnostic” mam- mography for billing even though th...
6
0
0.015
0.02
0.03
0.04
0.065
0.065
6
850
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
null
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Not infrequently, findings noted on screening mammog- raphy require additional diagnostic imaging to resolve. Only a small portion of women recalled for diagnostic imaging will have cancer. A simplified U.S. screening pyramid (Fig. 11-1) provides an overview of the screening process. Assuming a cancer incidence of 3 pe...
6
0.92
0.8
0.7
0.1
0.03
0
0.92
1
851
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
Digital Breast Tomosynthesis
nan nan
Screens
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0.09
0.085
0.07
0.065
0.04
0.03
0.09
1
852
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
Digital Breast Tomosynthesis
nan nan
Recalls
6
0.01
0.095
0.08
0.07
0.06
0.02
0.095
2
853
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
Digital Breast Tomosynthesis
nan nan
Biopsy
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0.01
0.095
0.08
0.07
0.06
0.02
0.095
2
854
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
Digital Breast Tomosynthesis
nan nan
FIGURE 11-1 Simplified screening pyramid showing typical outcomes of 1,000 annually screened women of normal risk.
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0.095
0.087
0.062
0.043
0.035
0.027
0.095
1
855
Imaging Analysis: Mammography
SCREENING VERSUS DIAGNOSTIC MAMMOGRAPHY
Digital Breast Tomosynthesis
nan nan
FIGURE 11-2 (A) Film screen mediolateral oblique mammography view of a patient with invasive ductal carcinoma (arrow). (B) The cancer is better visualized on the 1-mm-thick tomosynthesis image.
6
0
0.095
0.087
0.063
0.048
0.008
0.095
2
856
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
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Mammographic interpretation is a difficult task that can be dichotomized into two basic processes: detection (perception, visualization) of a possible abnormality and characterization (classification, analysis) of a potential abnormality. The goal of image interpretation by screening is high-detection sensitivity which...
6
0.085
0.092
0.076
0.081
0.083
0.084
0.092
2
857
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
null
nan nan
commonly used U.S. threshold for biopsy is a probability of malignancy greater than or equal to 2% which corresponds to a BI-RADS classification of “suspicious finding” or BI-RADS 4 (7). Experienced readers can assign a reasonable proba- bility of malignancy to a finding recommended for biopsy, but tissue diagnosis is ...
6
0.015
0.038
0.069
0.087
0.092
0.098
0.098
6
858
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Radiologists’ Performance
nan nan
Interpretation of mammographic images involves the art and science of medicine. While the recognition and charac- terization of classic large tumors is often straightforward, the detection of the small, subtle lesions can challenge the most expert reader. Interpretive variability exists for screen- ing and diagnostic m...
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0.05
0.09
0.08
0.07
0.06
0.04
0.09
2
859
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Radiologists’ Performance
nan nan
Similar to other areas of human endeavor and medicine, differences have been found among radiologists interpret- ing mammograms (8–14). Beam et al., using an experimental model, found variation among practicing American radiolo- gists with overall sensitivity ranging from 59% to 100% and specificity 35% to 98% (11). Si...
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0.1
0.08
0.09
0.1
4
860
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Radiologists’ Performance
nan nan
associated with performance. To date, no definite set of parameters completely predict reader expertise. Common associations with favorable interpretive skills and expertise include concentration in breast imaging, academic practice, continuing education, association with a multidisciplinary breast center, and practice...
6
0.095
0.076
0.034
0.098
0.098
0.098
0.098
4
861
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Radiologists’ Performance
nan nan
Sensitivity and specificity are inversely related for any particular reader due to nonspecific appearance of early breast cancer. Sensitivity increases with recall rate over a range of recall rates. High sensitivity can be achieved only when a sufficient number of women are recalled from screen- ing for additional diag...
6
0.09
0.09
0.09
0.09
0.09
0.09
0.09
1
862
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Radiologists’ Performance
nan nan
Mammographic sensitivity increases with reader obser-
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0.065
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1
863
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Radiologists’ Performance
nan nan
vation time. Nodine and colleagues noted experienced mammographers made 71% of detections in the first 25 sec- onds but had continued true positive detections for approx- imately 80 seconds, albeit at a slower rate (18). Krupinski observed the detection of subtle findings occurred later in observation cycle than obviou...
6
0.06
0.03
0.02
0.01
0.01
0.01
0.06
1
864
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Double Reading
nan nan
Double reading (DR) has been advocated as a method to detect abnormalities overlooked by a single reader. Most independent DR studies have demonstrated improvement in sensitivity at a cost of lowered specificity. A review of clinical independent DR studies shows detection rate improvements of 4% to 15% (20). However, r...
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0.09
0.1
0.08
0.09
0.1
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865
Imaging Analysis: Mammography
MAMMOGRAPHIC INTERPRETATION
Computer-Aided Detection (CAD)
nan nan
CAD systems, commercially available, use artificial computer intelligence in an attempt to act as a second reader. Like DR, most clinical CAD trials have shown improvement in sen- sitivity but declines in specificity. A CAD system functions as a second reader by placing “marks” on a mammographic site deemed suspicious....
6
0.05
0.05
0.05
0.05
0.05
0.05
0.05
1
866
Imaging Analysis: Mammography
CHARACTERIZATION OF MAMMOGRAPHIC FINDINGS
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Characterization is the process to determine if a suspected mammographic finding represents normal tissue, a benign finding, or potentially breast cancer. The goal of character- ization is to establish a probability of malignancy and thresh- old the finding to determine if tissue sampling is required. This assessment i...
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0.01
0.095
0.08
0.07
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0.04
0.095
2
867
Imaging Analysis: Mammography
CHARACTERIZATION OF MAMMOGRAPHIC FINDINGS
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Mammography is not tissue specific. Some very low- probability-appearing abnormalities will prove to be malig- nant and conversely, some high-probability findings will be benign. Distinguishing between what lesions require biopsy and which can be followed involves thresholds. Most U.S. radiologists recommend biopsy for...
6
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0.085
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0.04
0.03
0.01
0.09
1
868
Imaging Analysis: Mammography
CHARACTERIZATION OF MAMMOGRAPHIC FINDINGS
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experts: Positive predictive value for biopsy 25% to 40%, recall rate 5% to 10%, incident cancer detection 2 to 4 per
6
0.025
0.002
0.002
0.002
0.002
0.002
0.025
1
869
Imaging Analysis: Mammography
CHARACTERIZATION OF MAMMOGRAPHIC FINDINGS
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tivity >85%, and specificity >90% (4). Different patient popu- lations will significantly impact on the ability of a screening population to attain these goals.
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0.07
0.06
0.03
0.02
0.01
0.01
0.07
1
870
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
To provide national uniformity for reporting and assess- ment of mammographic findings, the American College of Radiology developed a lexicon for final assessment clas- sifications (“BI-RADS”) (7). After analyzing a mammogram,
6
0.09
0.085
0.1
0.1
0.1
0.1
0.1
3
871
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
radiologists classify their findings into one of five final assessment categories (2,7). MQSA requires the use of final assessment categories paralleling those of the American College of Radiology (2). This lexicon is now used interna- tionally. The final assessment categories are presented in Table 11-1. The categorie...
6
0.09
0.085
0.06
0.04
0.03
0.02
0.09
1
872
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
Category 1: negative Category 2: benign finding
6
0.09
0.085
0.07
0.065
0.04
0.03
0.09
1
873
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
Category 3: probably benign finding Category 4: suspicious abnormality
6
0.09
0.085
0.07
0.065
0.01
0.02
0.09
1
874
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
Category 5: highly suggestive of malignancy (risk 95%)
6
0.01
0.08
0.07
0.06
0.04
0.03
0.08
2
875
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
Category 4 can be subdivided by risk into 4A (low), 4B (intermediate), and 4C (moderate). Functionally, Categories 1 and 2 represent a normal screening mammogram without
6
0.05
0.08
0.07
0.09
0.06
0.03
0.09
4
876
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
findings of malignancy. Category 2 may include a normal finding such as a calcified fibroadenoma, normal lymph node, or stable benign appearing calcifications. Category 3, probably benign, represents a finding of such low prob- ability for malignancy that imaging follow-up is recom- mended instead of biopsy. Multiple s...
6
0.098
0.075
0.085
0.095
0.09
0.08
0.098
1
877
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
A category “incomplete” (BI-RADS 0) is used when a screening study requires additional imaging such as recall
6
0.095
0.087
0.063
0.042
0.01
0.001
0.095
1
878
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
for diagnostic mammograms or comparison with older exams prior to rendering a final assessment. An incomplete assessment is just that, incomplete. An incomplete exam should not be considered “abnormal” as most will be shown to be normal. Only after diagnostic imaging or compari- son with older films can a Category 1 to...
6
0.09
0.08
0.07
0.06
0.04
0.03
0.09
1
879
Imaging Analysis: Mammography
FDA/BI-RADS FINAL ASSESSMENT CATEGORIES
null
nan nan
“negative” mammogram report. In these situations, tissue biopsy is recommended when the palpable or sonographic findings are suspicious even if the mammogram is “negative.” A “negative” mammogram in the presence of a suspicious clinical finding, suspicious USN, or suspicious MRI should never obviate a needed surgical b...
6
0.09
0.085
0.075
0.065
0.045
0.035
0.09
1
880
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
null
nan nan
OF BREAST CANCER
6
0.09
0.085
0.07
0.065
0.04
0.03
0.09
1
881
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
null
nan nan
There is a tendency to limit mammographic analysis to morphologic features. In practice, temporal change on serial mammograms provides a separate axis of analysis from morphologic features. A group of four calcifications that have been present for five years and unchanged may be observed while four new calcifications t...
6
0.005
0.01
0.02
0.03
0.04
0.05
0.05
6
882
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
null
nan nan
FIGURE 11-3 Smoothly marginated round 14-mm mass. Sonogram demonstrated a simple cyst.
6
0.09
0.085
0.07
0.065
0.05
0.02
0.09
1
883
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Masses
nan nan
Masses account for nearly half of all mammographic can- cers. Masses refer to space occupying lesions that can be detected in two different projections. If a finding is noted only in a single view same as a CC view, it is referred to as a focal asymmetry. A focal asymmetry may or may not prove to be a “real” finding. M...
6
0.05
0.09
0.08
0.1
0.07
0.06
0.1
4
884
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Masses
Shape nan
Because of the infiltrative biologic nature of most breast cancers, irregular or lobular shaped masses are more likely associated with malignancy than round or oval masses.
6
0
0.015
0.02
0.03
0.04
0.06
0.06
6
885
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Masses
Mass Density nan
Lesions that are fat density (black on a mammogram) are benign and do not require tissue diagnosis. These typi-
6
0.09
0.085
0.07
0.065
0.04
0.03
0.09
1
886
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Masses
Mass Density nan
FIGURE 11-4 Spot compression view of a circumscribed mass with associated, very coarse calcifications, typical for a benign, degenerating fibroadenoma.
6
0.09
0.085
0.075
0.065
0.055
0.035
0.09
1
887
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Masses
Mass Density nan
FIGURE 11-5 (A) Craniocaudal view shows a new small focal asymmetry in the lateral aspect of the breast (arrow). (B) Spot compression magnification view confirms the pres- ence of an indistinct, noncalcified mass: invasive ductal carcinoma.
6
0.09
0.08
0.07
0.06
0.04
0.03
0.09
1
888
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Masses
Mass Density nan
cally represent lipomas or areas of traumatic fat necrosis with oil cyst formation. Certain circumscribed fat contain- ing and fibroglandular density tissues may have appearance pathognomonic for a benign hamartoma and not require biopsy. Otherwise, density is of limited value in discriminat- ing benign from malignant ...
6
0
0.015
0.02
0.03
0.04
0.065
0.065
6
889
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
nan nan
For reasons not entirely understood, calcifications are formed or are associated with breast carcinoma. Fortunately, calcifications are exquisitely detected by mammography with particles as small as 50 m being visible. Because cal- cium absorbs x-rays, they produce a bright white spot on a mammogram. This inherent con...
6
0.098
0.1
0.076
0.092
0.094
0.093
0.1
2
890
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
nan nan
significance of calcifications. Magnification mammography is critical in characterizing calcifications. This allows better morphologic assessment of individual particles and clus- ters. Assessment of microcalcifications includes location, morphology, distribution, number, and biologic stability or progression. All of t...
6
0.09
0.085
0.075
0.065
0.045
0.035
0.09
1
891
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Location nan
Calcifications present within the skin may masquerade as parenchymal calcifications. These calcifications are typically small (less than 1 mm) with lucent centers. Radiologists can, with incremental imaging, prove with certainty that calcifica- tions reside in the skin by tangential views. Dermal calcifica- tions requi...
6
0
0.025
0.37005
0.46002
0.89005
0.93007
0.93007
6
892
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Morphology nan
FIGURE 11-6 Spot compression view demonstrates the circumscribed margins of an invasive ductal carcinoma, medullary type.
6
0.09
0.085
0.075
0.04
0.03
0.02
0.09
1
893
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Morphology nan
High probability for cancer calcifications include pleo- morphic or heterogeneous calcifications which are fine
6
0.09
0.085
0.075
0.065
0.045
0.035
0.09
1
894
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Morphology nan
FIGURE 11-7 (A) Palpable, spiculated mass with associated microcalcifications (arrow).
6
0.09
0.085
0.06
0.04
0.03
0.02
0.09
1
895
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Morphology nan
(B) Spot magnification view confirms the presence of the spiculated mass with associated calcifications: invasive ductal carcinoma with DCIS.
6
0.09
0.1
0.085
0.075
0.06
0.04
0.1
2
896
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Morphology nan
FIGURE 11-8 Benign calcifications associated with duc- tal ectasia. These rod-shaped calcifications are oriented toward the nipple in this postmenopausal woman.
6
0.09
0.075
0.06
0.04
0.03
0.02
0.09
1
897
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Morphology nan
linear or fine linear branching calcifications conforming to a casting pattern of a duct. These calcifications are often associated with high-grade ductal in situ, with or without invasive cancer (Fig. 11-11).
6
0.095
0.087
0.063
0.042
0.031
0.021
0.095
1
898
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Number nan
Although no number absolutely distinguishes benign from malignant, attempts have been made to determine reason- able thresholds for clinical intervention based on number of
6
0.09
0.085
0.075
0.065
0.045
0.035
0.09
1
899
Imaging Analysis: Mammography
MAMMOGRAPHIC APPEARANCE
Calcifications
Number nan
FIGURE 11-9 Benign calcifications associated with lucent masses typical for oil cysts and fat necrosis.
6
0
0.05
0.025
0.075
0
0
0.075
4