For instance if there is a mass that causes architectural distortion, the likelihood of malignancy is greater than in the case of a mass without distortion. Notice the distortion of the normal breast architecture on oblique view yellow circle and magnification view. A resection was performed and only scar tissue was found in the specimen. Findings that represent unilateral deposits of fibroglandulair tissue not conforming to the definition of a mass.
Here an example of global asymmetry. In this patient this is not a normal variant, since there are associated features, that indicate the possibility of malignancy like skin thickening, thickened septa and subtle nipple retraction.
Radiology of Birds: An Atlas of Normal Anatomy and Positioning
Ultrasound not shown detected multiple small masses that proved to be adenocarcinoma. All types of asymmmetry have different border contours than true masses and also lack the conspicuity of masses. Asymmetries appear similar to other discrete areas of fibroglandulair tissue except that they are unitaleral, with no mirror-image correlate in the opposite breast. An asymmetry demonstrates concave outward borders and usually is interspersed with fat, whereas a mass demonstrates convex outward borders and appears denser in the center than at the periphery. The use of the term "density" is confusing, as the term "density" should only be used to describe the x-ray attenuation of a mass compared to an equal volume of fibroglandular tissue.
In the atlas calcifications were classified by morphology and distribution either as benign, intermediate concern or high probability of malignancy. In the version the approach has changed. Since calcifications of intermediate concern and of high probability of malignancy all are being treated the same way, which usually means biopsy, it is logic to group them together.
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Calcifications are now either typically benign or of suspicious morphology. Within this last group the chances of malignancy are different depending on their morphology BI-RADS 4B or 4C and also depending on their distribution. There is one exception of the rule: an isolated group of punctuate calcifications that is new, increasing, linear, or segmental in distribution, or adjacent to a known cancer can be assigned as probably benign or suspicious.
Read more on breast calcifications. The arrangement of calcifications, the distribution, is at least as important as morphology. These descriptors are arranged according to the risk of malignancy:. Associated features are things that are seen in association with suspicious findings like masses, asymmetries and calcifications. Associated features play a role in the final assessment. Special cases are findings with features so typical that you do not need to describe them in detail, like for instance an intramammary lymph node or a wart on the skin.
Many descriptors for ultrasound are the same as for mammography. For instance when we describe the shape or margin of a mass. Special cases - cases with a unique diagnosis or pathognomonic ultrasound appearance:. When additional imaging studies are completed, a final assessment is made. Always try to avoid this category by immediately doing additional imaging or retrieving old films before reporting.
Even better to have the old examinations before starting the examination. This patient presented with a mass on the mammogram at screening, which was assigned as BI-RADS 0 needs additional imaging evaluation. Additional ultrasound demonstrated that the mass was caused by an intramammary lymph node. Don't forget to mention in the report that the lymph node on US corresponds with the noncalcified mass on mammography. In the paragraph on location we will discuss how we can be sure that the lymph node that we found with ultrasound is indeed the same as the mammographic mass.
The breasts are symmetric and no masses, architectural distortion or suspicious calcifications are present. Use BI-RADS 1 if there are no abnormal imaging findings in a patient with a palpable abnormality, possible a palpable cancer, BUT add a sentence recommending surgical consultation or tissue diagnosis if clinically indicated. Like BI-RADS 1, this is a normal assessment, but here, the interpreter chooses to describe a benign finding in the mammography report, like:. It is not expected to change over the follow-up interval, but the radiologist would prefer to establish its stability. Lesions appropriately placed in this category include:.
Here a non-palpable sharply defined mass with a group of punctate calcifications. Continue with follow up images. Follow-up at 6, 12 and 24 months showed no change and the final assessment was changed into a Category 2. Nevertheless the patient and the clinician preferred removal, because the radiologist was not able to present a clear differential diagnosis. At 12 month follow up more than five calcifications were noted in a group.
This proved to be DCIS with invasive carcinoma. This category is reserved for findings that do not have the classic appearance of malignancy but are sufficiently suspicious to justify a recommendation for biopsy.
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By subdividing Category 4 into 4A, 4B and 4C , it is encouraged that relevant probabilities for malignancy be indicated within this category so the patient and her physician can make an informed decision on the ultimate course of action. This finding is sufficiently suspicious to justify biopsy. A benign lesion, although unlikely, is a possibility. This could be for instance ectopic glandular tissue within a heterogeneously dense breast. The pathologist could report to you that it is sclerosing adenosis or ductal carcinoma in situ.
Both diagnoses are concordant with the mammographic findings. Highly Suggestive of Malignancy. The current rationale for using category 5 is that if the percutaneous tissue diagnosis is nonmalignant, this automatically should be considered as discordant. Here images of a biopsy proven malignancy. On the initial mammogram a marker is placed in the palpable tumor. Due to the dense fibroglandular tissue the tumor is not well seen. Ultrasound demonstrated a 37 mm mass with indistinct and angular margins and shadowing.
After chemotherapy the tumor is not visible on the mammogram. There may be variability within breast imaging practices, members of a group practice should agree upon a consistent policy for documenting. When you use more modalities, always make sure, that you are dealing with the same lesion. For instance a lesion found with US does not have to be the same as the mammographic or physical finding.
Sometimes repeated mammographic imaging with markers on the lesion found with US can be helpful. Cysts can be aspirated or filled with air after aspiration to make sure that the lesion found on the mammogram is caused by a cyst. Here images that you've seen before. They are of a patient with a new lesion found at screening. With ultrasound an intramammary lymph node was found, but we weren't sure whether this was the same as the mass on the mammogram.
Continue with the mammographic images after contrast injection. Contrast was injected into the node and a repeated mammogram was performed. Here we have proof that the mass is caused by an intramammary lymph node, since the mammographic mass contains the contrast. This patient presented with a tumor in the left breast. However in the right breast a group of amorphous and fine pleomorphic calcifications was seen. Ultrasound examination was performed.
Ultrasound of the region demonstrated an irregular mass, which proved to be an adenocarcinoma with fine needle aspiration FNA. To find out whether the mass was within the area of the calcifications, contrast was injected into the mass. The mass is evidently in another region of the breast. Now a vacuum assisted biopsy has to be performed of the calcifications, because maybe we are dealing with DCIS in one area and an invasive carcinoma in another area. Mass Longest axis of a lesion and a second measurement at right angles. In a spiculated mass the spiculations should not be included.
Architectural distortion and Asymmetries Approximation of its greatest linear dimension. Calcifications The distribution should be measured by approximation of its greatest linear dimension. Indication for examination Painful mobile lump, lateral in right breast. No previous history of breast pathology. Mammography Overall breast composition: b. Scattered areas of fibroglandular density. Lateral in the right breast, concordant with the palpable lump, there is a mass with an oval shape and margin, partially circumscribed and partially obscured. The mass is equal dense compared to the fibroglandular tissue.
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Hundreds of high-quality images clearly demonstrate normal avian anatomic and radiographic features in a wide variety of species so that you can recognize abnormal features. This book includes detailed directions for patient positioning along with radiographic exposure guidelines, ensuring that you obtain the highest quality diagnostic images. Complete directions for positioning during radiographic examination help you take high-quality radiographs for accurate interpretation. Radiographic exposure guidelines are provided for each species and radiographic view, so you can determine optimal settings and technique.
Line drawings are superimposed on radiographic images, so you can identify anatomic structures accurately. Published in: Internet. Full Name Comment goes here. Are you sure you want to Yes No. Be the first to like this. No Downloads. Views Total views. Actions Shares. Embeds 0 No embeds. No notes for slide.
Radiology of birds an atlas of normal anatomy and positioning 1. Publisher : Saunders Release Date : 3. Use this atlas to interpret radiographic images and make accurate diagnoses! Hundreds of high- quality images clearly demonstrate normal avian anatomic and radiographic features in a wide variety of species so that you can recognize abnormal features.
This book includes detailed directions for patient positioning along with radiographic exposure guidelines, ensuring that you obtain the highest quality diagnostic images.