00:01
Welcome.
00:02
In this relatively brief talk, we're going
to cover the aspects of mammography
that you need to understand
as a medical student.
00:08
Mammography is just the radiologic
imaging to evaluate breast lesions.
00:13
It may occur at different frequencies
depending on the indication.
00:17
All women should have at least
one mammogram after the age of 40.
00:24
And then the
frequency thereafter
is going to be vary depending on
the findings and other risk considerations.
00:30
High risk individuals, someone
who has a first degree relative,
or a family history of breast cancer
should be evaluated by the age of 30,
and then probably annually.
00:41
If there's a palpable mass in
any woman over the age of 30,
that probably merits
a mammography.
00:47
And for the evaluation of breast
pain or tenderness, nipple discharge,
skin and nipple retraction or
changes, all those merit a mammogram.
00:58
There are kind of standard views.
01:00
So we're showing the typical
procedure with a cranial caudal view
with the breast being compressed
between plates to distribute the tissue
as much as possible so that
we get good radiation penetration.
01:12
The medial lateral oblique view
or the MLO view is a better view
for the superior lateral quadrant,
the upper outer quadrant of the breast,
that's actually where the majority
of breast cancers will occur.
01:24
That's where the
majority of breast tissue is
because the breast actually
extends up into the axilla.
01:30
So normal breast is composed
of parenchyma, ducts and lobules
as well as mesenchymal or
connective tissue, and fat, and vessels.
01:41
And so when we look at the normal breast
compressed between the radiographic plates,
we're going to see relative areas of clarity,
that's going to be mostly fatty tissue,
and then where we see white, that's going
to represent the parenchyma, the epithelium,
as well as the vasculature
and the connective tissue.
01:59
It makes a difference whether
you're looking at a young woman
who has relatively dense
breasts with a lot of parenchyma,
and greater mesenchymal elements,
such as fibrous connective tissue,
versus an older woman,
who will have mostly fat,
there's been regression
of a lot of the epithelium.
02:17
So in a young woman, there is
going to be dense parenchyma.
02:22
And clearly, small tumors
can hide better within the tissue.
02:29
On the other hand,
in the geriatric patient,
it's very radiolucent because there
isn't much in the way of parenchyma
and the other stroma elements,
and you can see through it quite easily,
much harder for a
tumor to hide in there.
02:44
Characteristic findings
on a mammogram.
02:46
So a normal mammogram
will have that kind of distribution
mesenchymal elements, fat, parenchyma.
02:55
Benign cysts, which are going to
be more common than malignancy
are going to be typically
smooth, uniform, rounded, things
that can be mobile
within the breast.
03:08
Breast calcifications
will occur frequently
either with fibrocystic change
or can occur with malignancy.
03:14
So the mammographer will want
to be very careful in evaluating those
and looking at areas
of microcalcifications.
03:21
It's about 50/50 between benign
things and malignant things
when they're little
areas of calcium.
03:27
And then breast cancer tends
to be an irregular radio dense,
kind of stellate looking
crab like appearance lesion,
which will radiate again
into the associated tissue.
03:41
Once we've identified
something on mammography.
03:43
The mammographer may put
a needle or a wire in to show
the surgeon exactly where to do a
biopsy or to actually do an excision.
03:55
We want to evaluate
abnormal findings clearly.
03:58
If it seems like it's a
uniform round structure,
then an ultrasound may be sufficient
to just demonstrate that it's a cyst.
04:05
We can also do MRI and CT.
04:08
For lesions that are amenable
we may put in a long needle
and just aspirate out to make sure
that the cells that are in there are benign.
04:16
Or we may do a biopsy.
04:18
And what's been shown is
benign fibrocystic change.
04:22
And again, I will refer you
to another talk elsewhere
within the breast pathology
section of the Lecturio slides
for fibrocystic change, or
infiltrating ductal carcinoma,
which can be something else
that you would see on biopsy,
and we'll talk about breast
cancer in a separate set of talks.
04:39
With that, I think you've got the
fundamentals of thinking about mammography,
how to evaluate it, and how to
explain to your patients what's going on.