Ebook Atlas of mammography (3/E): Part 2

(BQ) Part 2 book “Atlas of mammography” has contents: Prominent ductal patterns, the thickened skin pattern, the male breast, the postsurgical breast, the augmented breast, needle localization, percutaneous breast biopsy, asymmetry and architectural distortion,… and other contents.

GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 339 Techbooks[PPG-Quark] C h a p t e r ◗ Prominent Ductal Patterns Linear densities on the mammogram may represent arteries, veins, and lactiferous ducts There should be no confusion between vascular shadows and ducts Lactiferous ducts are linear, slightly nodular densities that radiate back from the nipple into the breast The normal lactiferous ducts are thin, measuring to mm in diameter, and often are not evident as separate structures on mammography Enlarged ducts may occur in benign and malignant conditions When ducts are enlarged, correlation with clinical examination as to the presence of discharge is important Galactography is of help in providing further information in the evaluation of a nipple discharge, with or without dilated ducts being seen on mammography A diffusely prominent ductal pattern bilaterally (Fig 7.1), associated with small nodular densities, has been described by Wolfe et al (1,2) as placing the patient at higher-than-average risk for developing breast cancer According to Wolfe, the breast parenchyma was classified into four patterns: N1 or fatty replaced, and P1, P2, or DY with increasing amounts of ductal or glandular tissue Because of surrounding collagen, individual ducts may not be identified; instead, a dense, triangular fanshaped density is present beneath the areola (3) The association between a prominent ductal pattern and breast cancer incidence has been debated, with some authors (4,5) agreeing with the association and others (6–8) finding no reliable indicator of risk by mammographic pattern Ernster et al (9) suggested that nulliparous women and women with a family history of breast cancer are more likely to have dense breasts and a prominent ductal pattern and that breast parenchymal pattern may be related to other risk factors Funkhouser et al (10) found a twofold increase in breast cancer risk in women with a P2 or DY Wolfe pattern in comparison with an N1 pattern (fatty breasts) Andersson et al (11) also found an increased frequency of the dense ductal patterns with advancing age at first pregnancy and with nulliparity Brisson et al (12) assessed breast cancer risk as related to parenchymal pattern in a study of 3,412 women and found that parenchymal pattern was strongly correlated with risk The authors found that the risk of breast cancer was five- to sixfold greater in women who had breasts that were composed of 85% or more dense tissue than in women who had no density on mammography DUCT ECTASIA Another cause of bilateral ductal prominence is duct ectasia (Figs 7.2–7.5) Haagenson (13) described the condition as beginning with bilateral dilation of the main lactiferous ducts in postmenopausal women Amorphous debris within the ducts is irritating and causes periductal inflammation and fibrosis without epithelial proliferation Retraction of the nipple may occur secondary to fibrosis in the periductal space In a more recent study, Dixon et al (14) found that periductal inflammation around nondilated ducts occurred in younger patients and that older patients had ductal dilatation as the main feature Neither parity nor breastfeeding was found to be an important etiologic factor in this condition (14) Dilated ductal structures may also be associated with inflammatory or infectious etiologies (Fig 7.6) In a patient with a breast abscess or with chronic mastitis, there may be intraductal extension of the infection This may appear as dilated ducts around an indistinct mass or as dilated subareolar ducts with overlying skin thickening Sonography may depict the abscess cavity and the extension of fluid into ducts surrounding the cavity PAPILLOMATOSIS Intraductal papillomatosis is a benign lesion characterized by a papillary proliferation of the epithelium that may fill and distend the duct (15) This lesion is distinguished from a solitary intraductal papilloma Papillomatosis tends to be scattered throughout the parenchyma and is within the 339 GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 340 Techbooks[PPG-Quark] 340 Atlas of Mammography A B Figure 7.1 HISTORY: A 74-year-old gravida 4, para patient for screening MAMMOGRAPHY: Bilateral MLO (A) and CC (B) views show heterogeneously dense breasts These are diffuse small areas of nodularity and linear structures consistent with a prominent ductal pattern IMPRESSION: Prominent ductal pattern bilaterally, within normal limits Figure 7.2 HISTORY: A 64-year-old patient who is status post–right breast biopsy, for routine screening of the right breast MAMMOGRAPHY: Right CC view shows extensive ductal dilatation extending from the subareolar area centrally and medially Architectural distortion is present in the area of surgical scar This pattern had been stable for many years and is consistent with duct ectasia IMPRESSION: Duct ectasia GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 341 Techbooks[PPG-Quark] Chapter • Prominent Ductal Patterns A 341 B Figure 7.3 HISTORY: A 58-year-old gravida 8, para woman for screening mammography MAMMOGRAPHY: Left (A) and right (B) CC views show the breasts to contain scattered fibroglandular densities There are prominent ducts present bilaterally (arrows), appearing as tubular nodular structures extending back from the nipples IMPRESSION: Bilateral ductal ectasia spectrum of fibrocystic change Sometimes papillomatosis is also called intraductal hyperplasia of the common type On mammography, the finding of a prominent ductal pattern may be evident, and fine microcalcifications are sometimes seen On galactography, an irregular filling defect or multiple filling defects are found (Fig 7.7) Papillary duct hyperplasia is an unusual lesion that occurs in children and young adults (16) Three patterns have been described: a solitary papilloma, papillomatosis, and sclerosing papillomatosis The condition causes a distention of the duct or ducts Solitary or Focally Dilated Ducts When asymmetrically dilated ducts or a solitary duct are found on mammography, the possibility of ductal malignancy must be considered Huynh et al (17), in a review of 46 women with asymmetrically dilated ducts, found that 24% had ductal carcinoma Factors associated with malignancy in dilated duct patterns were the presence of associated microcalcifications, a nonsubareolar location, and interval change The benign causes for the appearance of dilated ducts include a solitary papilloma, multiple papillomas, papillomatosis, ductal hyperplasia, and ductal adenoma GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 342 Techbooks[PPG-Quark] 342 Atlas of Mammography A Figure 7.4 HISTORY: A 62-year-old woman for screening MAMMOGRAPHY: Bilateral MLO (A) and CC (B) views show scattered fibroglan- B dular densities There are prominent tubular densities in both subareolar areas, radiating back from the nipple IMPRESSION: Bilateral duct ectasia NOTE: Because the ducts are evident as discrete tubular structures, and because of their widened diameter, the finding represents dilated ducts or duct ectasia GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 343 Techbooks[PPG-Quark] Chapter • Prominent Ductal Patterns 343 Figure 7.5 HISTORY: A 56-year-old woman for screening MAMMOGRAPHY: Bilateral MLO views show relatively fatty-replaced breasts There are enlarged subareolar ducts bilaterally in a symmetrical distribution The ducts can be observed as individual structures, and they radiate back from the nipple in a typical pattern of duct ectasia IMPRESSION: Duct ectasia Dilated ducts are an uncommon presentation of carcinoma but occasionally may be the only sign of this disease A unilateral dilated duct or ducts, especially those with associated microcalcifications, are suspicious for the possibility of malignancy (18) Dilated ducts located deeper in the breast may be of greater concern for a hyperplastic or malignant lesion; a subareolar duct is more commonly seen in an intraductal papilloma (18) Intraductal Papilloma A solitary intraductal papilloma often presents when small and nonpalpable with a serosanguineous or bloody nipple discharge Papillomas are usually situated beneath the nipple in a major duct; in 90% of cases, they arise within cm of the nipple (19) The papilloma is connected to the duct by a thin connective tissue stalk that contains the blood supply, and it is covered by a frondlike epithelium Because of the tenuous blood supply, these lesions tend to undergo infarction and sclerosis (20,21) When a papilloma infarcts, it may produce a bloody discharge, identified on clinical examination, and it may calcify Depending on the size of the papilloma, it may not be seen on mammography, and a galactogram may be necessary to identify the location of the lesion When papillomas are identified on the mammogram, they appear as a dilated duct or as a well-defined mass (20) (Figs 7.8–7.13) In a study of 51 patients with solitary papillomas, Cardenosa and Eklund (22) found that 37 were symptomatic; 36 presented with spontaneous nipple discharge, and had a palpable mass Ductography was performed in 35 patients and was positive in 32 In some patients, prominent asymmetric ducts were noted at mammography, yet galactography was more useful in diagnosis by GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 344 Techbooks[PPG-Quark] 344 Atlas of Mammography B A C Figure 7.6 HISTORY: Patient presents with a very tender, red right breast with a palpable subareolar mass MAMMOGRAPHY: Right MLO (A) and CC (B) views show a dense microlobulated mass in the immediate subareolar area There are numerous tubular structures extending from the mass posteriorly into the breast Ultrasound (C) shows a markedly hypoechoic mass with microlobulated borders IMPRESSION: Large mass with intraductal extension: carcinoma versus abscess NOTE: The lesion was drained and represented on large breast abscess Follow-up mammography was negative GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 345 Techbooks[PPG-Quark] Chapter • Prominent Ductal Patterns 345 Figure 7.7 HISTORY: A 46-year-old woman with a bloody left nipple dis- charge MAMMOGRAPHY: Left galactogram magnification view The can- nulated duct is dilated There is a smooth filling defect (arrowheads) involving two branches of the lactiferous duct, without evidence for distortion of architecture or encasement of the ducts The finding suggests intraductal papilloma or papillomatosis, although a papillary carcinoma cannot be excluded HISTOPATHOLOGY: Intraductal papillomatosis (Case courtesy of Dr George Oliff, Richmond, VA.) showing a dilated duct with an intraluminal filling defect Woods et al (23) reviewed the clinical and imaging findings in 24 women with solitary intraductal papillomas and found that 88% presented with nipple discharge In 42% of patients, mammography was abnormal, including showing dilated ducts in 26% of women Galactography was successfully performed in 13 patients and showed an intraluminal defect in 12 (92%) and a duct obstruction in patient Figure 7.8 HISTORY: A 52-year-old woman for screening MAMMOGRAPHY: Left CC view shows a lobular mass with rela- tively circumscribed margins located laterally There is a tubular extension from the mass posteriorly, suggesting that this could be a dilated duct Excisional biopsy was performed IMPRESSION: Suspicious mass, possibly an intraductal lesion HISTOPATHOLOGY: Papilloma On ultrasound, a papilloma may be observed as a small hypoechoic solid mass Often the dilated duct containing fluid is seen, and a solid component representing the papilloma is evident The sonographic distinction between benign or malignant papillary lesions is not reliable (24) Women who are diagnosed with solitary intraductal papilloma are thought to have a 1.5 to times relative risk of developing breast cancer (25) However, women who have multiple small papillomas, a condition GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 346 Techbooks[PPG-Quark] 346 Atlas of Mammography B A Figure 7.9 HISTORY: A 48-year-old woman with a small palpable left breast mass MAMMOGRAPHY: Left CC view (A) shows a fatty-replaced breast There is a markedly dilated duct containing microcalcifications (arrow) in the immediate subareolar area, at the site of palpable abnormality On the magnified image (B), the somewhat pleomorphic appearance of these intraductal calcifications is noted IMPRESSION: Dilated duct, suspicious for DCIS HISTOPATHOLOGY: Intraductal papilloma often involving several ducts, have a 7.4 times relative risk of developing breast cancer (26) Ductal Carcinoma In Situ Unilateral dilated ducts, with or without microcalcifications (27), or a solitary dilated duct (28,29) may be the only mammographic indication of a malignancy (Figs 7.14–7.25) Usually, no mass is palpable (29); however, in an extensive area of ductal dilatation associated with ductal carcinoma in situ (DCIS), palpable thickening may be noted In some patients, a uniorificial serous or bloody nipple discharge is observed The solitary duct has a tubular, slightly nodular shape that tapers as it proceeds into the parenchyma (29) When the lesion is associated with microcalcifications, the level of suspicion is greater Although the presentation of a nonpalpable cancer as a solitary dilated duct is not common (30,31), this finding should not be overlooked In a series of 73 women with intraductal carcinoma in whom no microcalcifications were present on mammography, Ikeda and Andersson (32) found that 12 presented with focal ductal-nodular patterns, and had dilated retroareolar ducts GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 347 Techbooks[PPG-Quark] Chapter • Prominent Ductal Patterns B A C Figure 7.10 HISTORY: A 47-year-old asymptomatic woman for screening mammography MAMMOGRAPHY: Left MLO view (A) and histopathology (B and C) The breast is heteroge- neously dense In the upper aspect of the breast, there is a linear, slightly nodular density representing a solitary duct A solitary dilated duct is one of the least common signs of nonpalpable breast cancer Other possible diagnoses in this case are a papilloma, papillomatosis, or duct ectasia IMPRESSION: Solitary dilated duct: intraductal carcinoma versus papilloma HISTOPATHOLOGY: Intraductal papilloma NOTE: The papilloma projects into the ductal lumen; its dense, central, connective-tissue core is covered by the papillary epithelium (12.5ϫ) (B) A cross section through the duct (C) shows a less sclerotic portion of the papilloma with complex branching and prominent fibrovascular stalks (50ϫ) 347 GRBQ182-2801G-C07[339-362].qxd 02-25-2007 10:25 AM Page 348 Techbooks[PPG-Quark] 348 Atlas of Mammography A B Figure 7.11 HISTORY: A 65-year-old gravida 3, para woman with a family history of breast cancer, present- ing with a right nipple discharge and a subareolar mass of at least 10 years’ duration MAMMOGRAPHY: Right MLO (A) and CC (B) views The breast is mildly glandular There is a large, high-density circumscribed mass in the immediate subareolar area The posterior margin of the lesion is contiguous with a tubular density containing coarse calcifications (B) The shape of the lesion suggests that this is a dilated duct, obstructed and mostly fluid filled The calcification may be related to chronic hemorrhage The chronicity of findings is more consistent with a benign lesion, such as an intraductal papilloma, although a neoplasm cannot be entirely excluded IMPRESSION: Massive duct dilatation secondary to an obstructing lesion HISTOPATHOLOGY: Intraductal papilloma, cystic dilatation of duct Ductal dilatation may also be evident on sonography in some cases of DCIS In a study of 60 patients with symptomatic DCIS, Yang and Tse (33) found that 22% of patients had ductal dilatation and/or extension on ultrasound Sonography may also demonstrate as intraductal solid component within a distended, fluid-filled duct This finding has the appearance of a complex cyst when observed in cross section On magnetic resonance imag- ing, DCIS may have an appearance of segmental, linear clumped enhancement, which represents the involved dilated ducts Papillary carcinoma constitutes 1% to 2% of breast cancers in women (34) and presents with bloody nipple discharge in 22% to 34% of cases (34,35) On histology, papillary cancers are characterized by a frondlike growth pattern on a fibrovascular core that lacks a GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 677 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index Cytologic analysis, 610 Cytology, negative, 94 Cytoplasm snouts, 247 D Danazol, 14 DCIS See Ductal carcinoma in situ Dedicated unit, for mammography, 18–19, 19f radiolucent compression device for, 19 Density See also Breast(s), density of nonmass, 363 on one view, 363 Deodorant, as artifact, 238, 239f Dermal calcifications, 243f, 252f morphology of, 242 occurrence of, 252 possibility of, 38 reduction mammoplasty and, 493f in scar, 490 shape of, 253f tangential view of, 50f targeting of, 242–243 types of, 495 Dermal lymphatics carcinoma and, 423f–424f involvement of, 421f poorly differentiated carcinoma in, 425f tumor in, 428f Dermatomyositis, dystrophic calcifications of, 269f Desmoid tumor, 209, 212f–213f, 392f indistinct mass as, 73 Desmoplastic reaction, 195, 211–214, 222 Development anomalies of, of breast, simultaneous, 23 Diabetes mellitus type 1, 370 vascular calcification and, 255 Diabetic fibrous mastopathy, 370, 371f Diagnostic mammogram, complete evaluation and, 62 Digital detector, development of, 23 Digital image, interpretation of, 23 Digital Mammographic Imaging Screening Trial (DMIST), 22 Digital mammography, 22–25 increased contrast resolution in, 23 spatial resolution of, 23 Direct digital image capture, 23 Disease imaging, 97–101 DMIST See Digital Mammographic Imaging Screening Trial Double-lumen implant with, 534f rupture of, 540f ultrasound of, 540f Doubling times, for breast carcinoma, 83, 104 Duct(s) abnormal, 82 amorphous debris within, 339 cannulated, 7f casts of, 287 diameter of, 15f pattern of, 341 dilation of, 10, 13f, 292f, 339, 348, 355f carcinoma and, 343 cystic, 348f DCIS and, 346f, 350f fluid filling and, 13f focally, 341–343, 351f, 353f, 355f with intracystic solid components, 353f massive, 348f progesterone and, 10 solitary, 341–343, 352f in subcutaneous area, 2f distended, 339 distortion of, 194 enlargement of, 339 excision of, 568 fluid-filled, 348 growth of, puberty and, identification of, 339 malignant cells in, 308f menopause and, 10 microcalcification in, 248 multiple, discharge from, 567 normal anatomy of, 569f path of, 569 patterns of, 339–362 proximal end of, 350f rudimentary, shape of, 82 structures of, normal, 7f Duct ectasia, 231, 339, 340f, 343f bilateral, 15f, 341f–342f cystic, 571f inspissated secretions of, 264 in main lactiferous ducts, occurrence of, marked, 570f nipple discharge and, 569 plasma cell mastitis and, 374 secretory disease and, 383f signals of, 15f Ductal adenoma, 349 complex form of, 360f Ductal calcifications, intraductal carcinoma vs., 245 Ductal carcinoma, 135, 251f, 357f, 391 infiltrating, 262f, 376f, 410f, 433f, 502f DCIS and, 316f, 649f intermediate nuclear grade, 222f with lymphatic tumor, 422f with negative axillary nodes, 413f poorly differentiated, 224f invasive, 37f, 168f, 407f, 414f–415f architectural distortion and, 378f in axillary tail, 96f BI-RADS® 4, 408f DCIS and, 86f, 216f, 309f, 322f–323f, 390f, 658f, 664f with dermal lymphatic involvement, 421f forms of, 214 high-grade, 165f–166f hypoechoic mass as, 77f irregular, 80f with lobular features, 223f localization of, 590f lymph nodes and, 226f in men, 479f with mucinous features, 44f, 169f multicentric, 406f, 651f multifocal, 227f with multiple foci, 98f nuclear grade 2, 39f, 171f with positive axillary nodes, 367f recurrent, 520f solid focal asymmetry and, 372f sonography for, 174f 677 spiculated lesion of, 187f suspicion for, 409f with tubular features, 412f with metastatic axillary nodes, 465f multicentric, 99f Paget disease and, 356f suspicion for, 312f Ductal carcinoma in situ (DCIS), 39f, 334f, 346–349, 351f, 391, 582f, 619f, 663f See also Intraductal carcinoma abscess and, 208f BI-RADS® 4, 303f bracketing of, 596f calcifications in, 247 calcium oxalate and, 249 comedo subtype, 319f comedo type, 325f with comedonecrosis, 304f, 315f, 319f, 326f intermediate nuclear grade, 314f cribriform type, 97f, 355f with comedonecrosis, 332f dilated ducts and, 346f, 350f on excision, 324f with foci, of invasion, 310f high nuclear grade, 596f high-grade, 56f, 332f, 519f with comedonecrosis, 518f hook wires for, 592f IDC and, 225f infiltrating ductal carcinoma and, 316f with positive node, 649f intermediate grade with comedonecrosis, 317f solid type, 317f, 517f, 578f with invasion, 318f invasive carcinoma and, 86f, 188f, 216f, 252f, 303f, 311f–312f, 320f, 322f, 353f–354f, 377f, 390f, 658f multicentric, 664f multifocal, 309f invasive carcinoma vs., 82 invasive lobular carcinoma and, with multiple foci, 100f low grade, 313f in men, 477f micropapillary, 216f micropapillary type, 353f mimicry of, 306f MRI of, 348 multicentric comedonecrosis and, 311f Paget carcinoma with, 321f multifocality of, 97, 226f, 334f papilloma vs., 158f, 349f, 352f recurrent, 334f BI-RADS® 4, 335f residual, 503f small focus of, 208f solid type, 97f, 217f with comedonecrosis, 332f symptoms of, 348 types of, 249 Ductal dilation, 78 Ductal hyperplasia, 126 See also Papillomatosis atypical, 381f, 572f intraductal papilloma with, 158f site of, 188–193 on core, 324f Ductal lumen, 570 projection into, 347f GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 678 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 678 Index Ductal patterns bilateral, 339 breast cancer and, 339 prominent, 339–362 bilateral, 340f Ductal pleomorphic calcifications, 350f Ductal proliferation, 193 Ductular epithelial cells, secretory cells and, 10 Ductules hormonal response of, pregnancy and, narrowing of, 247 structure of, 7f DuPont LoDose system, 20 DuPont LoDose screen-film system, 20 Dust, on film, 240 Dye injection, 584 blue dye for, 587 localization of, 586 Dystrophic calcifications, 264 benign, 264f bilateral, 264 circular configuration of, 266f of dermatomyositis, 269f extensive, 266f of fat necrosis, 331f keloids with, 255f from reduction mammoplasty, 291f E Echotexture, 634 Ectodermal dysplasia, breast maldevelopment and, 4f Edema asymmetric, 439f of breast, 418 density of, reduction in, 482 focal, 437 mild, 437 pattern of, 418, 423f, 429f arterial calcifications and, 441f congestive heart failure and, 439f, 443f radiation and, 431f renal failure and, 440f vascular calcifications and, 442f reduction of, 12 trauma and, 195 unilateral, unknown etiology of, 442 Eggshell calcifications, 269, 490 of fat necrosis, 278f pattern of, 277f EIC See Extensive intraductal component Elastosis, 194 Embedded clips, 588 as biopsy marker, 592f Encapsulated implant, 536f Endogenous hormones, effects of, menstrual cycle and, 10 Endometrial metastatic breast cancer, 429f Eosinophilic material, in lobules, of lactating breast, 13f Epidermal inclusion cysts, 130 fibroadenoma and, 146f Epithelial buds, hormones and, 567 Epithelial cells apocrine-type, 117 changes to, prolactin and, displacement of, 626 ductular, differentiation of, 10 proliferation of, 339 estrogen and, 10 Epithelial hyperplasia as benign proliferative disorder, 245 fibroadenoma with, 151f fibrocystic changes with, 296f intraductal papilloma and, 575f of larger ducts, occurrence of, sclerosing adenosis with, 189f site of, 188–193 Equipment, for mammography, 18–19 Erythema, mild, 434f Erythematous pitting edema, 418 Estrogen effects of, menstrual cycle and, 10 epithelial cell proliferation and, 10 HRT and, benign breast disease and, 14 Estrogen-receptor assays, 587 Etiology for architectural distortion, 366t for focal asymmetry, 366, 366t of galactography filling defects, 570t of gynecomastia, 470 of nipple discharge, 568t of solitary defect, 571 Evaluation of calcifications, 78–82 diagnostic mammogram and, 62 of mass, with ultrasound, 84 of palpable breast mass, 87–94 of seroma, at lumpectomy site, 506f Exaggerated craniocaudal lateral mammographic view (XCCL), 32–33 of invasive ductal carcinoma, 37f, 41f for posterolateral lesions, 34f of spiculated lesion, 38f Exaggerated craniocaudal medial mammographic view (XCCM), 32–33 cleavage view and, 33 of infiltrating ductal carcinoma, 40f for posteromedial lesions, 35f Excision, 224 of carcinoma, 626 contour defect following, 484f DCIS on, 324f for dilated duct, 352f of ducts, 568 of lesions, 498 needle localization with, 576 recommendation for, 350f surgery and, 589 Excisional breast biopsy, 482 mammographic findings of, 482 scarring after, 486f Exogenous hormones, effects of, on breasts, 12 Explant site, 555 bilateral, 561f fibrous capsules from, 560f free silicone in, 563f of prior silicone implant removal, 560f Exposure, assessment of, 54 Extended-cycle processing, 20 Extensive intraductal component (EIC) IDC and, 251f identification of, 250 presence of, 250 Extracapsular rupture, 530, 531f, 556f, 659, 663f Extralobular terminal duct, structure of, 7f Extramammary primary carcinoma, 136–142 Extravasation of contrast, with lymphatic intravasation, 569f F Fallopian tube, metastatic carcinoma from, 179f False negatives, occurrence of, 94 False positives, 186 Fast-spin echo (FSE), 553 Fat See also Subcutaneous fat BI-RADS® and, 61 cells of, anuclear, 105 deposition of increase in, weight gain and, 14 entrapped, 484 glandular tissue ratio to, 61 interspersed, 122f necrosis of, 67f, 105, 112f, 198f–199f, 267f, 281f, 484, 514f, 525f, 644f acute inflammation and, 435f benign calcifications of, 523f bilateral, 85f, 202f calcifications of, 276f–277f, 490 changes to, 496f characteristics of, 105t chronic inflammation with, 201f density of, 76 development of, 494f dystropic calcifications of, 331f eggshell calcification of, 278f fibrosis and, 275f foreign-body giant-cell reaction and, 204f hemorrhage with, 645f interstitial hematoma with, 436f as irregular mass, 195 lipoma and, 110f, 278f lucent-centered calcification of, 280f in men, 470, 476f with microcalcifications, 200f microcystica and, 275f oil cyst and, 488f postoperative, 487f postsurgical scar and, 203f postsurgical seroma and, 195f probable, 498f radiation and, 501 reduction mammoplasty and, 497f resolution of, 283 trauma and, 195 round mass containing, 67f Fatty halo, 126f, 174f lesion surrounded by, 120–124 lucent halo vs., 134f presence of, 68 Fatty hilum, 109, 445 circumscribed, 446f evidence of, 449f hyperechoic, 127f of intramammary lymph node, 128f spot-compression of, 129f Fatty infiltration, 445 Fatty mass, 123f Fatty notch, 108 Fatty replacement, 78f of breast, 281f Fibroadenolipoma, 106–108, 117f, 122f–123f See also Hamartoma appearance of, 106 BI-RADS® 2, 118f fat-containing mass consistent with, 125f GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 679 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index Fibroadenomas, 32f, 120–124, 142f–144f, 149f, 262f, 642f–643f, 657f appearance of, 120 breast cancer risk and, 120 with calcifications, 306f calcified, 88, 132f, 148f, 173f carcinoma vs., 178f characteristics of, 105t circumscribed mass and, 146f, 149f cyclosporin and, 124 cystosarcoma phylloides vs., 153f degenerating, 259f calcified, 260f, 262f with coarse calcification, 261f as dystrophic calcification, 264f early stages of, 265f differential diagnosis of, 153f epidermal cyst and, 146f with epithelial hyperplasia, 151f follow-up of, 120 giant, 152f growth of, 120 histology of, 120 isodense, 110 large, 124 malignancy of, 124 mammographic findings of, 120–124 palpation of, 259 possibility of, 147f risk for, proliferative disease and, 120 size of, 124 sonographic features of, 638 in TDLU, triple test diagnosis of, 120 ultrasound for, 124 in young patient, 95f Fibrocystic changes, 186–193, 190f, 192f as asymmetry, 366 in bilateral cysts, 141f to breast, 10 with calcifications, 83f, 299f calcifications with, 193f calcium in, 288f characteristics of, 105t cystic hyperplasia as, 247, 273 diffuse, 141f, 287f round lobular calcifications with, 290f with epithelial hyperplasia, 296f focal, forms of, 188 forms of, 374 history of, 15f, 30f indistinct mass as, 73 lobular microcalcifications and, 293f mild, 571f milk of calcium and, 244f nonproliferative, 297f with papillary apocrine metaplasia, 157f proliferation of, 247 punctate microcalcifications and, 295f sclerosing adenosis and, 157f spectrum of, 341 within TDLU, 245 Fibrocystic disease caffeine consumption and, 117 Danazol and, 14 manifestation of, 117 signs of, 82 Fibroepithelial tumor, 124 Fibroglandular tissue densities of, 44f HRT and, 16f scattered, 72f increase in, HRT and, 12 orientation of, nipple and, 67 scattered, 162f, 411f BI-RADS® and, 61 Fibromatosis, 209, 211f–213f, 386, 392f of abdominal wall, 209 appearance of, 209 treatment of, 209 Fibrosis, 186, 190f, 383f as benign proliferative disorder, 245 fat necrosis and, 275f focal, 368f as asymmetry, 366 as hyperechoic mass, 641 on mammography, 188 microcalcifications and, 515f periductal, 247, 306f sclerosing adenosis and, 382f stromal, 306f occurrence of, 188 Fibrous capsule calcification of, 531 from explant site, 560f implants and, 531f Fibrous mastopathy, 652f Fibrous response, extent of, 195 Fibrous tumors, 94 Fibrovascular stalks, 347f Filling defects, 570, 570t, 572f–573f, 580f Film contrast on, 21 dust on, 240 emulsion of, damage to, 240 handling of, 242 fingerprint from, 242f processing of extended-cycle, 20 quality control of, 20 temperature for, 20 Film-screen mammography, 20 artifacts on, 54, 240 dedicated units for, 18–19 various functions of, 22–23 Film-screen specimen radiography, 598–600 Filter materials, 18 target materials and, 18 combination effects of, 20f Final assessment category, 61 Fine linear branching microcalcifications, 287 Fine-needle aspiration biopsy (FNAB), 609–613 See also Aspiration accuracy of, 93–94, 611f advantage of, 613 criteria for, 609–610 errors in X-axis, 613f, 615f–616f Y-axis, 612f, 615f–616f Z-axis, 614f false negatives with, occurrence of, 94 guidance for, 602, 610 limitation of, 602 needle position for, 611f sensitivity of, 94 stereotactically guided, 608–609, 612 technique for, 605 use of, 93 Fingerprint, as artifact, 242f Fluid collection, 195 debris in, 484 on mammography, 484 679 overload of, 437 renal disease and, 442f postoperative, 484 Fluid-air level, 164f Focal asymmetry, 76, 218f, 363–364 in axillary tail, 64f biopsy for, 364 BI-RADS® 3, 62 BI-RADS® 4, 396f as cancer, 76 carcinoma and, 370 etiologies of, 365, 366t, 370 lymphoma and, 370 malignant, 368f mammographic evaluation of, 364 screening mammography of, 64f solid, 372f ultrasound for, 364 Focal blur, 242 Focal calcification, 385f Focal density, 156f Focal distortion, 67 Focal fibrosis, 126, 368f as asymmetry, 366 characteristics of, 105t definition of, 188 as hyperechoic mass, 641 occurrence of, 126 Focal intraductal hyperplasia, 156f Focal masslike density, 9f Focal puckering, in glandular tissue, 67–68 Focal skin thickening, 420f Focal spot, size of, 18 Focally dilated ducts, 341–343, 353f Focal-spot detector, 19 size of, 19 Foci of invasion, 664 multicentric DCIS and, comedonecrosis and, 311f Follicle-stimulating hormone, release of, pituitary gland and, Foreign bodies, 489f in breasts, 240, 491 Foreign-body giant-cell reaction, 514f, 525f fat necrosis and, 204f FSE See Fast-spin echo Full-field digital mammography, 18 selenium detector in, tungsten/rhodium target/filter and, 19f G Galactocele, 105–106, 115f–116f characteristics of, 105t Galactogram, normal, 570f Galactography, 567–582 diagnosis with, 343–345 filling defects on, etiologies of, 570t intraductal carcinoma on, 571 papillomatosis on, 341 performance of, 568–582 purpose of, 339 sensitivity of, 568 supplies for, 568f Gauze, sterile, 568f Gaze duration, 65 missed lesions and, 65 Gel bleed, 555 Gelfoam, 588 Geometric blurring, reduction of, 18–19 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 680 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 680 Index Glandular density scattered, 411f tamoxifen on, 17 view of, 363 Glandular development, Glandular growth, 246–247 Glandular tissue density of, 363 draping of, 107f fat ratio to, 61 focal puckering in, 67–68 overlay from, 186 Global asymmetry, 76 See also Asymmetric breast tissue benign, 363 definition of, 363 normal variant of, 365f–366f Global overview, 63 Gold, deposition of, 240, 240f–241f, 466f Granular cell tumor, 206–209, 209f–210f, 210f in bile duct, 206 from Schwann cells, 206 Granular microcalcifications, 249 Granuloma, silicone, 263f, 661f Granulomatous calcification, in axillary node, 450f Granulomatous infections, 448 Granulomatous inflammation, 639f Grids dense breast mammography and, 19 reciprocating, 19 use of, 19 Gross anatomy, of normal breast, 6f Growth hormone, prolactin and, Growth rate, of breast cancer, 83 Guaiac testing, for nipple discharge, 567 Gynecomastia, 470–478, 474f bilateral, 471f–473f carcinoma and, 480f etiologies of, 470 forms of, 470 imaging for, 470 occurrence of, 470 sonography for, 470 unilateral, 471f–473f, 475f H Halo sign, 438f lesions and, 143f lucent, 134f presence of, 117 Hamartoma, 117f, 120f–123f, 126f See also Fibroadenolipoma appearance of, 124f BI-RADS® 2, 118f characteristics of, 105t as hyperechoic mass, 641 lesion appearance and, 73f parenchymal displacement by, 106 Hemangioma, 232, 235f characteristics of, 105t contraction of, 128 location of, 130 mammographic detection of, 232 Hematoma, 161f abscess vs., 208f appearance of, 128 at biopsy site, 482 characteristics of, 105t formation of, 597 as indistinct mass, 197f indistinct mass as, 73 interstitial, with fat necrosis, 436f localization of, 482 in male breast, 470 needle biopsy and, 159f, 483f organizing, 639f postoperative change with, 160f, 485f resolving, 644f size of, 164f trauma and, 70, 195, 370 tumor vs., 208f Hemorrhage, 439f, 636 with fat necrosis, 645f Hemosiderin laden macrophages, 514f Hidradenitis suppurativa, 468f High-density masses, 110–117 See also Mass High-intensity view boxes, 56 Histiocytes cyst fluid with, 155f proteinaceous debris and, 90f Histologic correlation, radiologic correlation and, 245–250 Histology of calcifications, 245f of fibroadenomas, 120 HIV See Human immunodeficiency virus Hormone(s) See also Hormone replacement therapy ductule response to, pregnancy and, endogenous, 10 epithelial buds and, 567 TDLU and, Hormone replacement therapy (HRT) breast density on, increase in, 14 cysts and, 181f effects of, on mammography, 16f fibroglandular tissue and, 12 densities of, 16f HRT See Hormone replacement therapy Human immunodeficiency virus (HIV), 448 Hypercalcemia calcification from, 263 tumoral calcinosis secondary to, 263f Hyperechogenicity, 165f Hyperplasia, 186, 300f, 369f See also Atypical ductal hyperplasia; Atypical lobular hyperplasia; Ductal hyperplasia cystic, 243 as fibrocystic change, 247, 273 milk of calcium in, 285f, 287f ductal, 126 atypical, 381f, 572f as benign proliferative disorder, 245 on core, 324f intraductal papilloma with, 158f site of, 188–193 epithelial as benign proliferative disorder, 245 fibroadenoma and, 151f fibrocystic changes and, 296f intraductal papilloma and, 575f sclerosing adenosis with, 189f site of, 188–193 focal intraductal, 156f intraductal, 297f atypical, 307f lobular as sign of fibrocystic disease, 82 in TDLU, papillary duct, 341 PASH, 105t, 128 sclerosing lobular, 130 Hyperplastic lesions, 135 Hyperplastica, 301f Hypoalbuminemia, 437 Hypoechoic cortex, 127f Hypoechoic mass, 610f as invasive ductal carcinoma, 77f solid, 75f ultrasound of, 77f width of, 92f Hypoplasia of breast, left, 6f iatrogenic origin of, 6f mammary, Poland’s syndrome and, 5f I Iatrogenic origin, of hypoplasia, 6f IDC See Infiltrating ductal carcinoma ILC See Infiltrating lobular carcinoma; Invasive lobular carcinoma Image(s) artifacts and, 54 of asymmetries, 648–649 of calcifications, 648–649 of disease, extent of, 97–101 evaluation of architectural distortion, 370 areas considered in, 54 of implants, 650–653 interpretation of, 49, 56 of mastectomy site, 514–518 modalities for, 442 prebiopsy, 159f reading of, experience in, 65f review of, 584 segmentation of, 63 stereotactic, 592f, 618f reference point for, 588 symmetry in, review of, 63 Image contrast, 21 Image quality assessment of, 49–59 factors affecting, 18 Image recording system, 19–20 Imaging evaluation, 584 Imaging modality, 88 for gynecomastia, 470 Implants See also Augmentation; Saline; Silicone appearance of, normal, 537 for augmentation, 530 bilateral, MLO of, 4f calcification of, 537f, 538f capsular, 544f collapse of, 541f complications of, 530–534, 555 cosmetic reasoning for, 530 displacement of, CC view and, 52f with double-lumen, 534f encapsulation of, 536f explant site of, 555 extracapsular rupture of, 542f–543f, 659, 661f imaging for, 650–653 incidence of, 528 intracapsular rupture of, 658–659, 662f irregularity of, 531, 536f normal, 557f, 650, 658 mammography and, 53f parenchyma anterior to, 53f parenchymal abnormalities and, 555 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 681 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index patients with imaging of, 38–45 positioning of, 51f–52f placement of, 542f positioning of, 530 retroglandular, cyst anterior to, 556f retromuscular, 531 rupture of, 531, 531f, 651 calcification of, 544f extension of, 652 linguine sign of, 554f misdiagnosis of, 547 palpable irregularity with, 534 sonography for, 534–537 surgical treatment for, 546f saline MLO view of, 53f prepectoral, 535f subpectoral, 532f single-lumen, 658 standard mammographic views and, 45 subpectoral, 53f suspicious mass and, 557f types of, 530 ultrasound and, 534–547 volvulus of, 540f wall of, 531f Incision, healing of, 501 Inclusion cyst, characteristics of, 105t Incomplete workup, 72f Indurative mastopathy, 186 Infection, 427–428, 597 granulomatous, 448 in lymph node, 206 Infiltrating ductal carcinoma (IDC), 21f, 78f, 93f, 173f, 262f, 376f, 410f, 433f, 502f, 559f, 581f biopsy of, 594f CC view of, 43f comedocarcinoma and, 70f, 84f DCIS and, 225f, 316f with positive node, 649f with EIC, 251f grade II, 97f intermediate nuclear grade, 222f intraductal carcinoma and, 87f–88f, 359f low nuclear grade, 558f with lymphatic tumor, 422f macrometastases and, 79f MLO of, 21f with multicentric intraductal carcinoma, 28f with negative axillary nodes, 81f, 413f poorly differentiated, 224f presentation of, 215 spot-compression of, 43f well-differentiated, 69f XCCM of, 40f Infiltrating lobular carcinoma (ILC), 36f, 101f, 232f, 398f, 403f as architectural distortion, 224 as asymmetry, 224 BI-RADS® 4, 396f with mucinous carcinoma, 231f occurrence of, 224 positive nodes in, 421f scirrhous response from, 225 Inflammation acute, 208f fat necrosis and, 435f chronic as benign proliferative disorder, 245 with fat necrosis, 201f conditions of, 231 granulomatous, 639f of lymph nodes, 208f marked, 636 periductal, 339, 383f Inflammatory breast cancer hallmark of, 427f with metastatic axillary nodes, 422f microcalcifications in, 419 MRI of, 424 pathology of, 418–419 presentation of, 418 sonography of, 419 Inflammatory carcinoma, with axillary node metastases, 426f Inflammatory nodes, 448 Informed consent, 584 Inframammary fold opening of, 24f–25f upper abdomen and, overlap of, 22 Inspissated milk, 105–106 Inspissated secretions, 264 Insulin-resistant type diabetes, 370 Intensity windowing, 56 Interconnecting lumina, of sebaceous glands, 250 Internal duct lumen, 283 Interpretation skills, of radiologist, 18 for digital images, 23 Interstitial hematoma, with fat necrosis, 436f Interstitial markings, 501 Interstitium, thickness of, 440f Interventional techniques, 99 Intracapsular rupture, 531f, 537, 554f, 651, 658–659, 662f bilateral, 551f, 662f Intracystic neoplasm, 178f Intracystic papillary carcinoma, 177f–178f development of, 117–120 Intraductal carcinoma, 55f, 135, 358f, 589f See also Ductal carcinoma in situ appearance of, 571 calcifications within, 135 comedo type, 85f, 315f ductal calcifications vs., 245 extensive, 304f, 581f infiltrating ductal carcinoma and, 87f–88f, 359f, 600f intraductal papilloma vs., 347f microcalcifications and, 346 multicentric, 28f with papillary/cribriform patterns, 214f solid/cribriform types, 579f Intraductal filling defects, 570 Intraductal hyperplasia, 297f See also Intraductal papillomatosis Intraductal lesion, 345f Intraductal papillomas, 126, 343–346, 346f, 349f, 355f, 577f with atypical ductal hyperplasia, 158f epithelial hyperplasia and, 575f intraductal carcinoma vs., 347f nipple distance to, 343 solitary, 126–128, 343 Intraductal papillomatosis, 339–349, 345f See also Intraductal hyperplasia 681 in parenchyma, 339–341 solitary intraductal papilloma vs., 339 Intraductal small cell carcinoma, 357f Intralobular connective tissue, Intralobular terminal duct, 7f Intraluminal filling defects, 572f, 576 Intraluminal secretions, 247 Intramammary adenopathy, 142, 183f Intramammary lymph nodes, 108–109, 127f–128f, 646f characteristics of, 105t enlarged, 174f fatty hilum of, 128f normal, 128f, 129f size of, 109 visibility of, Intraparenchymal scars, after biopsy, 194 Invasive ductal carcinoma, 30f, 38f, 46f, 168f, 170f, 219f–220f, 407f, 414f–415f, 610f architectural distortion and, 378f axillary nodes and, 367f in axillary tail, 96f BI-RADS® 4, 408f with comedocarcinoma, 328f DCIS and, 86f, 188f, 216f, 252f, 303f, 311f–312f, 320f, 322f–323f, 353f–354f, 377f, 390f, 658f multicentric, 664f multifocal, 309f DCIS vs., 82 with dermal lymphatic involvement, 421f forms of, 214 high-grade, 165f–166f hypoechoic mass as, 77f indistinct mass as, 76f with intraductal extension, 320f invasive lobular carcinoma vs., 388 irregular, 80f with lobular features, 223f localization of, 590f lymph nodes and, 226f in men, 479f metastatic, 462f MLO of, 37f with mucinous features, 44f, 169f multicentric, 483f, 651f with dermal lymphatic involvement, 421f with negative axillary nodes, 406f multifocal, 227f with multiple foci, 98f–99f with multiple lymph nodes, 226f nuclear grade 2, 39f, 171f with papillary features, 640f pathology of, 589f poorly differentiated, 609f with positive axillary nodes, 367f recurrent, 520f solid focal asymmetry and, 372f sonography of, 174f spiculated lesion of, 187f suspicion of, 409f with tubular features, 412f XCCL of, 41f Invasive ductal carcinoma not otherwise specified (NOS), 135, 215f occurrence of, 209 Invasive lobular carcinoma (ILC), 64f, 229f–230f, 368f, 373f, 376f, 387–391, 397f, 400f–402f, 404f, 657f, 660f GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 682 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 682 Index Invasive lobular carcinoma (ILC) (continued) BI-RADS® 4, 399f DCIS and, with multiple foci, 100f density of, 389 IDC vs., 388 multicentric, 71f with positive axillary nodes, 464f recurrent, 667f Invasive papillary carcinoma, presentation of, 120 Ipsilateral arm elevation of, 27 receptor relationship to, 31 Ipsilateral lymphadenopathy, 448 Ipsilateral multiple carcinoma, identification of, 97 Isodense lesion, lobular, 150f Isodense mass, 110–117 See also Mass circumscribed, 68 lobular, 75f round, 75f Isosulfan blue, 587 J Juvenile fibroadenoma, as variant, 120 J-wire, 584–587 position of, 587f K Keloids at biopsy sites, 133f, 438f with dystrophic calcifications, 255f as pseudomasses, 254f Keratoses, 129f, 252 indication of, 109 seborrhea, 131f L Lactating adenoma, 128–130 characteristics of, 105t Lactation, 648 abscess during, 656f accessory breast and, 655f breast abscess during, 201 breast during, 12f changes to, 13f–14f cessation of, hypertrophied lobules and, 10 inspissated milk following, 105–106 onset of, 10 secretory cells during, eosinophilic material in, 13f Lactiferous duct(s) description of, 339 development of, 567 parenchymal drainage by, silicone casts of, 546f Large rodlike calcifications, 264–269 f secretory disease with, 274f secretory disease with, 270f, 272f BI-RADS® 2, 271f Lateral medial mammographic view (LM), 31 patient positioning for, 29f Lateromedial oblique mammographic view (LMO), 31–32 advantages of, 31 angulation for, 31f patient positioning for, 31f Latissimus dorsi muscle, 518 LCIS See Lobular carcinoma in situ Lesions See also Calcification(s); Radial scar anechoic nature of, 137f oval, 140f anterior, 391f antibiotics for, 163f appearance of, 101f, 358f hamartoma and, 73f aspiration of, 163f atypical, biopsy of, 490 benign, 65, 186 criteria for, 75f diagnosis of, 602 evaluation of, 68 identification of, 87 biopsy for, 65, 584 diagnostic accuracy of, 623 borders of, 175f, 211, 634 of breast, 132f diagnosis of, 602 calcification within, 173f CC view of, 37f change in, 83 classification of, 602 collapse of, 155f columnar cell, 629 compression of, 110 cutaneous, multiple, 134f cystic, 154f, 635 study of, 117 density of, 106, 211, 384f dermal origin of, 161f description of, lexicon for, 61 displacement of, 33, 80f drainage of, 344f epithelial-lined clefts within, 125 excision of, 70f, 206, 595f, 598 indication for, 621 fat-containing, 126f radiolucent, 68 fatty halo surrounding, 120–124 features of, judging by, 66f, 84 found by MLO, 32–33 halo around, 137f, 143f hyperechoic, 641 hyperplastic, 135 presence of, 247 hypoechoic, 152f identification of, 616 additional evaluation following, 61 criteria for, 61 ill-defined, 186 indeterminate, 591 indistinct/ill-defined, 70 infarction of, 343 inhomogeneous, 152f intracystic, 640f intraductal, 345f benign, 126 isodense, lobular, 150f localization of, 29, 568, 588 excision of, 598 height of, 32 problems with, 590 ultrasound guided, 599 on upper breast, 45f malignancy of, 186 margins of, 186, 215 in medial aspect, of breast, 27f metastatic, 142 from metastatic deposits, 209f mimicry by, 186 missed, gaze duration and, 65 MLO view of, 590 multiple BI-RADS® and, 61 suspicious, 603 near chest wall, 29 node vs., 72f nomenclature for, 61 noncalcified, 68, 598 nonencapsulated sclerosing, 193 nonpalpable, 75f obstructing, 348f occurrence of, 467 orientation of, 147f palpable, 167f papillary, 345 asymptomatic, 628 persistence of, 46f possibility of, 37 posterior, 590 posterolateral location of, 34f XCCL for, 34f posteromedial location of, 35f projection of, radiographic field and, 34f–35f proliferative, 627 pseudo, 364f radiolucent, 186 removal of, 591 on sagittal plane, 37 sclerosing complex, 377 nonencapsulated, 377 size of, 154f of skin, 109–110, 129f–130f, 130, 467f air in, 131f characteristics of, 105t evidence of, 66f keratosis, 131f solid, 144f, 154f, 219f, 635 lobular, 147f sonography of, 149f sonography of, 108, 149f, 154f, 588 spiculated, 405f bilateral, 390 demonstration of, 40f focal, 36f of invasive ductal carcinoma, 187f radial scar and, 385f spot-compression of, 80f XCCL view of, 38f spot-compression of, 80f, 186 TDLU and, 247 tendrils surrounding, 186, 188, 211 types of, 591 BI-RADS® and, 62 ultrasound for, 157f unusual, 231–232 vascular, 232, 235f visualization of, 29, 588, 598 in young patients, 95 Leukemia, recurrent, 458f Lexicon of BI-RADS®, 61 use of, 61 Linear branching microcalcification, 287 Linear densities, 349 branching of, 361f on mammogram, 339 orientation of, 67 periductal/perilobular fibrosis and, Linear microcalcification, 323f, 326f Linguine sign, 554f, 662f Lipogranuloma, 525f GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 683 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index Lipoma, 105, 106f, 120f BI-RADS® 2, 107f characteristics of, 105t with fat necrosis, 110f, 278f as hyperechoic mass, 641 identification of, 87 location of, 105 oil cyst vs., 108f Lipomatosis, 445 Liponecrosis macrocystica, 275f Liponecrosis macrocystica calcificans, 490 Liponecrosis microcystica, 275f LM See Lateral medial mammographic view LMO See Lateromedial oblique mammographic view Loa Loa, 287–318 Lobe, Lobular calcifications, 82 Lobular carcinoma in situ (LCIS), 300f, 369f description of, 247–248 diffusely invading pattern of, 370 focal, sclerosing adenosis and, 296f hyperplastica and, 301f mammographic findings in, 248 management of, 628 microcalcifications in, 225 punctate microcalcifications and, 276 in TDLU, Lobular hyperplasia as sign of fibrocystic disease, 82 in TDLU, Lobular hyperplastica, atypical, 301f Lobular lesion, isodense, 150f Lobular microcalcifications, fibrocystic changes and, 293f Lobular neoplasia, 247–248, 628 punctate microcalcifications in, 276 as sign of fibrocystic disease, 82 Lobular proliferation, in sclerosing adenosis, 146 Lobule(s) abnormal, 296f adenosis in, 295f calcifications within, 246 comedonecrosis extending into, 317f composition of, as constituents of lobe, cysts and, 117 eosinophilic material in, lactation and, 13f fibrocystic center with, 194, 276 formation of, progesterone and, hypertrophied, lactation cessation and, 10 increase in, pregnancy and, 7–10 proliferation of, 188 regression of, menopause and, size of, structure of, 7f terminal, disappearance of, 10 Local server, 23 Localization See also Needle localization of known carcinomas, 590–596 of microcalcifications, 595f MRI-guided, 596–597 Localization hook wire(s), 489f, 584, 585f, 599f–600f number of, 591–592 placement of, 591 transection of, 598 Localization plate, 242, 585f abnormalities obscured by, 590 placement of, 586 removal of, 586, 587f Localizer grid, 597 Locally advanced breast cancer, 418–426 Loiasis, 329f Lotion, as artifact, 238 Lucent halo, fatty halo vs., 134f Lucent-centered calcifications, 269 of fat necrosis, 280f trauma and, 279f Lump, palpable, in axillary tail, 59f Lumpectomy, 482 calcifications following, 318 contour defect following, 484f evaluation following, 510f evolution of, 510f local recurrences following, 500 margin at, 333f patients following, 374, 432f patients treated by, 500 radiation and, 498–514 changes following, 504f, 509f mastectomy vs., 498 scar from, 161f, 194, 379f resolution of, 511f site of architectural distortion at, 432f calcification at, 280f knot-shaped calcification at, 283f oil cyst within, 508f postoperative change at, 160f seroma at, 506f size of, 521f skin thickening at, 501 sutural calcifications at, 330f surgical pathology of, 590f Lung, 142, 180f Lupus, adenopathy and, 456f Luteinizing hormone, release of, pituitary gland and, Lymph nodes, 447f See also Intramammary lymph nodes; Intramammary nodes appearance of, 108 in axillae, 48f definition of, 108 drainage of, 428–437 enlargement of, 121f, 174f fatty replacement of, 448 gold deposition in, 241f infection in, 206 inflammation of, acute, 208f invasive ductal carcinoma and, 226f metastatic melanoma in, 436f negative, sentinal, 96f normal, 127f silicone-laden, 451 tumor in, 327f, 422f ultrasound of, 109 Lymphadenopathy axillary, 451 ipsilateral, 448 rheumatoid arthritis and, 461 Lymphatic drainage of breast, 2–5 impaired, 428–437 route of, Lymphatic intravasation, extravasation of contrast with, 569f Lymphocytic infiltration, 430f Lymphoid tissue, narrowing of, 445 683 Lymphoma, 142, 180f, 459f adenopathy secondary to, 183f axillary node enlargement in, 452 features of, 227–231 focal asymmetry and, 370 indistinct mass as, 73 malignant, 234f, 461f non-Hodgkin’s, 181f, 233f, 460f occurrence of, 227 occurrence of, 142 primary, 225–227 recurrent, 459f M Mach band effect, 68 Macrocalcifications shape of, 264 vermiform, 287–318 Macrometastases, infiltrating ductal carcinoma and, 79f Magnetic resonance imaging (MRI) as alternative modality, 99 for augmented breasts, 656–659 biopsy devices, 596 in breast cancer, 62 breast cancer screening with, 667 breast coils, 596 for breast conservation, 500 for carcinoma, 663–664 clinical roles of, 654–667 of DCIS, 348 detection from, 222 for direct injection breast augmentation, 528 disadvantages of, 667 implants and, 547–555 of inflammatory breast cancer, 424 localization guided by, 596–597 postoperative, 664 for primary carcinoma, 460 problem solving with, 659–663 for silicone implants, 553 Magnification mammography, 243 role of, 501 views of, 276 Magnification tool, 23 radiographic, 45–49 spot-compression and, 44f Magnification views, 82 Male breast See also Men Malignancy, 225–231 of focal asymmetry, 368f high suspicion for, 36f history of, 448 of lesions, 186 likelihood of, 76f positive for, 522f primary signs of, 349 secondary signs of, 186, 225 Mammary gland, See also Breast Mammary hypoplasia, Poland’s syndrome and, 5f Mammogram baseline, 82, 86f normal findings on, 501 preradiotherapy, 503f changing, 82–86 diagnostic, microcalcifications and, 238 focal abnormalities in, 82 follow-up, 84 interpretation of, 238, 482 linear densities on, 339 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 684 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 684 Index Mammogram (continued) negative, 89 post-chemotherapy, 183f postmenopausal, 176f preoperative/postoperative, 501 pretreatment, as baseline, 501 review of, 584 of skin thickness, 418 view of, 616 Mammographic examination, 65 changes in, 82–86 of focal asymmetry, 364 of gynecomastia, 470 Mammographic findings assessment of, 61 of carcinoma, 217f clinical findings and, 65 evaluation of, 65f of excisional biopsy, 482 of fibroadenomas, 120–124 in LCIS, 248 variance in, 491 visualization of, 363 Mammography abnormality on, localization of, 584 for acute breast abscess, 201 analog, 19–20 analysis of, approaches to, 61–101 axillary tail and, 26f biopsy-proven carcinoma and, 61 breast cancer and, 56 early detection of, 18 calcifications present in, 78 of carcinoma, 217f cassettes specific for, 20 conventional, radiation dose in, 49 cysts on, 117 dedicated units for, 18–19, 19f development for, 21 of dense breasts, grids and, 19 diagnostic improvements in, 22, 238 diagnostic vs screening, 62 for direct injection augmented breasts, 528 equipment for, 18–19 evaluation of, 65f evolution of, 18 of fibrosis, 188 film-screen, 18 final positioning for, 24f fluid collection on, 484 full-field digital, 18 hemangioma detection by, 232 HRT effects on, 16f importance of, 89 limited, 94 magnification, 45–49, 243 microcalcifications and, 57f mastectomy and, 81f missed lesions in, gaze duration and, 65 needle localization guided by, 584–588, 585f negative, 89 as preoperative procedure, 87 radial scar on, 380 resolution requirements for, 22 screening, 22f bilateral MLO and CC views of, 64f BI-RADS® categories for, 61 focal asymmetry in, 64f serial, clinical examination and, 501 standard views of, implants and, 45 step-one, 363 sternalis muscle on, supplementary views for, 29–38 views of, 242–245 Mammography Quality Standards Act (MQSA), 18 redefinition of, 61 viewing conditions of, 56 Mammoplasty augmentation direct injection for, 529f silicone granulomas from, 263f post-radiation, 67f postreduction changes for, 230f reduction, 266f, 491–497 dermal calcifications and, 493f fat necrosis secondary to, 497f postoperative changes secondary to, 491f–492f, 495f, 499f round/dystrophic calcifications from, 291f Mammotome, 625 Margins of calcifications, of secretory disease, 274f definition of, 186 evaluation of, 78f features of, 644 importance of, 104, 117, 591 indistinct, 137f irregular, 168f of lesions, 186 at lumpectomy site, 333f of masses, 634 of spiculated mass, 186 well-defined, 174f Mass(es) See also High-density masses; Isodense mass; Pseudomasses in axillary tail, 41f benign, 126–134 in men, 470 ultrasound features of, 638t borders, analysis of, 68 in breast, evaluation of, 68–75 circumscribed assessment of, 104–105 bilateral, 181f biopsy for, 68–70 differential diagnosis of, 105t division of, 104 evaluation of, 78f of fat density, 105–106 fibroadenoma and, 146f, 149f isodense, 635–645 management algorithm for, 74f mixed-density, 106–142 nonpalpable, 68 position of, 147f sonography for, 182f spot-compression for, 68, 157f complex, 428, 636–638, 639f–649f components of, 122f cyst vs., 75f, 635 definition of, 186 dense round, at chest wall, 38f density of, 68 high, 69f, 98f, 110–117, 145f development of, 149f echogenicity of, 634 evaluation of, ultrasound for, 84 extension of, 162f fat-containing, 125f fatty, 123f fat-water level in, 106 focal density of, 156f heterogeneous, 123f hyperechoic, 641 hypoechoic, 610f circumscribed, 644–645 solid, 75f ultrasound for, 77f width of, 92f indistinct, 70f, 76f, 229f central, 71f hematoma as, 197f identification of, 186 noncalcified, 73 ultrasound for, 73 infiltrating ductal carcinoma, 376f with intraductal extension, 344f irregular fat necrosis and, 195 high-density center of, 186 isodense, 101f, 110–117 circumscribed, 68 lobular, 98f, 151f lobulated, 142f, 144f high-density, 167f location of, 68 lucencies within, 135f malignant, sonographic features of, 641t margination of, 117, 634 mixed-density, 118f multiple, 167f noncalcified circumscribed, 62 nonpalpable, 70 noncystic, 68 nonpalpable localization of, 584 management algorithm for, 74f orientation of, 68 palpable, 71f, 205f, 391f, 415f evaluation for, 87–94, 645–647 free silicone as, 545f management algorithm for, 89f, 94f radiolucent, 119f silicone as, 545f, 549f solid, 150f sonography for, 606f, 653f ultrasound for, 89 palpation of, 59f senior women and, 66f posterior, 391f potential for, workup for, 77f radiolucent, 105, 109f, 119f round, 483f development of, 142 fat-containing, 67f hypoechoic, 648f isodense, 75f non-fat-containing, 89 shape of, 68, 104, 118f, 186, 634, 660 microlobulated, 94 oval, 122f simple cysts as, 139f size of increase in, 84 stability of, 104 small density of, 46f high suspicion of, 46f spot-compression of, 46f solid, 82, 143f, 635 BI-RADS® 4, 142f GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 685 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index features of, 117 homogeneous, 636 identification of, 186 sonographic features of, 641t ultrasound for, 89, 181f, 638t solitary, 591 sonography of, 94 spiculated, 43f, 224f, 230f, 617f in axilla, 208f identification of, 186 margins of, 186 new, 501 stability of, 125f stellate, 188 in subareolar area, 175f, 183f in subcutaneous fat, 180f in supra-areolar area, 289f thin rims of, 113f true, 76f ultrasound of, 165f, 407f visualization of, 44f well-circumscribed, CC view of, 32f well-defined, 138f Masslike density asymmetry and, 65f cleavage view of, 9f mammographic views of, shape change and, 9f visibility of, 30f Mastectomy for breast cancer, mammography and, 81f lumpectomy/radiation vs., 498 for multicentric carcinoma, 603, 603f of patients sonography for, 514 ultrasound for, 514 prophylactic subcutaneous, 516 radical, 482 imaging of, 516 segmental, 482 site of benign calcifications at, 523f imaging of, 514–518 study of, 224 Mastitis, 239f, 434f acute, 207f, 654f chronic, 383f diffuse, 428 Mastopathy, 652f Mediolateral mammographic view (ML) linearity of, 273 of medullary carcinoma, 27f patient positioning for, 26f prior to needle localization, 584 spot-compression in, 69f sternalis muscle in, 6–7 tangential, calcifications on, 50f Mediolateral oblique mammographic view (MLO), 26–28 angulation for, 31f of asymmetric density, 375f of axillary nodes, 445 bilateral of implants, 4f screening mammogram and, 64f of calcifications, 243 concept of, 26 of heterogeneously dense breasts, 3f imaging of, 62 of infiltrating ductal carcinoma, 21f of invasive ductal carcinoma, 37f of lesion, 590 lesions found by, 32–33 of medullary carcinoma, 27f off-angle positioning for, 41f patient positioning for, steps in, 24f of pectoralis major muscle, 9f pectoralis major muscle and, performance of, 26 of saline implants, 53f segmentation of, 64f of spiculated lesion, 36f standard, implants and, 51f well-positioned, 25f Medullary carcinoma, 135–136, 175f, 214 appearance of, 644 calcification of, 135 CC of, 27f growth pattern of, 135 malignant, 171f in men, 481f ML of, 27f MLO of, 27f necrosis of, 135 occurrence of, 222 ultrasound of, 135 Melanoma, 142, 180f metastatic, 182f, 429f, 436f Men BI-RADS® 5, 477f breasts of, 470–481 carcinoma of, 476 diseases of, 470 normal, 470 carcinoma in, 476, 478f DCIS in, 477f presentation of, 478 gynecomastia in, 470–478, 471f–473f, 475f, 480f invasive ductal carcinoma in, 479f medullary carcinoma in, 481f nipple retraction for, 478 oil cyst in, 476f sebaceous cysts in, 470, 475f Menopause ducts during, 10 lobule regression during, parenchyma during, involution of, 10 tumors following, 120 Menstrual cycle days before, 10 endogenous hormones and, effects of, 10 first half of, estrogen during, 10 follicular phase of, 12 luteal phase of, 12 Mesenchyma, of chest wall, invagination of, Metaplastic carcinoma, 214, 297f rarity of, 225 Metastases, 136–142 characteristics of, 105t in men, 470 nonbreast, 448 origin sites for, 142, 180f Metastatic axillary nodes, inflammatory breast cancer and, 422f Metastatic carcinoma in axillary nodes, 121f, 216f, 354f, 422f, 426f, 460, 465f from fallopian tube, 179f Metastatic deposits, 109 lesions from, 209f Metastatic diseases, 427 685 in axillary node, 448f enlargement of, 109 Metastatic lesion, 142 Metastatic melanoma, 182f, 429f, 436f Metastatic mucinous carcinoma, from umbilicus, 305f Metastatic node breast carcinoma vs., 59f carcinoma and, 226f Methylene blue, 587 Microcalcifications, 156f, 514f See also Calcification(s) amorphous, 215, 297f, 335f, 591f BI-RADS® 4, 298f–299f cluster of, 303f development of, 318 asymmetry with, 369f in axillary node, 461 biopsy of, 602 BI-RADS® 4, 296f borders of, 56f cluster of, 57f, 67f, 83f, 100f, 159f amorphous, 302f benign, 313f pleomorphic, 302f suspicious, 313f core biopsy of, 599f diagnostic mammography for, 238 diffuse bilateral, 246f distribution of, 249 ductal origin of, 248 dystrophic, 282f etiologies of, 57f evaluation of, 57f mammographic views for, 242–245 fat necrosis with, 200f fibrosis and, 515f fine linear branching, 287 formation of, 248 granular, 249 in inflammatory breast cancer, 419 intraductal, 247 intraductal carcinoma and, 346 irregular, 188, 251f linear, 215, 326f branching, 287 new, 323f lobular, fibrocystic changes and, 293f in lobular carcinoma, 225 magnification mammography of, 57f malignant, 319f management of, 57f patterns of benign, 273 benign etiologies of, 245–247 malignant etiologies of, 248–250 suspicious, 283–335 pleomorphic, 39f, 86f, 215, 283–287 development of, 318 segmentally oriented, 596f presence of, 99 psammomatous, 461 punctate, 111f, 297f, 366–370 LCIS and, 276 scattered, 294f radial scar with, 194 recurrent, 507 regional, 285f core biopsy of, 599f crescentic shape of, 286f localization of, 595f round, 366–370 segmented, 292f GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 686 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 686 Index Microcalcifications (continued) as secondary malignancy sign, 186 shapes of, 56f, 250 size of, 250 sonography for, 649 spot-compression of, 55f suspicious, 73, 302f, 332f in tumor bed, 334f Microcystica fat necrosis and, 275f milk of calcium in, 286f Microcysts, cluster of, 117 Microglandular adenosis, 190f Microlobulation, 169f Micropapillomas, 300f, 369f Milk presence of, 273–276 production of, 10 function of, secretion of, pregnancy and, 7–10 Milk streak accessory breasts along, orientation of, Milk-of-calcium, 273–276 calcifications from, 242 in cyst, 289f in cystic hyperplasia, 285f, 287f fibrocystic changes and, 244f in microcystica, 286f MinR system, 20 Mitotic rate, 214 ML See Mediolateral mammographic view MLO See Mediolateral oblique mammographic view Moles, 130 indication of, 109 Molybdenum characteristic peaks for, 18 as target material, 18 Mondor disease, 349 Morphology, identification of, 82 MQSA See Mammography Quality Standards Act Mucinous carcinoma, 92f, 214 appearance of, 644 description of, 221f infiltrating lobular carcinoma with, 231f metastatic, from umbilicus, 305f mixed, 136 peripheral location of, 136 pure, 136 Mucinous features, invasive ductal carcinoma with, 44f Mucoepidermoid carcinoma, 179f Mucoid degeneration, 120 Multicentric carcinoma, 91f, 167f, 228f, 376f breast conservation and, 224 occurrence of, 222 sonography of, 167f Multicentric disease, 97 Multicentric intraductal carcinoma, 28f Multicentric invasive lobular carcinoma, 71f Multifocal carcinoma, 659f occurrence of, 222 with papillomatosis, 355f Multifocal disease, 97 Multimodality approach, 117 Multiple myeloma, 231 Muscle invasion, 419 Myoblastoma, 206–209 Myocutaneous flaps, 516 Myoepithelial cells, presence of, 387 N National Cancer Institute Surveillance, Epidemiology and End Results (SEER), 476–478 Necrosis of fat, 67f, 105, 112f, 198f–199f, 267f, 281f, 484, 525f, 644f acute inflammation and, 435f benign calcifications of, 523f bilateral, 85f, 202f calcifications of, 276f–277f, 490 changes to, 496f chronic inflammation with, 201f density of, 76 development of, 494f dystrophic calcifications of, 331f eggshell calcification of, 278f fibrosis and, 275f foreign-body giant-cell reaction and, 204f hemorrhage with, 645f interstitial hematoma and, 436f as irregular mass, 195 lipoma and, 110f, 278f lucent-centered calcification of, 280f in men, 470, 476f with microcalcifications, 200f microcystica and, 275f oil cyst and, 488f postoperative, 487f postsurgical scar and, 203f postsurgical seroma and, 195f probable, 498f radiation and, 501 reduction mammoplasty and, 497f resolution of, 283 trauma and, 195 of medullary carcinoma, 135 poorly differentiated carcinoma and, 79f Necrotic focus cavitation, 105 Needle cutting, 623 oblique/horizontal insertion of, 593f position of accuracy of, 607 for FNAB, 611f sizes of, 602 vertical insertion of, 589, 593f Needle biopsy, 482, 519f accuracy of, 623 hematoma secondary to, 159f, 483f negative ultrasound and, 89 performance of, 299f prior to, 89 technique for, 605f Needle localization, 584–600 breast compression for, 585f of breast mass, 11f complications of, 597–598 excision with, 576 hook wire used for, 585f mammography guided, 584–588 ML view before, 584 needle placement for, 588 needle used for, 585f prior to, 584 procedure of, 584, 585f, 595f prolonged bleeding during, 598 risks of, 597–598 series of, 586f stereotactically guided, 591f successful, 595f ultrasound guided, 588–589 Neoadjuvant chemotherapy, 665 Neoplasm confirmation of, 87 intracystic, 178f lobular, 247–248, 628 Neurofibromas, 467f indication of, 110 Nevi, 252 Nipple(s) accessory, areolar complex with, 568 discharge from, 7f, 345 bloody, 346, 567 causes of, 567 clinical assessment of, 567 clinical evaluation of, 567 colors of, 567 etiologies of, 568t evaluation of, 567–568 Guaiac testing for, 567 in nonlactating breast, 567 patient with, 569f presence of, 568 elevation of, 25f fibroglandular tissue orientation toward, 67 intraductal extension to, 327f line of, accessory breast tissue below, 4f papilloma near, 343 profile of, 26f, 132f characteristics of, 105t retraction of, 71f during compression, 79f indication of, 109 for men, 478 spiculated mass beneath, 43f Nitro-Bid patch, on skin, 135f Node(s) See also Axillary nodes axillary, 445 abnormal, 451 granulomatous calcification in, 450f normal, 446f positive, 666 fatty infiltration of, 445 features of, 467 inflammatory, 448 intramammary, 127f, 646f lesion vs., 72f malignant, 445 metastasis of, 463f negative, 172f size of, 448 tumor infiltration of, 460 Nodular adenosis, 126 Nodular cortex, 647f Nodular-tubular densities, 351f Nodule compression of, 134f disappearance of, 609 fibrous, 188 firmness of, 162f isodense, lobulated, 123f nonpalpable, 132f palpable, 145f presence of, 188 Noise, assessment of, 54 Nomenclature, for lesions, 61 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 687 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index Noncalcified lesions, 68, 598 Noncystic masses, 68 Nonencapsulated sclerosing lesion, 193 Non-Hodgkin’s lymphoma, 181f, 233f, 460f occurrence of, 227 Nonmass densities, 363 Nonpalpable asymmetry, in premenopausal women, 76 Nonpalpable mass, circumscribed, 68 NOS See Invasive ductal carcinoma not otherwise specified O Object-to-receptor distance, 54f Obvious findings, danger of, 97 Occluded pore, 162f Occult carcinoma, 650 Oil cyst, 87, 111f–112f BI-RADS® 2, 113f calcification of, 278f characteristics of, 105t fat necrosis and, 488f lipoma vs., 108f within lumpectomy site, 508f posttraumatic, 105 radiolucent, 195 trauma and, in men, 476f Ointment, as artifact, 238 Opaque overlay, 63 Oral antibiotics, 434f Osteoid matrix, carcinosarcoma with, 305f Ovary, 142 Ovoid masslike densities, 8f Ovoid nodules, 109f Ovulation, progesterone and, 10 P Pacemakers, SIO view and, 33f PACS See Picture archiving and communication system Paget carcinoma, with multicentric DCIS, 321f Paget disease ductal carcinoma and, 356f with intraductal extension, 321f Papillary apocrine metaplasia, fibrocystic changes with, 157f Papillary carcinoma, 374f definition of, 177f invasive, presentation of, 120 Papillary duct hyperplasia, 341 Papillary patterns, intraductal carcinoma and, 214f Papilloma, 345f, 574f See also Intraductal papillomas blood supply to, 128 carcinoma vs., 640f characteristics of, 105t DCIS vs., 158f, 349f, 352f development of, 117 ductal, sclerotic, 572f identification of, 343 intracystic, sclerotic, 640f intraductal, 349f, 355f, 573f, 577f with atypical ductal hyperplasia, 158f epithelial hyperplasia and, 575f sclerotic, 574f, 576f solitary, 126–128 multiple, 345 projection of, 347f sclerotic, partial, 575f size of, 343 Papillomatosis, 339–349 See also Ductal hyperplasia as benign proliferative disorder, 245 intraductal, 345f multifocal intraductal carcinoma with, 355f pattern of, 247 sclerosing adenoma and, 380f Paraneoplastic syndrome, 28f Parasites, calcification of, 329f Parasternal musculature, asymmetry of, 11f Parenchyma abnormalities of implants and, 555 skin lesions and, 66f anterior structures in, 45f, 52f asymmetry of, 363 automatic exposure control and, 40f background of, 124f of breast classification of, 339 exposure concern for, 21 as breast tissue constituent, changes to, pregnancy and, 7–10 density of, 56f, 70, 82f, 294f, 405f displacement of, 106 divisions of, filling of, nipple discharge and, 7f forward pull of, 51f heterogeneous density of, 14f implants and, 53f involution of, menopause and, 10 normal, adenopathy and, 48f papillomatosis throughout, 339–341 pattern of breast cancer risk and, 339 in young patient, 12f redistribution of, 491 superimposition on, 363 Parenchymal calcifications, location of, 243 Parenchymal scar, 484 Parotid gland tumor, 430f PASH See Pseudoangiomatous stroma hyperplasia Pathologic correlation, 626–630 Pathologic findings, 630 Pathological examination, clinical examination vs., 460 Pathologist information for, 627 radiologist communication with, 630 Patient(s) acceptance of, 589 body habitus of, 27 comfort of, 589 final assessment category and, 61 hair of, as artifact, 58f history of benign biopsy and, 91f breast cancer in, 339, 411f surgery and, 65 with implants, imaging for, 38–45 kyphotic, 33f lactating, 648 FNAB for, 626 lumpectomy treatment for, 500 motion of blur from, 49 unsharpness from, 54 with nipple discharge, 569f 687 with palpable mass, approach for, 87–94 positioning of, 26–38, 54f artifacts and, 58f assessment of, 54 implants and, 51f–52f modifications of, 45 for needle localization, 588 postlumpectomy, 374 pregnant, ultrasound in, 647–648 premenopausal, nonpalpable asymmetry in, 76 recall of, 465f tenseness of, 27 treatment of, 598 young breast density in, 95 fibroadenoma in, 95 imaging for, 94–96 lesions in, 95 malignancy in, 94 management algorithm for, 94f ultrasound in, 647–648 Pectoralis fascia, 209, 392f Pectoralis major muscle, angle of obliquity of, 6, 24f axillary breast tail and, imaging of, 23 breast relation to, calcified parasites in, 329f in CC view, development of, lack of, 5f fixation of, 73 forward bulge of, 25f forward pulling of, 27 implants and, 531f mass within, 495 MLO and, 5, 26 normal, MLO view of, 9f origins of, visualization of, 40f Pectoralis minor muscle, breast relation to, Percutaneous biopsy See Percutaneous needle biopsy Percutaneous needle biopsy, 99, 602–630 advantages of, 602 cost of, 604 diagnosis by, 627 guidance for, 73 Periareolar soft tissue changes, 495 Periductal collagen, deposition of, Periductal connective tissue, increase in, Periductal fibrosis, 306f calcifications in, 247 linear densities and, sclerosing adenoma and, 382f Periductal inflammation, 339, 383f Perilobular connective tissue, Perilobular fibrosis, linear densities and, Photocell, incorrect position of, 54 Phototiming, use of, 40f Phylloides tumor, 124–125, 152f, 643f See also Cystosarcoma phylloides calcification in, 125 carcinoma vs., 178f malignancy of, 125 occurrence of, 125 palpation of, 125 probability of, 153f Physical examination, 117 Picture archiving and communication system (PACS), 23 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 688 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 688 Index Pituitary gland follicle-stimulating hormone and, luteinizing hormone and, Plasma cell mastitis, 231 description of, 264f duct ectasia and, 374 features of, 273f Plasma cell tumor, history of, 6f Pleomorphic calcifications, ductal, 350f Pleomorphic microcalcifications, 39f, 283–287 categories of, 283 cluster of, 302f development of, 318 segmentally oriented, 596f shapes of, 287 Pneumocystogram, 623f Pneumocystography, 615–621 cavity on, 141f performance of, 117 technique of, 616, 622f Pneumonectomy, 6f Pneumothorax, 597 PNL See Posterior nipple line Poland’s syndrome, mammary hypoplasia secondary to, 5f Polymastia, Polythelia, Pore, occluded, 162f Posterior nipple line (PNL), 29 Postmenopausal breast, 12f density of, 16f mammogram of, 176f normal, 15f Posttraumatic changes, 194–201 Posttreatment changes, 505f Precipitated calcium salts, 276 Pregnancy accessory breast changes of, axilla and, 2f axillary mass enlargement during, 2f breast cancer and, 95 ductules and, hormonal response of, erythema during, 434f lobule increase during, 7–10 milk secretion and, 7–10 nipple discharge, bloody, 567 parenchymal changes during, 7–10 terminal ductule expansion during, 7–10 ultrasound and, 647–648 Primitive milk streak accessory breast tissue development and, 4f incomplete regression of, dispersion or, Progesterone ductal dilation and, 10 lobule formation and, ovulation and, 10 Projections craniocaudal, 621 mediolateral, 621 Prolactin, epithelial cell changes from, Proliferative disease, fibroadenoma risk and, 120 Prostate, 142 Proteinaceous debris, histiocytes and, 90f Psammomatous microcalcifications, 461 formation of, 466f Pseudoangiomatous stroma hyperplasia (PASH) angiosarcoma, 193 asymmetrical breast tissue and, 363 characteristics of, 105t hyperplasia, 105t, 128 occurrence of, 193 Pseudocalcifications artifacts and, 238–242 cause of, 240 from zinc oxide, 239f Pseudolesion, 364f Pseudomasses, keloids as, 254f Pseudosarcomatous metaplasia, 225 Psoriasis, adenopathy and, 455f Psoriatic arthritis, 109 Puberty breast during, 12f ductal growth during, Pulmonary embolism, superior vena cava clot and, 8f Punch biopsy, 428f Punctate calcifications, 276 description of, 276 fibrocystic changes and, 295f Purulent fluid, 428 Purulent material, removal of, 163f Q Quantum mottle, 54 R Radial scar, 186, 193, 194f, 298f, 300f, 369f, 374–386, 384f, 387f, 389f, 653f architectural distortion and, 388f carcinoma vs., 402f central region of, 382 cytologic features of, 387 diagnosis of, preoperative, 382 frequency of, 377 histologic features of, 387 lesions of, 194 on mammography, 380 microcalcifications and, 194 possibility of, 381f as proliferative lesion, 628 sonography of, 382 spiculated lesion favoring, 385f tubular carcinoma from, 222 Radiation changes following, 507f, 513f edema pattern secondary to, 431f evolution of, 510f fat necrosis and, 501 latent changes following, 501 lumpectomy and, 498–514 changes following, 504f, 509f mastectomy vs., 498 mammoplasty and, 67f scaring from, 194 scattered, 21, 49 therapy with, 482 Radiation dose, 21–22 factors in, 21–22 increase in, 49 reduction in, 18, 20 Radical mastectomy, 482 Radiographic field, lesion projection and, 34f–35f Radiographic magnification, 45–49 Radiography, specimen, 598–600 Radiologic correlation, histologic correlation and, 245–250 Radiologic findings, 630 Radiologist appropriate view selection by, 65–68 BI-RADS® and, 61 challenges for, augmented breast and, 528 correlations by, 273 errors by, 72f interpretation skills of, 18 mammogram interpretation by, 238 pathologist communication with, 630 role of, 49 search patterns of, 62 Radiolucencies large, 277f oil cysts as, 195 size of, 194 Radiolucent center, presence of, 186 Radiolucent compression device, 19 Radiolucent lesions, 68 Radiolucent mass, 105, 109f with eggshell calcifications, 490 palpable, 119f Radiopaque marker, 66f Radiotherapy, 427, 498 baseline mammogram before, 503f pretreatment mammogram as baseline for, 501 skin thickening and, 431f Raynaud disease, 268f Receptor breasts on, 35f elevation of, 25f ipsilateral arm and, 31 object distance from, 54f Reciprocating grids, composition of, 19 Reconstruction See also Augmentation; Implants of breasts, 555–565 implant placement for, 558f with TRAM, 564 normal, 564f–565f Recording system, resolution and, 18 Recurrent carcinoma, 332f, 515f, 517f, 518, 522f assessment of, 664–665 findings of, 501 invasive ductal, 520f in reconstructed breast, 526f Reduction mammoplasty, 266f, 491–497 dermal calcifications and, 493f fat necrosis secondary to, 497f postoperative changes secondary to, 491f–492f, 495f, 499f round/dystrophic calcifications from, 291f Remote server, 23 Renal disease, 437 arterial calcification from, 258f edema pattern secondary to, 440f end-stage, 441f fluid overload and, 442f Resolution recording system and, 18 screens for, 20 spatial, 23 Retromuscular implants, 531f Rheumatoid arthritis, 109, 231 adenopathy and, 454f chrysotherapy for, 240, 240f–241f, 461 lymphadenopathy and, 461 Rhodium, as target material, 18 Rimlike calcifications, 269 Rolled views, interpretation of, 37 Round calcifications, 276 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 689 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index as BI-RADS® 3, 62 with diffuse fibrocystic changes, 290f occurrence of, 276 from reduction mammoplasty, 291f Round microcalcification, segmented, 292f S Sagittal plane, lesions on, 37 Saline, implants of, 530 collapsed, 541f free silicone and, 548f–549f normal, 550f prepectoral, 535f rupture of, 540f subpectoral, 532f Salvage rate, 500 Sarcoidosis, 109, 448 adenopathy secondary to, 449f Sarcoma, 142, 180f Scan pattern, 65 Scar marker of benign biopsy site, 53f fat necrosis and, 76 features of, 194 location of, 67 importance of, 186 from lumpectomy, 161f Scar tissue, in breast, postmammoplasty, 67f Scarring appearance of, 197f calcification of, 281f dermal calcifications in, 490 diminishing, 196f dystrophic calcification in, 254f enlargement of, 507 from lumpectomy, 379f resolution of, 511f postsurgical, 370–374 evolution of, 379f from surgery, 196f–197f, 203f, 432f, 486f Scatter radiation, 19, 21 reduction of, 19 Schwann cells, granular cell tumors from, 206 Scirrhous carcinoma, 215 Scirrhous response, production of, 225 Scirrhous stroma, 214 Sclerosing adenosis, 126, 154f, 192f, 300f, 369f as asymmetry, 366 as benign proliferative disorder, 245 definition of, 188 with epithelial hyperplasia, 189f fibrocystic change and, 157f with focal LCIS, 296f irregular density of, 188 lobular proliferation in, 246 mammographic presentation of, 154f papillomatosis and, 380f periductal fibrosis and, 382f presentation of, 245–246 as sign of fibrocystic disease, 82 in TDLU, Sclerosing ductal proliferation, 193f Sclerosing lesion complex, 377 nonencapsulated, 377 Sclerosing lobular hyperplasia, 130 Sclerotic ductal papilloma, 572f Sclerotic intracystic papilloma, 640f Sclerotic intraductal papilloma, 574f, 576f Screening ultrasound, 649–650 Screens dusting of, 20 for resolution increase, 20 wet-cleaning of, 20 Search patterns, 62–65 literature on, 65 Sebaceous cysts, 130, 161f–162f, 467f, 638f appearance of, 636 in men, 470, 475f Sebaceous glands, interconnecting lumina of, 250 Seborrhea keratosis, 131f Secreting alveoli, Secretory cells ductular epithelial cells and, 10 in lactating breast, 13f Secretory disease as benign, 260f benign calcifications of, 273f margination of, 274f description of, 264 duct ectasia, 383f with large rodlike calcifications, 270f, 272f BI-RADS® 2, 271f large rodlike calcifications of, 274f nipple discharge and, 569 SEER See National Cancer Institute Surveillance, Epidemiology and End Results Segmental mastectomy, 482 Seroma at lumpectomy site, evaluation of, 506f postoperative change with, 160f, 485f fat necrosis and, 195f Silicone for breast augmentation, 263 capsular calcification of, 539f cysts of, 547 free, 545f, 661f bilateral, 547f in explant site, 563f extracapsular, 539f as palpable mass, 545f, 549f residual, 550f saline implants and, 548f–549f globules of, 534 implants of, 531f bilateral leakage of, 552f extracapsular leak of, 541f, 663f extracapsular rupture in, 661f intracapsular rupture in, 551f, 662f MRI for, 553 positioning of, 533f rupture of, 448–451, 451f, 531–534, 553f–554f subpectoral, 533f injection of, augmentation by, 528–529 lactiferous duct casts of, 546f residual free, 534 tissue reaction to, 652 Silicone-induced granulomatous adenitis, 448 Simultaneous development, of computerized radiography, 23 SIO See Superoinferior oblique mammographic view Sjögren’s disease, adenopathy and, 457f 689 Skin artifacts on, 238 of breast, calcifications within, 50f, 250–254, 253f excoriations of, 239f folds of, smoothing of, 29 lesion of, 109–110, 129f–130f, 130, 467f air in, 131f characteristics of, 105t evidence of, 66f keratosis, 131f parenchymal abnormalities and, 66f pedunculated, 130f marking, 590 Nitro-Bid patch on, 135f retraction of, 195 substances on, 238–240 thickening of benign causes of, 427–442 of biopsy site, 482 burn injury and, 437f at lumpectomy site, 501 malignant causes of, 418–427 postoperative, 491 radiotherapy and, 431f thickness of, 67 breast size and, 418 carcinoma and, 420f diffuse, 424 increase in, 68, 130, 195, 206, 419t malignant causes of, 418–427 mammography of, 418 normal, 418, 419t, 442 pattern of, 418–443 ulcerations in, 239f Skin tags, 252 Smear, atypical, 94 Solitary defect, etiology of, 571 Solitary dilated ducts, 341–343, 347f excision for, 352f Solitary intraductal papillomas intraductal papillomatosis vs., 339 in main lactiferous ducts, occurrence of, Solitary mass, 591 Sonography for abscess cavity, 339 for biopsy guidance, 73 of carcinoma, 217f for circumscribed masses, 182f cysts on, 117 features of, 117 of fibroadenomas, 638 for gynecomastia, 470 for implant rupture, 534–537 of inflammatory breast cancer, 419 of invasive ductal carcinoma, 174f of lesion, 108, 149f, 588 cystic, 154f solid, 154f malignant criteria for, 117 for mastectomy patient, 514 for microcalcifications, 649 of multicentric carcinoma, 167f for palpable mass, 606f, 653f of radial scars, 382 of solid mass, 94 Spatial resolution, of digital mammography, 23 Specimen radiography, 598–600 calcifications on, 627 Spherical calcifications, 269 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 690 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q 690 Index Spiculated density, interpretation of, 490 Spiculated lesion, 370, 405f bilateral, 390 central high density of, 70f demonstration of, 40f distortion of, 100f focal, MLO view of, 36f of invasive ductal carcinoma, 187f radial scar and, 385f XCCL view of, 38f Spiculated mass, 224f, 230f, 617f identification of, 186 margins of, 186 new, 501 Spicules, radiation of, 188 Spot field, 33 Spot magnification, patient positioning for, 54f Spot-compression, 33–37, 54f CC view, 11f for circumscribed mass borders, 68, 157f with collimation, 243 of fatty hilum, 129f of infiltrating ductal carcinoma, 43f of lesions, 186 magnification and, 44f of microcalcifications, 55f in ML view, 69f nipple retraction and, 79f positioning for, 42f for potential mass, 77f of small mass, 46f of spiculated lesion, 80f Standardized terminology, 61 Steatocystoma multiplex, 105, 114f Stellate masses, 188 Step-oblique mammography, 363 Stereotactic aspiration, 620f Stereotactic core needle biopsy, 519f, 607–609 FNAB and, 612 Stereotactic guidance, bracketing procedure using, 596f Stereotactic images, reference point for, 588 Stereotactic localization, 588 Stereotaxis, 88 principle of, 607 Sterile gauze, 568f Steristrips, 568f Sternal border, muscle at, Sternalis muscle, 8f bilateral CC views of, 9f in CC view, 10f in MLO view, 6–7 occurrence of, right, in CC view, 11f Stevens Johnson syndrome, 239f Stomach, 142 Stroma as breast tissue constituent, calcifications of, 283 cellularity of, 120 connective-tissue, 120 dense collagenous, 193 scirrhous, 214 types of, Stromal fibrosis, 306f occurrence of, 188 Structure, of breast, 1–2 Subareolar abscess, 206f Subclavian vein thrombosis, 361f Subcutaneous fat See also Fat of breast, breast cancer extension into, 418 duct dilation in, 2f mass in, 180f palpable nodule in, 145f symmetry of, 67 Subcutaneous tissues, tumor in, 209f Subject contrast, 21 Superficial thrombophlebitis, of breast/upper abdominal wall, 349 Superior vena cava, clot in, pulmonary embolism and, 8f Superoinferior oblique mammographic view (SIO), 31–32 pacemakers and, 33f patient positioning for, 33f Surgery architectural distortion following, 78 breast following, 482–526 changes following, 335f, 507f excision and, 589 for implant rupture, 546f pathology of, 590f postoperative MRI with, 664 prior site of, 91f procedures of, 482 scarring from, 196f, 203f, 370–374, 432f, 486f evolution of, 379f Surgical resection, 224 Sutural calcifications, 269–273, 284f, 500f, 516f at lumpectomy site, BI-RADS® 2, 330f suspicion of, 273 Sweat gland, breast as, 4f Synchronous bilateral breast cancer, incidence of, 97–99 Syringe, 568f, 621 Systemic lupus erythematosus, 109 history of, 268f T Tail of Spence, 468f Tamoxifen, effects of, glandular density and, 17 Tangential mammographic view, 38 Tangential view, 38 of dermal calcifications, 50f positioning for, 49f Target materials filter materials and, 18 combination effect of, 20f types of, 18 TDLU See Terminal duct lobular unit Temperature, contrast and, 21 Terminal duct composition of, intralobular, structure of, 7f Terminal duct lobular unit (TDLU), as basic unit, 245 calcifications within, 245 fibrocystic changes within, 245 hormone sensitivity of, lesions of, 247 structure of, 7f Terminal ductules, expansion of, pregnancy and, 7–10 Terminal lobule, disappearance of, 10 Thorax burn injury to, 254f cross section through, 23f Tissue See also Asymmetric breast tissue accessory, asymmetric, 3f benign disease of, 297f, 515f composition of, categories of, 61 density of, 88 BI-RADS® and, 61 ectopic, 467, 468f granulation, 654f parenchyma of, sampling, 584, 608f silicone and, 652 structure of, Toluidine blue, 587 Tongue, tumor of, 209f TRAM See Transverse rectus abdominis myocutaneous flap Transducer, 633 Transverse rectus abdominis muscle, 518 Transverse rectus abdominis myocutaneous flap (TRAM), 524f normal, 564f–565f reconstruction with, 564 Trauma breast abscess secondary to, 164f fat necrosis and, 195 hematoma and, 370 history of, 70, 200f lucent-centered calcifications secondary to, 279f oil cyst and, in men, 476f response to, acute, 195 skin thickening from, 437 Trichinella spiralis, 318 Trichinosis, with calcified parasites, 329f Triple test concept of, 93 fibroadenoma diagnosis from, 120 prediction by, 93 True lateral (90-degree) views, 29–30 Tube output, decrease in, 49 Tuberculosis, 231 Tubular adenoma characteristics of, 105t rarity of, 130 Tubular carcinoma, 214, 380, 386–387 assessment of, 222 characteristics of, 215–222 cytologic features of, 387 differentiation of, 387 growth of, 387 histologic features of, 387 radial scar and, 222 suspicion of, 393f–395f Tubular densities, 15f Tubular features, invasive ductal carcinoma with, 412f Tubular structures, 344f Tubular-nodular densities, 351f Tumor See also Phylloides tumor abscess vs., 208f adenosis, characteristics of, 105t calcification of, 227, 238 cells of, displacement of, 626 circumscribed, 215 in cyst cavity, 178f in dermal lymphatics, 428f desmoid, 392f indistinct mass as, 73 emboli of, 424 extensions of, 211 fibrous, 94 foci of, 664 GRBQ182-2801G-Ind[671-692].qxd 01/03/2007 10:11 PM Page 691 PMAC-291 PMAC-291:Books:GRBQ JOBS:GRBQ182-DePerdes: TechBooks [PPG -Q Index granular cell, 206–209 in bile duct, 206 from Schwann cells, 206 gross examination of, 211 growth of, factors of, 120 hematoma vs., 208f intraductal extension of, 665f in lymph nodes, 327f, 422f mucoid degeneration of, 120 neovascularity of, 660 node infiltration by, 460 of parotid gland, 430f phylloides, 124–125, 152f, 643f solid, 214 squamous changes in, 225 in subcutaneous tissues, 209f of tongue, 209f vascular, 130 Tumor bed, 331f boost to, 500 local changes to, 501 microcalcifications in, 334f Tumoral calcinosis, hypercalcemia and, 263f Tungsten, as target material, 18 U Ultrasound biopsy guided by, 594f, 598f, 604–607 for breast conservation, 500 for calcifications, 82, 86f core biopsy guided by, 606f cyst aspiration guided by, 605f cyst demonstration with, 68 of cysts, 140f of double-lumen implant, 540f for fibroadenomas, 124 for focal asymmetry, 364 for hypoechoic mass, 77f, 150f implants and, 534–547 incorporation of, 633 for indistinct mass, 73 for lesions, 157f of lymph nodes, 109 of mass, 165f, 407f for mass evaluation, 84 for mastectomy patient, 514 of medullary carcinoma, 135 needle localization guided by, 588–589 negative, 89, 366 for palpable mass, 89 papilloma on, 345 for potential mass, 77f pregnancy and, 64–648 for primary carcinoma, 460 reasons for, 88 role of, 633–645, 633t expansion of, 633 screening, 649–650 for solid mass, 89, 181f use of, 99, 633 vacuum-assisted system for, 626f for young patients, 647–648 Umbilicus carcinoma of, mucin-producing, 466f metastatic mucinous carcinoma from, 305f Uniorificial serous discharge, 346 Upright unit, 607 Uterine cancer, history of, 155f V VAB See Vacuum-assisted probes Vacuum-assisted biopsy, 482, 602 probe for, 624f, 654f clips and, 625 development of, 624 technique for, 605–607 Vacuum-assisted probes (VAB), 606 Vascular calcifications, 255–259, 259f as benign, 260f bilateral, 282f diabetes mellitus and, 255 edema pattern and, 442f Vascular lesions, 232, 235f Vascular structures, circuitous, 8f Vascular tumor, 130 Vasculitis, 234f Vasovagal reaction, 597–598 Vein(s) dilation of, asymmetrical, 361f normal, 360f thrombosed, 349 Venography, 361f Venous collaterals dilated, 361f enlarged, 8f 691 Venous drainage route, Vermiform macrocalcifications, 287–318 Vessel calcification of, 55f puncture of, 482 Vitamin D supplements, breast density and, 17 Volvulus, of implant, 540f W Waldenstrom’s macroglobulinemia, 231 Water-soluble contrast, 568f Wegener’s granulomatosis, 231, 234f Weight gain of, breast appearance and, 14 loss of body fat and, 14 on breasts, 14 Women breast cancer history of, 339, 411f nulliparous, 339 senior breast palpation for, 66f fatty infiltration in, 445 Women’s Health Initiative, randomized trial of, 14 Workup, incomplete, 72f Worms, calcified, 329f X X-axis errors, 613f, 615f–616f XCCL See Exaggerated craniocaudal lateral mammographic view XCCM See Exaggerated craniocaudal medial mammographic view X-ray beam direction of, 29f tube target materials of, 21 Y Y-axis error, 612f, 615f–616f Z Z-axis error, 614f Zinc oxide as artifact, 238 pseudocalcification from, 239f ... DCIS GRBQ1 82- 2801G-C07[339-3 62] .qxd 02- 25 -20 07 10 :25 AM Page 3 52 Techbooks[PPG-Quark] 3 52 Atlas of Mammography A Figure 7.16 HISTORY: A 56-year-old woman for screening mammography MAMMOGRAPHY:... 359 GRBQ1 82- 2801G-C07[339-3 62] .qxd 02- 25 -20 07 10 :26 AM Page 360 Techbooks[PPG-Quark] 360 Atlas of Mammography A B Figure 7 .26 HISTORY: A 52- year-old woman for screening mammography MAMMOGRAPHY:... papillomatosis GRBQ1 82- 2801G-C07[339-3 62] .qxd 02- 25 -20 07 10 :26 AM Page 356 Techbooks[PPG-Quark] 356 Atlas of Mammography Figure 7 .22 HISTORY: A 65-year-old woman with a scaling, ulcerating lesion of the right