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Breast Imaging Companion GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page i Aptara (PPG-Quark) BREAST IMAGING COMPANION T HIRD E DITION GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page ii Aptara (PPG-Quark) GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page iii Aptara (PPG-Quark) BREAST IMAGING COMPANION T HIRD E DITION Gilda Cardeñosa, MD Veronica Donovan Sweeney Professor of Breast Imaging Director of Breast Imaging Department of Radiology Virginia Commonwealth University Health System Medical College of Virginia Hospitals Richmond, Virginia GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page iv Aptara (PPG-Quark) Acquisitions Editor: Lisa McAllister Managing Editor: Kerry Barrett Project Manager: Rosanne Hallowell Manufacturing Manager: Benjamin Rivera Marketing Manager: Angela Panetta Art Director: Risa Clow Cover Designer: Larry Didona Production Services: Aptara, Inc. Third Edition © 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer business 530 Walnut Street Philadelphia, PA 19106 LWW.com © 2001 by Lippincott Williams & Wilkins (Second Edition). © 1997 by Lippincott-Raven (First Edition). All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilizing by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Printed in the United States Library of Congress Cataloging-in-Publication Data Cardenosa, Gilda. Breast imaging companion / Gilda Cardenosa. — 3rd ed. p. ; cm. Includes bibliographical references and index. ISBN-13: 978-0-7817-6491-9 ISBN-10: 0-7817-6491-2 1. Breast—Cancer—Diagnosis. 2. Breast—Imaging. I. Title. [DNLM: 1. Breast Diseases—radiography—Handbooks. 2. Mammography— Handbooks. WP 39 C266b 2008] RC280.B8C366 2008 616.99'449075—dc22 2007037067 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regula- tions, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Admin- istration (FDA) clearance for limited use in restricted research settings. It is the responsibility of health care providers to ascertain the FDA status of each drug or device planned for use in their clinical practice. The publishers have made every effort to trace copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320. International customers should call (301) 223-2300. Visit Lippincott Williams & Wilkins on the Internet: at LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6 pm, EST. 10987654321 GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page v Aptara (PPG-Quark) I dedicate the third edition of this book to The memory of my mother Gilda Paniza Cardeñosa (1923–2003). Her unwavering determination to give me every possible opportunity against significant odds, brought unique adventures spanning continents and cultures and now a cache of memories few can rival. She was tenacious in her beliefs that there is nothing like the American Dream, and the unalienable rights afforded citizens in this country, and that it could be ours, if we remained true to ourselves and worked hard. She was right. We made it beyond our wildest imagination; she was quite a lady. My father Ricardo Cardeñosa Barriga and Dr. Regina O’Brien GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page vi Aptara (PPG-Quark) GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page vii Aptara (PPG-Quark) CONTENTS Preface xiii Acknowledgments xv CHAPTER ONE • Breast Cancer: An Overview 1 Breast Cancer Facts 1 Prognostic Factors 2 Risk Marker Lesions 5 Genetics 6 Chemoprevention 7 National Surgical Adjuvant Breast and Bowel Project (NSABP) 8 Breast Cancer Staging (TNM Classification) 10 Breast Cancer Staging 11 CHAPTER TWO • Regulatory Issues 13 Mammography Quality Standards Act of 1992: Background 13 MQSA: Requirements 14 MQSA: Inspections 15 MQSA: Personnel Qualifications 17 Interpreting Physicians 17 Radiologic Technologists 18 Medical Physicists 18 MQSA: Reporting of Results 19 MQSA: Equipment Standards 20 Quality Assurance Under MQSA 22 MQSA and Full Field Digital Mammography 24 American College of Radiology, Mammography Accreditation Program: Background 24 Mammography Accreditation Program 25 CHAPTER THREE • Quality Control 28 General Comments 28 Film Labeling 30 QC Tests (Technologists) 31 Darkroom Cleanliness 32 Processor QC (Operating Levels) 33 Processor QC (Daily) 34 Processor QC (Control Film Crossover) 35 Screen Cleanliness 36 GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page viii Aptara (PPG-Quark) viii CONTENTS Phantom Images 37 Viewboxes and Viewing Conditions 39 Visual Checklist 40 Repeat Analysis 40 Analysis of Fixer Retention in Film 41 Darkroom Fog 42 Screen-Film Contact 44 Compression 45 QC Tests (Physicists) 45 CHAPTER FOUR • Technical Considerations 48 Equipment 48 Contrast 49 Technical Factors 51 Automatic Exposure Control 53 Grids 55 Compression 56 Image Blur 56 Cassettes, Screens, and Film 59 Processing 60 Artifacts 60 Processor Artifacts 67 Digital Mammography 69 CHAPTER FIVE • Screening Mammography 72 General Comments 72 Screening Trials 73 Screening Recommendations 74 Screening Views: General Comments 75 MLO Views 79 CC Views 85 Exaggerated Craniocaudal (XCCL) Views 89 Breast Compression and Anterior Compression Views 92 Imaging Women with Implants 94 Approach to Screening Mammography 97 Looking For . 106 CHAPTER SIX • Diagnostic Mammography and Problem Solving 112 General Comments 112 Spot Compression Views 116 Micro-Focus Double Spot Compression Magnification Views 121 Tangential Views (TAN) 123 Rolled Spot Compression Views (Change of Angle Views) 125 Mediolateral Views (ML) 129 Lateromedial Views (LM) 129 Cleavage Views (CV) 131 Caudocranial Views (FB From Below) 132 Lateromedial Oblique Views (LMO) 132 Superolateral to Inferomedial Oblique (SIO) Views 133 GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page ix Aptara (PPG-Quark) CONTENTS ix Benign Characteristics 133 Probably Benign Lesions 133 Malignant Characteristics 135 Triangulation 136 CHAPTER SEVEN • Breast Ultrasound 146 General Comments 146 Technical Considerations 152 Scanning 153 Normal Anatomy 158 Benign Characteristics (Solid Masses) 166 Intermediate Characteristics (Solid Masses) 168 Malignant Characteristics (Solid Masses) 168 American College of Radiology Ultrasound BI-Rads Lexicon 175 Ultrasound Artifacts 176 CHAPTER EIGHT • Magnetic Resonance Imaging 180 General Comments 180 Technical Considerations 187 Artifacts and Pitfalls 189 Lesion Evaluation 191 American College of Radiology MR Lexicon 196 CHAPTER NINE • Skin 202 General Comments 202 Skin Manifestations of Breast or Systemic Diseases 209 Keloids and Hypertrophic Scars 215 Epidermal and Sebaceous Cysts 218 Neurofibromatosis 223 Mondor’s Disease 224 Steatocystoma Multiplex 227 Cutaneous Angiosarcoma (Postradiation) 228 Inflammatory Carcinoma 229 Miscellaneous 234 CHAPTER TEN • Nipple-Areolar Complex 237 Normal Anatomy 237 Nipple Changes Associated with Breast Cancer 240 Dermatitis 241 Paget’s Disease 242 Nipple Adenoma 244 CHAPTER ELEVEN • Major Subareolar Ducts 248 General Comments 248 Duct Ectasia 251 Subareolar Abscess 256 Solitary Papillomas 261 Papillary Carcinoma 266 GRBT261-3456G-FM.[i-xvi].qxd 9/21/07 12:00 PM Page x Aptara (PPG-Quark) x CONTENTS CHAPTER TWELVE • Terminal Ducts 270 Normal Anatomy 270 Multiple (Peripheral) Papillomas 270 Radial Scars/Complex Sclerosing Lesions (CSL) 275 Ductal Hyperplasia 278 Ductal Carcinoma in Situ (DCIS) 281 DCIS with no Central Necrosis, Often Low, Intermediate Nuclear Grade DCIS (Well-Differentiated, Cribriform, Micropapillary, Solid) 282 DCIS with Central Necrosis: Often High Nuclear Grade DCIS (Poorly Differentiated, Comedo, Large Cell) 283 Invasive Ductal Carcinoma, Not Otherwise Specified (NOS) 291 Tubular Carcinoma 298 Mucinous Carcinoma 301 Medullary Carcinoma 305 Atypical Medullary Carcinomas 306 Invasive Cribriform Carcinoma 308 Adenoid Cystic Carcinoma 309 Miscellaneous 311 Squamous Cell Carcinoma 311 Metaplastic Carcinoma 311 Secretory Carcinoma (Juvenile Carcinoma) 311 CHAPTER THIRTEEN • Lobules 314 Normal Anatomy 314 Cysts 316 Galactocele 325 Juvenile Papillomatosis 327 Fibroadenomas 327 Complex Fibroadenomas 338
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