Mammography is a kind of X-ray examination technology to check breast diseases. Mammography can reflect the general anatomical structure of the entire breast, observe the influence of various physiological factors on the structure of the breast, and can dynamically observe it to more reliably identify the mammary gland. Benign and malignant tumors; some precancerous lesions can be found and follow-up radiographs can be performed.
When to do a mammogram
1. When the breast skin becomes thick, the axillary lymph nodes are swollen, the skin has inflammatory manifestations, and bloody nipple discharge occurs, mammography should be performed to find out the invisible lesions in the breast tissue.
2. When there is a lump in the breast, its nature should be determined.
3. When breast cancer is detected, a comprehensive examination of the breast should be carried out before a clear treatment plan is made to determine whether there are hidden lesions, as well as the nature and scope of the lesions.
4. Breast cancer patients should undergo regular mammography examinations after breast conserving surgery to monitor the recurrence of breast cancer.
5. Other conditions, and situations in which the breast specialist feels that mammography should be used to examine the breast.
Common signs of mammography
1. Mass: A space-occupying lesion that can be found
in two different irradiation positions has a bulging edge, which is a mass; a suspicious mass shadow that appears only in one irradiation position is called a “dense shadow”.
Masses are usually described in terms of morphology, density, and margins. ① form. There are lobular, oval, round and irregular shapes. Oval and round shapes are mostly benign signs, while irregular shapes are usually malignant signs; lobulated shapes are intermediate signs, most of which are malignant signs, but some are benign masses. ② density. Compared with the breast tissue of the same volume around the mass, it can be divided into four types: high, equal, low and fat density when describing. Most breast cancers are hyperdense or isodense; very few are hypodense; fat density is mostly benign. ③ edge or boundary. Marginal signs are the most critical in evaluating the benign and malignant nature of the mass, and are mainly described as clear, small lobulated, fuzzy, burr-like or star-like and serrated. The margin is clear, more than 75% of the tumor has a clear border and the surrounding normal tissue, and the rest of the margin can be covered by the surrounding glands, but there is no evidence of malignancy; the margin is blurred, and the tumor is covered by the adjacent gland tissue, which is difficult to make In-depth evaluation; small lobulation, small wave-like changes at the edge of the lesion; burr or serrated edge, indicating that the lesion is infiltrating around; star-shaped, the radial line shadow presented by the edge of the lesion. Small lobulated, star-like and serrated margins are usually signs of malignancy.
2. Calcification There are usually two aspects to
describe calcification, namely morphology and distribution.
Morphological descriptions of calcifications include typical benign calcifications, intermediate calcifications (i.e. suspected calcifications), and highly malignant probable calcifications. Typical benign calcifications include skin calcifications, typical skin calcifications with translucent changes in the center, and atypical skin calcifications can be distinguished by tangential projection. Popcorn-like or rough calcification is an important calcification feature of fibroadenoma; thick rod-shaped calcifications are generally more than 1 mm in diameter and occur mostly in secretory lesions, such as plasma cell mastitis and ductal dilatation; 1. Eggshell-like or annular calcification, with very thin annular wall, mostly occurs on the remains of fat necrosis, intraductal calcification, and occasionally fibroadenoma: milk-like calcification is more common in cysts. According to the shape of the cyst, it is divided into half-moon, linear and curved. Suture calcification, caused by the deposition of calcium on the suture material, mostly occurs after radiotherapy; dystrophic calcification is generally seen in the breast after trauma or radiotherapy. Others include punctate, oval, or round calcifications.
Intermediate calcifications include amorphous calcifications and rough heterogeneous calcifications. Morphologically, amorphous calcifications are small and indistinct, with no typical features; coarse and heterogeneous calcifications usually exceed 0.5 mm and are irregular or malignant. Of course, it sometimes occurs in benign fibroadenoma, fibrosis, and breast after trauma, and should be evaluated according to its specific distribution.
Highly malignant calcifications are usually pleomorphic fine calcifications (as granular punctate calcifications) and line-like or line-like branched calcifications.
Observing the distribution of calcification is helpful for judging the pathological type of breast cancer lesions. ① Scattered or diffusely distributed pleomorphic and punctate calcifications, usually benign lesions. ②Regional distribution of calcification should be comprehensively evaluated with reference to its specific morphology. ③ The calcifications are distributed in clusters, which means that more than 5 calcifications are located in a narrow space (<1 cubic centimeter), and both benign and malignant lesions are possible. ④ Linear distribution of calcification, arranged in a linear, usually malignant lesions. ⑤ Calcifications with segmental distribution are sometimes benign secretory lesions, but if the calcification morphology is not a benign feature, it should be evaluated as malignant calcification. Because the disease itself is very complex, it is necessary to conduct a comprehensive analysis on the basis of imaging data, take a physical examination, understand the family history and surgical treatment history, and finally draw accurate clinical conclusions.