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Mammography and Interventional Breast Procedures
Published in Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack, Radionuclide Imaging of the Breast, 2021
Asymmetrically dense breast tissue is a broad area of radiographically dense tissue that does not form masses but is distinctly different from the corresponding contralateral volume of tissue. It refers to a relative increase in the volume of fibroglandular tissue compared with the corresponding area in the contralateral breast. The architecture of the breast is maintained, the underlying trabecular pattern is preserved, and fat can be frequently seen distributed through the area. Simple benign asymmetrically dense tissue should not have definable margins, and it does not have an easily defined center. If calcifications are present, the entity is no longer a simple asymmetry and may require biopsy. Nonspecific dense areas are evident in about 3% of mammograms. Virtually all are normal variations which occur due to either developmental asymmetry or different end-organ response to hormonal stimuli. The upper outer quadrant is the most common site. Asymmetrically dense breast tissue, if cancerous, is virtually always clinically evident (palpable). Therefore, biopsy of simple asymmetric breast tissue is recommended only when a corresponding palpable mass is present (Fig. 14) [26].
Imaging of the Breast with Photon-Counting Detectors
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Stephen J. Glick, Bahaa Ghammraoui
It is known that women with radiographically dense breast tissue are at increased risk of developing breast cancer.26,47 Breast density is typically assessed using the BI-RADS breast density rating scale that places patients into one of four categories, namely; fatty, scattered density, heterogeneously dense, and extremely dense. However, the assignment of BI-RADS scores is a subjective process, and inter-rate agreement is generally low. Some studies have suggested a Cohen's kappa coefficient to assess breast radiologist agreement of between 0.44 and 0.54.29,30 One approach to reducing this observer variability is the use of quantitative algorithms that can estimate area-based or volume-based breast density.48–51 Another idea involves using dual-energy mammography to estimate breast density52,53; however, this approach is limited in that it typically requires two scans at two different time points, and the delay between scans can result in motion artifacts.
Breast cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This is reserved for the investigation of younger women with more dense breast tissue or more difficult cases such as a suspicious lump arising in a breast augmented with a tissue expander or silicon implant, where mammography can be impractical. It is also useful in excluding multifocal disease in mammographically dense breasts and in helping to define the extent of the cancer and checking for occult contralateral breast cancer in those with invasive lobular carcinoma.
Idiopathic Granulomatous Mastitis: Etiology, Clinical Manifestation, Diagnosis and Treatment
Published in Journal of Investigative Surgery, 2022
Yulong Yin, Xianghua Liu, Qingjie Meng, Xiaogang Han, Haomeng Zhang, Yonggang Lv
IGM has no pathognomonic characteristics in mammography, and subtle lesions are often obscured by the relatively dense breast tissues of women of childbearing age [35, 50]. The usual mammographic appearance is a mass with uneven density and irregular borders. The heterogeneity of masses is related to local skin thickening, nipple inversion and axillary lymphadenopathy [51]. Barreto et al. argued that the most common manifestation of IGM by mammography was structurally distorted and irregular masses or nodules [52]. According to Dursun et al., masses with irregular shapes or obscure boundaries could be found mammographically in up to one-quarter of IGM patients, and single masses were most common [51]. Caution is critical, however, because mammograms may appear normal in patients with dense breast tissue or mild disease [53]. Notably, calcifications have rarely been reported in IGM, limited to some individual cases [54]. Therefore, the diagnosis of IGM can only be suspected by mammography, and the ''solitary mass'' of IGM on mammogram can easily be confused with breast cancer or other breast abscesses.
Role of breast density measurement in screening for breast cancer
Published in Climacteric, 2018
In addition to increased associated risk, mammographic density also reduces the sensitivity and specificity of a mammogram, making the detection of tumors more challenging at the time of screening and leading to higher rates of false-negative and false-positive screening outcomes for women with dense breasts29,43,85–88. Both tumors and dense breast tissue appear white/opaque on a mammogram and therefore abnormalities are often very difficult to distinguish within the dense tissue. This is often referred to as the masking effect. Odds ratios describing the association between mammographic density and breast cancer risk are consistently higher for interval detected cancers (diagnosed after a normal/negative screening mammogram) compared to screen-detected cancers; women with extremely dense breasts are up to 17 times more likely to develop an interval breast cancer than women of the same age with very little or no mammographic density6,13,15,17,44,87,89. It has recently been suggested that certain combinations of risk factors may be better suited as predictors of breast cancer risk whilst others may be better suited for predicting the ‘risk of masking’89. Krishnan and colleagues report that risk of breast cancer is best predicted by BMI in combination with either the absolute area of dense tissue or the percentage of dense area in a mammogram, but not the absolute area of non-dense tissue. The risk of masking was found to be best predicted by the percentage of dense area, and not by BMI89.
What influence does mammographic density have on breast cancer occurrence?
Published in Expert Review of Anticancer Therapy, 2022
Aanchal Mathur, Sebastien Taurin
The genes involved in developing and maintaining mammographic density are poorly understood. The heredity of mammographic density has been demonstrated in twin studies. The percentage of dense breast tissue had a correlation coefficient of 0.61 and 0.67 for monozygotic pairs and 0.25 and 0.27 for dizygotic pairs in Australia and North America, respectively, for women aged 40 to 70 years. A total of 46 mammographic density loci were identified by genome-wide association, including 17 linked to breast cancer [11]. Identifying the genes critical for mammographic density development will be essential to understand its impact as a breast cancer risk factor.