Breast Imaging
Core concepts
Master BI-RADS categories and their management implications. Know mammographic signs: mass, calcification (benign vs suspicious morphology and distribution), architectural distortion, and asymmetry. Understand ultrasound features: shape, margin, orientation, echogenicity, and posterior features. Learn MRI indications (high risk, problem solving) and image-guided biopsy. Know screening principles and the limitations of dense breasts. Understand male breast disease and inflammatory conditions (mastitis, inflammatory cancer).
Traps
- Grouped pleomorphic calcifications are suspicious; scattered round calcifications are usually benign.
- Architectural distortion without a mass may be the only sign of cancer.
- BI-RADS 3 is short-interval follow-up, not biopsy.
- Dense breasts reduce mammographic sensitivity-supplemental ultrasound/MRI may be needed.
- Do not call skin thickening benign without excluding inflammatory cancer.
Worked example / rule of thumb
A new spiculated mass with fine pleomorphic calcifications: BI-RADS 5-biopsy. Rule of thumb: BI-RADS 1–2 = routine; 3 = 6-month follow-up; 4–5 = biopsy. For calcifications, morphology and distribution both matter-grouped/linear/segmental distribution raises suspicion.
Key points
- Know BI-RADS categories and management.
- Suspicious calcifications: pleomorphic, linear, segmental.
- Architectural distortion may be the only cancer sign.
- Dense breasts reduce sensitivity.
- Skin thickening warrants exclusion of inflammatory cancer.