Ans. c (Clusters of microcalcification) (Ref Graingerys Diagnostic Radiology, 4th ed., 2239)Diagnostic mammography verses screening mammography# Diagnostic mammography should not be confused with screening mammography, which is performed after a palpable abnormality has been detected. Diagnostic mammography is aimed at evaluating the rest of the breast before biopsy is performed or occasionally is part of the triple-test strategy to exclude immediate biopsy.# Subtle abnormalities (like clustered microcalcifications, densities , and new or enlarging architectural distortion) that are first detected by screening mammography should be evaluated carefully by compression or magnified views.Mammographic features of breast cancer- "Irregular" "Spiculated" margins (of the mass) is most common feature- Architectural distortion- High density lesion 0- clusters of pleomorphic "Microcalcifications" is pathognomonic sign (may be seen in 30% cases of invasive carcinoma and 95% of cases of DCIS ).- Others:# "sunburst" appearance.# True radiolucent halo is almost always benign.# Fat-containing lesions are never malignant. 0# Granular calcification (amorphous, dot-like/elongated, fragmented, grouped very close to each other) and casting calcification (fragmented cast of calcification within ducts) favour malignancy.# Ultrasound features of breast cancer- Spiculations- Taller than wide- Angular margins- Acoustic shadowing- Branch pattern- Markedly hypoechoic- Calcifications- Duct extension- MicrolobulationEducational Points about Mammography# Screening tool of choice for Ca breast.0# Cannot substitute biopsy.# Every female after the age of 40 yrs should undergo annual mammography screening.# If during screening a lesion with "low index" of suspicion for Ca is encountered, follow-up every 6 months should be done.# If while screening a lesion with "high index" of suspicion for Ca is found, stereotactic core biopsy should be done.# Radiation (X-ray) energy used is less than even a chest radiograph.# 'Target material" or anode in mammography X-ray tubes should be made up of molybdenum or rhodium (not tungsten as it produces higher energy x-rays than that of Mb).# K-edege X-ray filters are used.# "Mean/average glandular dose per mammography should be < 0.2 mGy or 0.02 cGy (optimum dose per mammo should be 0.1 mGy or 0.01 cGy).# In young females mammography is not a good screening tool because young breast are more dense, i.e., glandular tissue is more than fatty tissue in young females.# MRI is screening tool of choice for Ca breast in young females, especially in those with positive family history or for who are BRCA1 &/or 2 gene carriers.# Triple assessment consists:- Clinical examination (palpation)- Mammography# The BIRADS (Breast Imaging Reporting and Dictation System) lexicon was developed by the American College of Radiology to provide a clear and concise way to report mammographic result.# MRI is more sensitive than mammography for DCIS.Sr. noType of calcificationBreast disease1.Coarse irregular 'popcorn'Benign lesions like fibroadenoma calcification2.Egg shell calcificationTraumatic fat necrosis3.Tentacles, spiculesScirrhous Ca4.Fine, irregular, polymorphic (clusters of) microcalcificationsCa breast (Scirrhous Ca, intraductal Ca)5.Needle shapedPlasma cell mastitis6.Crescentic or 'tea cup' likeMicrocysts7.Amorphous lumpsFat necrosis and scars8.Fine, smooth, punctate, spherePapilloma, sclerosing adenosis, epithelial hyperplasiaDIFFERENTIAL DIAGNOSIS OF FAT-CONTAINING BREAST LESIONSQ# Lipoma# Oil cyst# Galactocele = fluid with high lipid content (last phase)# Hamartoma# Traumatic fat necrosis (cyst)# Focal collection of normal breast fat