Breast imaging – Mammography interpretation – Mammography lexicon – Associated features
Associated features of the BI-RADS Lexicon are additional mammography findings that play a role in the final assessment when seen in association with a mass, an area of asymmetry, and/or calcifications.
Skin retraction associated with breast cancer is seen as a late change and will be clinically evident .
Postoperative skin retraction
Postoperative skin retraction may be seen in patients who have undergone breast-conserving surgery .
The normal skin of the breast is thin (0.5–2 mm), uniform, and sharply visualized on mammography. The skin overlying the breast is said to be thickened if it is > 2 mm. Skin thickening may be focal or generalized, unilateral or bilateral. Some causes of unilateral breast skin thickening are:
Inflammatory breast carcinoma mastitis and radiation
Skin thickening in breast malignancy
Skin thickening caused by other diseases Bilateral breast skin thickening can be caused by:
Nipple retraction is caused by scarring and contraction of the fibrous supportive tissues (e.g. ligaments of Cooper) of the breast stroma caused by the underlying pathology. Nipple retraction is either horizontal or vertical.
Normal nipple seen in profile
Physiological nipple retraction, grade 3
Pathological nipple retraction with underlying breast carcinoma
Trabecular thickening involves thickening of the lactiferous ducts and ligaments of Cooper. It can be caused by:
Mastitis inflammatory carcinoma and radiation
Axillary lymphadenopathy or enlarged lymph nodes
Intramammary metastatic node :
Architectural distortion with underlying primary mass is suggestive of extent of the disease process. Architectural distortion can be seen with breast cancer and also with non-malignant disease process including infective, inflammatory breasts and breast trauma .
Architectural distortion in breast cancer
Architectural distortion in breast inflammation
Architectural distortion in breast trauma
Intraductal calcifications are representative of duct carcinoma in situ (DCIS) . Calcifications of suspicious morphology seen with a mass categorise the lesion as malignancy. Calcifications of benign morphology categorise the mass as benign lesion.