Atlas of breast cancer early detection

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
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 .

Skin thickening
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 ;
• radiation;
• breast malignancy .

Inflammatory breast carcinoma       mastitis                                             and radiation

Skin thickening caused by other diseases Bilateral breast skin thickening can be caused by:

• congestive cardiac failure;
• dermatological conditions (e.g. psoriasis or scleroderma);
• anasarca; or
• bilateral breast carcinoma (rarely)

Nipple retraction
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.

• A horizontal slit is most likely benign pathology caused by periductal mastitis and fibrosis. There is no underlying mass and no sign of cancer .
• Vertical nipple retraction is caused by contraction of the fibrous structures and suggests an underlying cancer, which pulls the nipple upwards in the direction of the mass .

Normal nipple seen in profile

Trabecular thickening
Trabecular thickening involves thickening of the lactiferous ducts and ligaments of Cooper. It can be caused by:

• breast oedema resulting from mastitis ;
• inflammatory carcinoma ;
• cardiac failure; or
• radiation

Mastitis                                           inflammatory carcinoma                 and radiation

Axillary lymphadenopathy or enlarged lymph nodes

• breast carcinoma ;
• lymphoma;
• chronic lymphoid leukemia;
• infection .

Intramammary metastatic node :

• Nodal metastasis may also be seen involving the intramammary node of the ipsilateral breast.
• The metastatic intramammary node will be enlarged with altered morphology features including altered shape and density, thickened cortex and / or loss of fatty hilum.
• Presence of intramammary metastatic node may suggest further axillary nodal metastasis.

Architectural distortion
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

Calcifications
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.

Malignant calcifications