<prompt> Hallmark of breast malignancy on mammography?Low density lesionSmooth marginsClusters of microcalcificationPopcorn calcification  <response>: Ans. c Clusters of microcalcification Ref Graingerys Diagnostic Radiology, 4th ed., 2239Diagnostic 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-likeelongated, 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. Meanaverage 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 popcornBenign lesions like fibroadenoma calcification2.Egg shell calcificationTraumatic fat necrosis3.Tentacles, spiculesScirrhous Ca4.Fine, irregular, polymorphic clusters of microcalcificationsCa breast Scirrhous Ca, intraductal Ca5.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 