Diagnosis and Management of Common Ductal Abnormalities

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:

Breast Sonography: 3.25
Patient Care: 1.50
Patient Interactions and Management: 1.50
Procedures: 1.75
Anatomy and Physiology: 0.75
Pathology: 1.00

Mammography: 3.25
Procedures: 3.25
Anatomy, Physiology, and Pathology: 1.75
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.50

Magnetic Resonance Imaging: 3.25
Patient Care: 1.50
Patient Interactions and Management: 1.50
Procedures: 1.75
Body: 1.75

Registered Radiologist Assistant: 3.25
Procedures: 3.25
Thoracic Section: 3.25

Sonography: 3.25
Patient Care: 1.50
Patient Interactions and Management: 1.50
Procedures: 1.75
Superficial Structures and Other Sonographic Procedures: 1.75

Radiation Therapy: 3.25
Patient Care: 1.50
Patient and Medical Record Management: 1.50
Procedures: 1.75
Treatment Sites and Tumors: 1.75

Outline

1. Introduction
2. Ductal Anatomy
3. Imaging Evaluation
   1. Galactography
   2. Untrasonography
   3. MR Imaging
4. Biopsy Methods and Technical Issues Specific to Sampling of Ductal Abnormalities
5. Benign Diseases
   1. Duct Ectasia
   2. Blocked Ducts
   3. Inflammatory Infiltrates
   4. Periductal Mastitis
   5. Apocrine Metaplasia
   6. Papillomas
   7. Papillomatosis
6. Malignant Diseases
   1. Ductal Carcinoma in Situ
   2. Invasive Ductal Carcinoma
   3. Paget Disease
7. Conclusions

Objectives

Upon completion of this course, students will:

1. identify the advantage of vacuum-assisted biopsy
2. identify benign lesions of the ducts
3. know the importance of the basement membrane
4. describe nonspontaneous discharge
5. be familiar with physiologic nipple discharge
6. evaluate the need for follow-up to spontaneous nipple discharge
7. identify the TDLU anatomy
8. discuss the function of myoepithelial cells
9. discuss the anatomy of Cooper’s ligaments
10. understand the use of galactography
11. discuss the termination of the galactogram procedure
12. discuss the amount of compression used in galactography
13. be familiar with the normal appearance of the ducts on US
14. identify the variability in the ducts due to the lactational state of the patient
15. identify the cause of high intensity signal on MR imaging
16. discuss the difficulty of MR guided breast biopsy of the retroareolar region
17. discuss the use of site markers after vacuum assisted biopsy
18. define ductal ectasia
19. understand the relevance of peripherally located ectasia
20. discuss the evolution of blocked ducts into mastitis
21. know the organisms involved in lactation associated infections
22. know the methods of symptom relief for blocked ducts
23. identify the characteristics of lesions caused by inflammatory infiltrates
24. be familiar with risks factors for periductal mastitis
25. know the characteristics of apocrine metaplasia
26. discuss how apocrine metaplasia is demonstrated on glactography
27. explain how cysts are formed in apocrine metaplasia
28. identify the characteristics of benign solitary papillomas
29. explain the characteristics of papillomas on color Doppler ultrasound
30. discuss the characteristic of papillomas on MR imaging
31. compare the risk of breast cancer of patients with papillomatosis to average women
32. identify the origin of DCIS
33. discuss the appearance of microcalcifications in DCIS
34. know the appearance of invasive ductal cancer on mammography
35. identify the biopsy technique needed if an invasive cancer is cystic in nature
36. list the three main categories of primary invasive breast cancer
37. identify the specific malignant characteristics of invasive ductal carcinoma on US
38. know the surgical procedures that most patient with Paget disease undergo
39. discuss how Paget disease is diagnosed
40. identify the symptoms of Paget disease