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Location of Lesion & How to Report It

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It's also important to know where a

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lesion is located and how to describe it.

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So when we're talking about when we find a

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lesion, we want to know whether it's in the

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right breast, the left breast, or both breasts.

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We can use clock-face positions

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and quadrants of the breast.

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And we can also describe central

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retroareolar or axillary tail.

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And then as far as depth, we talk

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about the anterior, middle, and

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posterior third of the breast.

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And we can also give distance

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from a known structure such as the

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skin, the chest wall, the nipple.

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We will usually report a series

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and image number in our reports.

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For example, series 6, image 149.

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So that what we're trying to do with

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our location information is clearly

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communicate to other colleagues what

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we're seeing and where exactly it is.

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This is very helpful to our surgeons

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and other referring providers who may be

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reviewing the images that we have also

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interpreted and provided a report for.

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And also, within our radiology group, we

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may be asking a colleague to do a second

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look ultrasound to evaluate a lesion.

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We want to be able to clearly communicate

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where that is and how to find it.

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If we're doing an MRI biopsy, we want to

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make it clear that it's this lesion and not

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that other one that we want to have biopsied.

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So it's very important to be accurate

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about, as accurate as possible,

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about the location of the lesion.

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And it really does help to have a

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series and image number in your report.

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So just talking about Location of lesions in

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the breast in general, we have a diagram here

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of the right breast and the left breast, and

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I'm showing four quadrants based on vertical

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and horizontal lines drawn through the nipple.

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And if you're in the upper outer

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quadrant you're in this area.

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You can have upper inner quadrant, lower

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outer quadrant, and lower inner quadrant,

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and the same goes for the left side.

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So upper inner, upper outer,

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lower inner, lower outer.

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We also use clock-face positions

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very commonly in the breast, and

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I don't think they're used really

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anyplace else in the body.

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But very important in the breast.

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We use them in mammography, ultrasound, and

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MRI, and when describing physical findings.

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So, 12 o'clock is going to be toward the head,

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and 6 o'clock is going to be toward the feet,

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and that's with relationship to the nipple.

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And that's the same, whether it's right or left.

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But, nine o'clock on the right side is

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lateral and three o'clock is medial,

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but that's reversed for the left breast

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where nine o'clock will actually be

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medial and three o'clock will be lateral.

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So, important to use an appropriate

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type of location, whether it's clock

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face or quadrant, for the location

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of your lesion within the breast.

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We can also describe depth, and what I

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mean by that is dividing the breast into

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roughly into thirds, which is somewhat

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subjective, and anterior would be the

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tissue closer to the nipple, middle would

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be the mid-depth, and posterior would

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be the tissue closer to the chest wall.

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So for example, this little round white

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circular mass that we have here in the

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left breast, and this is left because

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we're showing the axillary tail here.

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So this is going to be left breast,

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four o'clock position, about four

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o'clock, because here's three o'clock.

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We're about four centimeters from the nipple.

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So left breast, four o'clock, four centimeters

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from the nipple at posterior depth.

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So we know that this is projecting over

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the posterior aspect of the breast tissue.

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So we can put all of that

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information into a fairly concise

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statement about the location.

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And that's, that's important for communication.

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So I wanted to show you a case that

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has a lesion in it and show you

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how we would locate that lesion.

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So this is a 49-year-old woman

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who has bilateral breast pain.

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And we know from our indication section

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that bilateral breast pain is not MRI.

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But nonetheless, the referring provider

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thought that MRI would be helpful.

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So we had an MRI of this patient.

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So here's the subtraction, first

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subtraction series on this patient.

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And you can see that there's a mass

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here in the left posterior breast.

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And as we scroll through a little

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bit, you can see that she has some

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moderate background enhancement and

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some scattered foci of enhancement.

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No explanation for bilateral breast

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pain, but she does have this mass.

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So we have to describe

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where that mass is located.

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And we know this is the top of the

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breast as we're scrolling down.

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We're getting toward the nipple, so this is

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the nipple, and the lesion is above that,

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above the nipple, and we're pretty much

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centered from side to side, so this is about,

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going to be about the 12 o'clock position.

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If we divide the breast into thirds at

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this location, this would be anterior, this

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would be mid, and this would be posterior.

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So this is posterior, posterior depth,

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maybe mid to posterior depth, and

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it's pretty central at 12 o'clock.

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And then we can make measurements of

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the mass and put that in our report.

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So reporting location for this mass,

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we would say something like this:

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"In the left upper central breast at posterior

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depth, there is a 12 by 8 millimeter

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oval enhancing mass with dark internal

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septations best seen on series six image 102.

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The mass demonstrates T2 hyper

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intense signal, rapid initial

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enhancement, and persistent kinetics."

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So that's a pretty good, it's two sentences,

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but it's a good concise explanation

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of what you're seeing, where it is,

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and kind of further characterizing it.

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And this mass was further

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evaluated with ultrasound.

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It was found on ultrasound and then

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was biopsied at the patient's request.

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And it was a fibroadenoma, so a benign mass.

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But I just wanted to show you an example of

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how we would report the location of a lesion.

Report

Description

Faculty

Lisa Ann Mullen, MD

Assistant Professor; Breast Imaging Fellowship Director

Johns Hopkins Medicine

Tags

Women's Health

MRI

Breast

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