Interactive Transcript
0:01
It's also important to know where a
0:04
lesion is located and how to describe it.
0:08
So when we're talking about when we find a
0:10
lesion, we want to know whether it's in the
0:12
right breast, the left breast, or both breasts.
0:15
We can use clock-face positions
0:17
and quadrants of the breast.
0:20
And we can also describe central
0:22
retroareolar or axillary tail.
0:25
And then as far as depth, we talk
0:27
about the anterior, middle, and
0:29
posterior third of the breast.
0:31
And we can also give distance
0:33
from a known structure such as the
0:37
skin, the chest wall, the nipple.
0:41
We will usually report a series
0:43
and image number in our reports.
0:45
For example, series 6, image 149.
0:49
So that what we're trying to do with
0:51
our location information is clearly
0:53
communicate to other colleagues what
0:57
we're seeing and where exactly it is.
1:00
This is very helpful to our surgeons
1:03
and other referring providers who may be
1:06
reviewing the images that we have also
1:10
interpreted and provided a report for.
1:13
And also, within our radiology group, we
1:18
may be asking a colleague to do a second
1:20
look ultrasound to evaluate a lesion.
1:23
We want to be able to clearly communicate
1:25
where that is and how to find it.
1:28
If we're doing an MRI biopsy, we want to
1:30
make it clear that it's this lesion and not
1:33
that other one that we want to have biopsied.
1:36
So it's very important to be accurate
1:38
about, as accurate as possible,
1:39
about the location of the lesion.
1:42
And it really does help to have a
1:43
series and image number in your report.
1:46
So just talking about Location of lesions in
1:51
the breast in general, we have a diagram here
1:55
of the right breast and the left breast, and
1:58
I'm showing four quadrants based on vertical
2:03
and horizontal lines drawn through the nipple.
2:07
And if you're in the upper outer
2:09
quadrant you're in this area.
2:12
You can have upper inner quadrant, lower
2:14
outer quadrant, and lower inner quadrant,
2:17
and the same goes for the left side.
2:19
So upper inner, upper outer,
2:21
lower inner, lower outer.
2:24
We also use clock-face positions
2:28
very commonly in the breast, and
2:30
I don't think they're used really
2:32
anyplace else in the body.
2:33
But very important in the breast.
2:36
We use them in mammography, ultrasound, and
2:39
MRI, and when describing physical findings.
2:43
So, 12 o'clock is going to be toward the head,
2:46
and 6 o'clock is going to be toward the feet,
2:49
and that's with relationship to the nipple.
2:51
And that's the same, whether it's right or left.
2:53
But, nine o'clock on the right side is
2:58
lateral and three o'clock is medial,
3:00
but that's reversed for the left breast
3:03
where nine o'clock will actually be
3:05
medial and three o'clock will be lateral.
3:07
So, important to use an appropriate
3:12
type of location, whether it's clock
3:15
face or quadrant, for the location
3:18
of your lesion within the breast.
3:21
We can also describe depth, and what I
3:25
mean by that is dividing the breast into
3:28
roughly into thirds, which is somewhat
3:30
subjective, and anterior would be the
3:33
tissue closer to the nipple, middle would
3:36
be the mid-depth, and posterior would
3:38
be the tissue closer to the chest wall.
3:41
So for example, this little round white
3:44
circular mass that we have here in the
3:47
left breast, and this is left because
3:49
we're showing the axillary tail here.
3:51
So this is going to be left breast,
3:54
four o'clock position, about four
3:56
o'clock, because here's three o'clock.
3:58
We're about four centimeters from the nipple.
4:02
So left breast, four o'clock, four centimeters
4:05
from the nipple at posterior depth.
4:07
So we know that this is projecting over
4:09
the posterior aspect of the breast tissue.
4:12
So we can put all of that
4:14
information into a fairly concise
4:17
statement about the location.
4:19
And that's, that's important for communication.
4:23
So I wanted to show you a case that
4:25
has a lesion in it and show you
4:27
how we would locate that lesion.
4:29
So this is a 49-year-old woman
4:32
who has bilateral breast pain.
4:33
And we know from our indication section
4:36
that bilateral breast pain is not MRI.
4:39
But nonetheless, the referring provider
4:42
thought that MRI would be helpful.
4:45
So we had an MRI of this patient.
4:48
So here's the subtraction, first
4:52
subtraction series on this patient.
4:54
And you can see that there's a mass
4:56
here in the left posterior breast.
4:58
And as we scroll through a little
4:59
bit, you can see that she has some
5:03
moderate background enhancement and
5:05
some scattered foci of enhancement.
5:09
No explanation for bilateral breast
5:11
pain, but she does have this mass.
5:14
So we have to describe
5:15
where that mass is located.
5:17
And we know this is the top of the
5:20
breast as we're scrolling down.
5:23
We're getting toward the nipple, so this is
5:25
the nipple, and the lesion is above that,
5:29
above the nipple, and we're pretty much
5:32
centered from side to side, so this is about,
5:35
going to be about the 12 o'clock position.
5:38
If we divide the breast into thirds at
5:41
this location, this would be anterior, this
5:44
would be mid, and this would be posterior.
5:47
So this is posterior, posterior depth,
5:50
maybe mid to posterior depth, and
5:52
it's pretty central at 12 o'clock.
5:55
And then we can make measurements of
5:57
the mass and put that in our report.
6:02
So reporting location for this mass,
6:04
we would say something like this:
6:06
"In the left upper central breast at posterior
6:09
depth, there is a 12 by 8 millimeter
6:12
oval enhancing mass with dark internal
6:14
septations best seen on series six image 102.
6:18
The mass demonstrates T2 hyper
6:20
intense signal, rapid initial
6:22
enhancement, and persistent kinetics."
6:25
So that's a pretty good, it's two sentences,
6:27
but it's a good concise explanation
6:30
of what you're seeing, where it is,
6:32
and kind of further characterizing it.
6:34
And this mass was further
6:36
evaluated with ultrasound.
6:38
It was found on ultrasound and then
6:39
was biopsied at the patient's request.
6:41
And it was a fibroadenoma, so a benign mass.
6:45
But I just wanted to show you an example of
6:48
how we would report the location of a lesion.
© 2024 MRI Online. All Rights Reserved.