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 Diagnosis of Diseases of the Breast, 2nd Edition

Table of Contents
1. Cover ....................................................................................................................................... 10
2. Frontmatter........................................................................................................................... 204
3. Library of Congress Cataloging-in-Publication Data ............................................................. 205
4. Contributors .......................................................................................................................... 207
5. Preface .................................................................................................................................. 212
6. Section I - Introduction ......................................................................................................... 214
6.1 Chapter 1 - The History of Breast Imaging ...................................................................... 214
6.1.1 PIONEERS OF MAMMOGRAPHY .............................................................................. 214
6.1.2 ERA OF TECHNOLOGIC PROGRESS ........................................................................... 221
6.1.3 OTHER MODALITIES FOR BREAST IMAGING ............................................................ 227
6.1.4 SCREENING MAMMOGRAPHY ................................................................................. 243
6.1.5 EDUCATION IN MAMMOGRAPHY ............................................................................ 247
6.1.6 HISTORY OF THE SOCIETY OF BREAST IMAGING...................................................... 248
6.1.7 HISTORY OF THE REGULATION OF MAMMOGRAPHY .............................................. 249
6.1.8 REFERENCES ............................................................................................................. 254
7. Section II - Mammography: Performing the Examination .................................................... 264
7.1 Chapter 2 - Mammography Equipment and Screen-Film Imaging Considerations ........ 264
7.1.1 X-RAY TUBE TARGET AND FILTER CONSIDERATIONS ............................................... 264
7.1.2 MAMMOGRAPHY EQUIPMENT ................................................................................ 273
7.1.3 SCREEN-FILM PROCESSING SYSTEM ........................................................................ 291
7.1.4 TECHNIQUES AND SELECTION OF SCREEN SPEED.................................................... 298
7.1.5 EQUIPMENT PERFORMANCE AUDITS AND MAINTENANCE .................................... 301
7.1.6 REFERENCES ............................................................................................................. 307
7.2 Chapter 3 - Positioning.................................................................................................... 308
7.2.1 GENERAL PRINCIPLES ............................................................................................... 308
7.2.2 MAMMOGRAPHIC PROJECTIONS ............................................................................ 315
7.2.3 REFERENCES ............................................................................................................. 338
7.3 Chapter 4 - Clinical Image Evaluation ............................................................................. 340
7.3.1 POSITIONING AND COMPRESSION .......................................................................... 340
7.3.2 IMAGE QUALITY ....................................................................................................... 354
7.3.3 ARTIFACTS ................................................................................................................ 362
7.3.4 COLLIMATION .......................................................................................................... 365
7.3.5 LABELING.................................................................................................................. 366

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 Diagnosis of Diseases of the Breast, 2nd Edition

7.3.6 FULL-FIELD DIGITAL MAMMOGRAPHY: CLINICAL IMAGE EVALUATION.................. 367

7.3.7 SUMMARY ................................................................................................................ 368
7.3.8 REFERENCES ............................................................................................................. 368
7.4 Chapter 5 - Quality Control ............................................................................................. 369
7.4.1 RESPONSIBLE INDIVIDUALS...................................................................................... 369
7.4.2 QUALITY CONTROL TESTS ........................................................................................ 381
7.4.3 WHERE TO GO FOR HELP ......................................................................................... 409
7.4.4 SUMMARY ................................................................................................................ 413
7.4.5 REFERENCES ............................................................................................................. 413
7.5 Chapter 6 - The MQSA and the Accreditation Process ................................................... 414
7.5.1 THE MAMMOGRAPHY QUALITY STANDARDS ACT OF 1992 .................................... 414
7.5.2 MAMMOGRAPHY QUALITY STANDARDS REAUTHORIZATION ACT OF 1998 ........... 418
7.5.3 KEY PLAYERS IN THE MAMMOGRAPHY QUALITY STANDARDS ACT ........................ 418
7.5.4 THE INTERIM RULES ................................................................................................. 420
7.5.5 MAMMOGRAPHY QUALITY STANDARDS: THE FINAL RULES ................................... 421
7.5.6 AMERICAN COLLEGE OF RADIOLOGY MAMMOGRAPHY ACCREDITATION PROGRAM
.......................................................................................................................................... 425
7.5.7 SUMMARY ................................................................................................................ 433
7.5.8 REFERENCES ............................................................................................................. 433
7.6 Chapter 7 - Reporting and Communication .................................................................... 434
7.6.1 INITIAL CONTACT AND ACTIVITIES BEFORE THE EXAMINATION ............................. 434
7.6.2 THE MAMMOGRAPHY EXAMINATION ..................................................................... 437
7.6.3 AFTER THE EXAMINATION ....................................................................................... 438
7.6.4 COMMUNICATION ISSUES AND THEIR RELATIONSHIP TO MALPRACTICE CLAIMS . 447
7.6.5 TECHNICAL REPORT ................................................................................................. 449
7.6.6 SUMMARY ................................................................................................................ 454
7.6.7 REFERENCES ............................................................................................................. 457
7.7 Chapter 8 - The Medical Audit ........................................................................................ 459
7.7.1 COLLECTION OF AUDIT DATA: WHAT SYSTEM SHOULD BE USED?.......................... 459
7.7.2 THE DATA: WHAT SHOULD BE COLLECTED? WHAT SHOULD BE CALCULATED? ..... 461
7.7.3 ANALYZING THE DATA: WHAT DO THE NUMBERS TELL YOU? ................................ 477
7.7.4 ANALYZING THE DATA WHEN SCREENING AND DIAGNOSTIC OUTCOMES ARE
COMBINED ........................................................................................................................ 486
7.7.5 FURTHER BENEFITS: THE AUDIT AS A TEACHING TOOL ........................................... 488
7.7.6 THE AUDIT AS REQUIRED BY THE MAMMOGRAPHY QUALITY STANDARDS ACT .... 489
7.7.7 SOURCES FOR AUDIT DATA ...................................................................................... 489

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 Diagnosis of Diseases of the Breast, 2nd Edition

7.7.8 THE VALUE OF THE AUDIT IN EVERYDAY PRACTICE: PERSONAL EXPERIENCE ......... 490
7.7.9 MEDICOLEGAL CONSIDERATIONS ............................................................................ 493
7.7.10 THE EXPANDING ROLE OF THE MEDICAL AUDIT: PROBLEMS AND PROMISE ........ 494
7.7.11 CONCLUSIONS ........................................................................................................ 494
7.7.12 ACKNOWLEDGMENTS ............................................................................................ 495
7.7.13 REFERENCES ........................................................................................................... 495
7.8 Chapter 9 - Coding and Billing in Breast Imaging ............................................................ 498
7.8.1 CODING AND BILLING TERMINOLOGY: THE “LANGUAGE” OF REIMBURSEMENT ... 498
7.8.2 MEDICARE REIMBURSEMENT: SETTING THE PRECEDENT; BACKGROUND AND
PRESENT STATUS ............................................................................................................... 499
7.8.3 CURRENT MEDICARE REIMBURSEMENT: ACCEPTABLE ICD-9-CM AND PROCEDURE
CODES FOR MAMMOGRAPHY, AND PAYMENT RATES ..................................................... 501
7.8.4 MEDICARE'S SPECIAL RULES RELATING TO MAMMOGRAPHY REIMBURSEMENT .. 507
7.8.5 FOLLOWING MEDICARE'S EXAMPLE: THE REST OF THE PAYERS ............................. 508
7.8.6 MAXIMIZING REIMBURSEMENT: STRATEGIES FOR SUCCESS .................................. 508
7.8.7 SUMMARY ................................................................................................................ 547
7.8.8 REFERENCES ............................................................................................................. 547
7.9 Chapter 10 - Medicolegal Issues in Breast Imaging ........................................................ 548
7.9.1 BASIC LEGAL CONCEPTS ........................................................................................... 548
7.9.2 THE LAW OF NEGLIGENCE........................................................................................ 551
7.9.3 STANDARD OF CARE................................................................................................. 553
7.9.4 THE SELF-REFERRED PATIENT .................................................................................. 558
7.9.5 COLLATERAL ISSUES ................................................................................................. 559
7.9.6 SECOND CONSULTATIVE OPINIONS ......................................................................... 561
7.9.7 FACING A LAWSUIT .................................................................................................. 564
7.9.8 CLAIMS DATA AND VERDICTS .................................................................................. 566
7.9.9 FUTURE ISSUES......................................................................................................... 569
7.9.10 REFERENCES ........................................................................................................... 570
8. Section III - Other Diagnostic Tools ....................................................................................... 573
8.1 Chapter 11 - Clinical Examination of the Breast ............................................................. 573
8.1.1 TECHNIQUE OF BREAST EXAMINATION ................................................................... 573
8.1.2 REFERENCES ............................................................................................................. 576
8.1.3 Chapter 12 - Breast Ultrasonography ...................................................................... 577
8.1.4 BASIC INTERPRETATION ........................................................................................... 587
8.1.5 REFERENCES ............................................................................................................. 614
8.2 Chapter 13 - Digital Mammography, CAD, and Other Digital Applications .................... 620

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 Diagnosis of Diseases of the Breast, 2nd Edition

8.2.1 LIMITATIONS OF CONVENTIONAL MAMMOGRAPHY .............................................. 620

8.2.2 BINARY NUMBERS .................................................................................................... 625
8.2.3 DIGITAL VERSUS ANALOG IMAGES .......................................................................... 627
8.2.4 REQUIREMENTS FOR A DIGITAL MAMMOGRAPHY SYSTEM ................................... 629
8.2.5 DIGITAL MAMMOGRAPHY SYSTEM DESIGNS .......................................................... 634
8.2.6 EXPOSURE TECHNIQUE ............................................................................................ 640
8.2.7 IMAGE STORAGE ...................................................................................................... 640
8.2.8 IMAGE PROCESSING ................................................................................................. 641
8.2.9 IMAGE DISPLAY ........................................................................................................ 647
8.2.10 COMPUTER-AIDED DETECTION .............................................................................. 649
8.2.11 TELEMAMMOGRAPHY ........................................................................................... 666
8.2.12 DUAL-ENERGY MAMMOGRAPHY, TOMOSYNTHESIS, AND CONTRAST-ENHANCED
DIGITAL MAMMOGRAPHY ................................................................................................ 668
8.2.13 CLINICAL SCREENING TRIALS ................................................................................. 670
8.2.14 CONCLUSIONS ........................................................................................................ 670
8.2.15 REFERENCES ........................................................................................................... 672
8.3 Chapter 14 - Magnetic Resonance Imaging of Breast Tumors ....................................... 680
8.3.1 PATHOPHYSIOLOGY OF ENHANCEMENT ................................................................. 680
8.3.2 BENEFITS AND DISADVANTAGES OF BREAST MAGNETIC RESONANCE IMAGING ... 686
8.3.3 TECHNIQUES OF BREAST MAGNETIC RESONANCE IMAGING .................................. 687
8.3.4 IMAGING APPEARANCE OF TYPICAL MALIGNANT BREAST TUMORS ...................... 688
8.3.5 IMAGING APPEARANCE OF TYPICAL BENIGN BREAST TUMORS .............................. 691
8.3.6 IMAGE ANALYSIS AND ASSESSMENT ....................................................................... 692
8.3.7 CURRENT CLINICAL PRACTICE FOR IMAGING THE BREAST ...................................... 702
8.3.8 POTENTIAL ROLES FOR BREAST MAGNETIC RESONANCE IMAGING ....................... 708
8.3.9 MRI-GUIDED BIOPSY AND WIRE LOCALIZATION ...................................................... 713
8.3.10 SUMMARY .............................................................................................................. 715
8.3.11 REFERENCES ........................................................................................................... 715
8.4 Chapter 15 - Nuclear Medicine Applications in Breast Imaging ..................................... 722
8.4.1 TECHNETIUM Tc 99M SESTAMIBI AND Tc 99M TETROFOSMIN .............................. 722
8.4.2 ANTIBODY TUMOR IMAGING................................................................................... 729
8.4.3 POSITRON EMISSION TOMOGRAPHY IN BREAST CANCER....................................... 729
8.4.4 STAGING AND EVALUATION OF BREAST CANCERS .................................................. 732
8.4.5 EVALUATION OF RESPONSE TO THERAPY ................................................................ 733
8.4.6 BREAST LYMPHOSCINTIGRAPHY AND THE SENTINEL LYMPH NODE ....................... 734
8.4.7 FUTURE TECHNOLOGY ............................................................................................. 737

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 Diagnosis of Diseases of the Breast, 2nd Edition

8.4.8 CONCLUSION ............................................................................................................ 737

8.4.9 REFERENCES ............................................................................................................. 737
9. Section IV - Interventional Breast Imaging Procedures ........................................................ 738
9.1 Chapter 16 - Presurgical Needle Localization ................................................................. 738
9.1.1 PROCEDURE ............................................................................................................. 738
9.1.2 SPECIMEN RADIOGRAPHY........................................................................................ 743
9.1.3 POTENTIAL COMPLICATIONS ................................................................................... 746
9.1.4 REFERENCES ............................................................................................................. 746
9.2 Chapter 17 - Imaging-Guided Core Needle Biopsy of the Breast.................................... 749
9.2.1 STEREOTACTIC CORE NEEDLE BIOPSY ...................................................................... 749
9.2.2 ULTRASOUND-GUIDED CORE NEEDLE BIOPSY ......................................................... 760
9.2.3 ADVANCED BREAST BIOPSY INSTRUMENTATION .................................................... 765
9.2.4 FINE-NEEDLE ASPIRATION CYTOLOGY ..................................................................... 765
9.2.5 PATHOLOGY ............................................................................................................. 766
9.2.6 CONTRAINDICATIONS TO CORE NEEDLE BIOPSY ..................................................... 769
9.2.7 COMPLICATIONS OF CORE NEEDLE BIOPSY ............................................................. 770
9.2.8 POST-BIOPSY PATIENT INSTRUCTIONS .................................................................... 771
9.2.9 POST-BIOPSY IMAGING FOLLOW-UP ....................................................................... 772
9.2.10 AMERICAN COLLEGE OF RADIOLOGY ACCREDITATION ......................................... 772
9.2.11 REFERENCES ........................................................................................................... 774
9.3 Chapter 18 - After the Imaging-Guided Needle Biopsy .................................................. 778
9.3.1 ASSESSING FOR CONCORDANCE .............................................................................. 778
9.3.2 ATYPICAL DUCTAL HYPERPLASIA ............................................................................. 781
9.3.3 RADIAL SCAR ............................................................................................................ 782
9.3.4 PAPILLARY LESIONS .................................................................................................. 783
9.3.5 LOBULAR NEOPLASIA ............................................................................................... 784
9.3.6 COLUMNAR CELL LESIONS ....................................................................................... 785
9.3.7 SCLEROSING ADENOSIS ............................................................................................ 785
9.3.8 FALSE-POSITIVE RESULTS ......................................................................................... 786
9.3.9 COMMUNICATION RESPONSIBILITIES ...................................................................... 786
9.3.10 SUMMARY .............................................................................................................. 787
9.3.11 REFERENCES ........................................................................................................... 787
9.4 Chapter 19 - Handling of Pathology Specimens .............................................................. 789
9.4.1 FINE-NEEDLE ASPIRATION........................................................................................ 789
9.4.2 CORE NEEDLE BIOPSY OF THE BREAST ..................................................................... 790
9.4.3 EFFECTS OF FINE-NEEDLE ASPIRATION CYTOLOGY AND CORE BREAST BIOPSY ...... 792

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 Diagnosis of Diseases of the Breast, 2nd Edition

9.4.4 INCISIONAL BIOPSY .................................................................................................. 794

9.4.5 MASTECTOMY SPECIMENS ...................................................................................... 800
9.4.6 IMMUNOHISTOCHEMISTRY AND SPECIALIZED TECHNIQUE .................................... 804
9.4.7 SUMMARY ................................................................................................................ 813
9.4.8 REFERENCES ............................................................................................................. 813
9.5 Chapter 20 - Other Ultrasonographically Guided Interventional Procedures ................ 817
9.5.1 TECHNICAL CONSIDERATIONS ................................................................................. 817
9.5.2 TECHNIQUE .............................................................................................................. 818
9.5.3 SPECIAL CONSIDERATIONS....................................................................................... 820
9.5.4 LEARNING THE TECHNIQUE ..................................................................................... 822
9.5.5 ULTRASONOGRAPHICALLY GUIDED CYST ASPIRATION............................................ 822
9.5.6 ULTRASONOGRAPHICALLY GUIDED PREOPERATIVE NEEDLE LOCALIZATION .......... 827
9.5.7 PLACEMENT OF MARKER CLIPS................................................................................ 829
9.5.8 POTENTIAL COMPLICATIONS OF ULTRASONOGRAPHICALLY GUIDED
INTERVENTIONAL PROCEDURES ....................................................................................... 830
9.5.9 CONCLUSIONS .......................................................................................................... 831
9.5.10 REFERENCES ........................................................................................................... 831
9.6 Chapter 21 - Galactography ............................................................................................ 833
9.6.1 TECHNIQUE .............................................................................................................. 833
9.6.2 INTERPRETATION ..................................................................................................... 836
9.6.3 OTHER MODALITIES FOR THE EVALUATION OF NIPPLE DISCHARGE ....................... 841
9.6.4 CONTRAINDICATIONS, PRECAUTIONS, AND POTENTIAL COMPLICATIONS ............. 842
9.6.5 APPLICATIONS TO PATIENT CARE ............................................................................ 843
9.6.6 REFERENCES ............................................................................................................. 843
10. Section V - Screening Mammography................................................................................. 847
10.1 Chapter 22 - The Epidemiology of Breast Cancer ......................................................... 847
10.1.1 BREAST CANCER STATISTICS: NUMBERS AND RATES ............................................ 847
10.1.2 INTERNATIONAL TRENDS ....................................................................................... 849
10.1.3 UNITED STATES TRENDS IN INCIDENCE, MORTALITY, AND SURVIVAL .................. 851
10.1.4 CUMULATIVE RISK AND RELATIVE RISK ................................................................. 865
10.1.5 GENES AND SYNDROMES ASSOCIATED WITH AN INCREASED RISK OF BREAST
CANCER ............................................................................................................................. 879
10.1.6 CONCLUSION .......................................................................................................... 883
10.1.7 REFERENCES ........................................................................................................... 884
10.2 Chapter 23 - Screening Results, Controversies, and Guidelines ................................... 895
10.2.1 SCREENING MODALITIES ........................................................................................ 895

6
 Diagnosis of Diseases of the Breast, 2nd Edition

10.2.2 HIGHER SURVIVAL RATES AMONG WOMEN WITH SCREENING-DETECTED CANCERS

.......................................................................................................................................... 897
10.2.3 RESULTS OF RANDOMIZED TRIALS......................................................................... 900
10.2.4 SCREENING MAMMOGRAPHY GUIDELINES ........................................................... 910
10.2.5 ADVERSE CONSEQUENCES AND COSTS OF SCREENING ........................................ 922
10.2.6 Summary ................................................................................................................ 932
10.2.7 REFERENCES ........................................................................................................... 932
11. Section VI - Normal Breast and Benign and Malignant Conditions .................................... 940
11.1 Chapter 24 - The Normal Breast ................................................................................... 940
11.1.1 EMBRYOLOGY AND DEVELOPMENT ...................................................................... 940
11.1.2 ANATOMY AND HISTOLOGY .................................................................................. 941
11.1.3 COMPOSITION OF BREAST TISSUE ......................................................................... 943
11.1.4 NORMAL VARIANTS ............................................................................................... 944
11.1.5 NORMAL ULTRASONOGRAPHIC ANATOMY ........................................................... 945
11.1.6 PATHOLOGY OF THE BREAST ................................................................................. 945
11.1.7 SUMMARY .............................................................................................................. 949
11.1.8 REFERENCES ........................................................................................................... 949
11.2 Chapter 25 - Benign Breast Lesions .............................................................................. 950
11.2.1 SKIN LESIONS.......................................................................................................... 950
11.2.2 VASCULAR LESIONS ................................................................................................ 961
11.2.3 LYMPH NODES ....................................................................................................... 963
11.2.4 POST-TRAUMATIC HEMATOMAS AND SCARS ....................................................... 969
11.2.5 FAT NECROSIS ........................................................................................................ 972
11.2.6 FOREIGN BODIES .................................................................................................... 978
11.2.7 INFECTIONS OF THE BREAST .................................................................................. 980
11.2.8 FIBROADENOMAS .................................................................................................. 985
11.2.9 HAMARTOMAS....................................................................................................... 993
11.2.10 FIBROCYSTIC CHANGE .......................................................................................... 997
11.2.11 CYSTS .................................................................................................................... 998
11.2.12 GALACTOCELES .................................................................................................. 1005
11.2.13 ADENOSIS ........................................................................................................... 1006
11.2.14 FIBROSIS ............................................................................................................. 1010
11.2.15 DUCT ECTASIA .................................................................................................... 1012
11.2.16 PAPILLOMA ........................................................................................................ 1015
11.2.17 RADIAL SCAR ...................................................................................................... 1022
11.2.18 EPITHELIAL HYPERPLASIAS WITH AND WITHOUT ATYPIA ................................. 1026

7
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 Diagnosis of Diseases of the Breast, 2nd Edition

11.2.19 LOBULAR CARCINOMA IN SITU, LOBULAR NEOPLASIA ...................................... 1032

11.2.20 PHYLLODES TUMOR ........................................................................................... 1033
11.2.21 OTHER BENIGN LESIONS .................................................................................... 1037
11.2.22 ACKNOWLEDGMENT .......................................................................................... 1042
11.2.23 REFERENCES ....................................................................................................... 1042
11.3 Chapter 26 - Noninvasive Carcinoma.......................................................................... 1055
11.3.1 DUCTAL CARCINOMA IN SITU .............................................................................. 1055
11.3.2 REFERENCES ......................................................................................................... 1072
11.4 Chapter 27 - Invasive Malignancies ............................................................................ 1075
11.4.1 INVASIVE BREAST CANCER ................................................................................... 1075
11.4.2 MALIGNANCIES OF THE BREAST NOT ARISING FROM DUCTAL TISSUES ............. 1109
11.4.3 REFERENCES ......................................................................................................... 1115
11.5 Chapter 28 - The Clinically Abnormal Breast .............................................................. 1120
11.5.1 PALPABLE MASS ................................................................................................... 1120
11.5.2 NIPPLE DISCHARGE .............................................................................................. 1128
11.5.3 SKIN CHANGES ..................................................................................................... 1131
11.5.4 PAGET'S DISEASE OF THE NIPPLE ......................................................................... 1133
11.5.5 REFERENCES ......................................................................................................... 1134
11.6 Chapter 29 - The Male Breast ..................................................................................... 1137
11.6.1 THE MAMMOGRAPHIC EXAMINATION ................................................................ 1137
11.6.2 NORMAL MALE BREAST ....................................................................................... 1138
11.6.3 ABNORMAL MALE BREAST ................................................................................... 1140
11.6.4 REFERENCES ......................................................................................................... 1166
12. Section VII - Management of Breast Diseases and Post-Treatment Evaluation ............... 1172
12.1 Chapter 30 - Treatment of Breast Disease .................................................................. 1172
12.1.1 TREATMENT OF BENIGN BREAST DISEASE ........................................................... 1172
12.1.2 DIAGNOSTIC SURGERY ......................................................................................... 1179
12.1.3 TREATMENT OF MALIGNANT BREAST DISEASE ................................................... 1185
12.1.4 REFERENCES ......................................................................................................... 1216
12.2 Chapter 31 - The Conservatively Treated Breast ........................................................ 1224
12.2.1 CLINICAL TRIALS OF BREAST-CONSERVING THERAPY .......................................... 1224
12.2.2 SELECTION OF WOMEN FOR BREAST-CONSERVING THERAPY ............................ 1226
12.2.3 PRETREATMENT ASSESSMENT WITH BREAST IMAGING TECHNIQUES ............... 1227
12.2.4 INTRAOPERATIVE EVALUATION OF ADEQUACY OF TUMOR RESECTION ............ 1229
12.2.5 POSTOPERATIVE DETERMINATION OF THE COMPLETENESS OF TUMOR RESECTION
........................................................................................................................................ 1231

8
 Diagnosis of Diseases of the Breast, 2nd Edition

12.2.6 ROUTINE MAMMOGRAPHY AFTER RADIATION THERAPY ................................... 1233

12.2.7 TUMOR RECURRENCE IN THE IRRADIATED BREAST ............................................ 1240
12.2.8 BENIGN SEQUELAE MIMICKING RECURRENCE .................................................... 1242
12.2.9 REFERENCES ......................................................................................................... 1244
12.3 Chapter 32 - The Augmented Breast .......................................................................... 1249
12.3.1 METHODS OF BREAST AUGMENTATION AND RECONSTRUCTION ...................... 1249
12.3.2 IMAGING AFTER BREAST IMPLANTS .................................................................... 1253
12.3.3 REFERENCES ......................................................................................................... 1271
12.4 Chapter 33 - Reduction Mammoplasty ....................................................................... 1274
12.4.1 INDICATIONS FOR IMAGING ................................................................................ 1274
12.4.2 MAMMOGRAPHIC FINDINGS AFTER REDUCTION MAMMOPLASTY .................... 1276
12.4.3 REFERENCES ......................................................................................................... 1280

9
 Diagnosis of Diseases of the Breast, 2nd Edition

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