In this lecture we demonstrate the rate of progression of cancers originating from the major ducts (DAB) using consecutive mammographic examinations and find widely varying growth rates. In most cases the casting type calcifications develop rapidly, by which time the MRI examination is positive; the other extreme is rare, when the development of calcifications progresses slowly and the malignancy is poorly seen at MRI. Rapid development of casting type calcifications filling most or all of a lobe on the mammogram and the presence of a palpable breast thickening are two important negative prognostic factors.
These carefully chosen, fully worked-up cases cover the full spectrum of malignant-type calcifications seen at mammography. You will learn how to find faint and subtle calcifications and recognize malignancy by the distribution of the calcifications, even when the individual calcifications appear benign. Our multimodality diagnostic approach benefits from the strengths of magnification mammography, ultrasound and MRI. The imaging findings are correlated in every case with large format thin section (and often thick section) histopathology images to show the underlying structure of the malignancies we see at imaging. Every case has illustrated teaching points reviewing the major findings and commenting on the appropriateness of the management. These lectures improve your skills in perception and diagnosis and give you greater confidence when communicating your findings to your pathologists and surgeons.