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.