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E1581. It's Okay to Be Superficial: Delving Deep Into Superficial Lesions of the Breast
Authors
  1. Cherisse Wada; University of California, Los Angeles
  2. Tiffany Chan; University of California, Los Angeles
  3. Nazanin Yaghmai; University of California, Los Angeles
  4. Hyung Won Choi; University of California, Los Angeles
  5. Bo Li; University of California, Los Angeles
Background
Radiologists often encounter patients referred for workup of superficial breast findings such as skin lesions, nipple changes, or superficial palpable abnormalities. We should be familiar with a proper clinical breast exam in conjunction with imaging techniques to optimally visualize superficial breast pathologies. The ability to correlate clinical breast concerns with imaging findings and develop the correct diagnosis increases the value of the radiologist. This presentation will review the skills and tools that are helpful in the evaluation of superficial lesions of the breast, including a clinical breast exam, imaging workup, and the formulation of reasonable differential diagnosis when appropriate.

Educational Goals / Teaching Points
The target audience for this educational electronic exhibit are breast and general radiologists as well as radiologists-in-training. In this exhibit, we will review breast anatomy, how to perform a clinical breast exam, and discuss imaging techniques for evaluating superficial breast lesions, breast ducts, and the nipple-areolar complex (NAC). The goals are to understand the clinical presentations and imaging findings for common and uncommon superficial breast lesions. Ultimately, the reader will be able to correlate clinical breast concerns with associated imaging findings, thereby increasing the value of the radiologist.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
1) How to perform a clinical breast exam (inspection, palpation, and NAC). 2) Breast Anatomy: skin (epidermis, dermis, subcutaneous fat), ducts, and NAC. 3) How to differentiate between intradermal and hypodermal lesions. 4) Imaging techniques for evaluating superficial breast lesions, breast ducts, and NAC will be illustrated (including using standoff gel pad, manipulating transducer orientation, peripheral compression technique, and rolled nipple technique). 5) Clinical presentation and imaging findings for common and uncommon superficial lesions (including epidermal inclusion cyst/sebaceous cyst, dermal calcifications, fat necrosis, lipoma, hemangioma, accessory/supernumerary nipple, nipple adenoma, nipple intraductal papilloma, nipple eczema, Paget’s disease, invasive ductal carcinoma, postsurgical changes, axillary lymph nodes, and gestational gigantomastia).

Conclusion
After reviewing this educational exhibit, the reader will be able to formulate an appropriate differential diagnosis of a superficial breast lesion by performing a focused clinical breast exam and employing the proper imaging techniques. This will allow for accurate diagnosis and effective treatment for the patient, thereby increasing the value of the radiologist and avoiding delays in diagnosis.