Conventional Mammography

Mammography is the basis of the technique used, change in density between the soft tissues that make up the breast, x-ray beam is based on the different absorption. Low-energy X-rays and obtained by applying a special compression technique for radiography. Radiation-induced breast cancer risk as much as possible should be given a low dose (93). Mammography units in the last 15 years, film screen image receptor, the movie is very important changes occurred in the process, and radiographic technique. Radiographs, mammogram quality of the radiation dose increased, and the patient also decreased significantly. Screen film mammography radiation dose combinations allows the reduction, reduces radiation dose by 30-50%.

Conventional mammography, general features.

a) It's cheap.

b) when combined with the screen (together), the image is quite successful in creating

c) 17-20 line pairs per milliliter has the ability to analyze, this feature is the ability of superior information in storage.


a) Films, both the detector and the imaging environment. Spacial contrast and resolution of technical factors of the film and into the bathroom in them directly affects the value of the irreversible problems, as reflected in the data.

b) Contrast resolution is lower than the digital method.

c) After the formation of the image can not be changed once. This is also compatible with the structure of the breast in the optimal conditions for exposure properties requires that a limitation is that all this creates in terms of selection of the appropriate window setting.

Digital Mammography

All studies related to development of breast imaging, breast cancer, early detection, and in so doing to contribute to the minimal possible harm is intended to be given to patients. That is the target, increase the rate of early diagnosis, it is to use less x-ray. For this purpose, which was developed digital mammography, in 1992 by the National Cancer Institute, "the treatment of breast cancer with the highest potential impact on the developing technology," defined as.

Digital X-rays absorbed by the detector is an electronic signal for each pixel generates an electric signal and an analog-digital converter that translated into a digital value. Then the digital values ​​are stored in computer memory. Digital images at any time be recalled from memory. During evaluation of the images according to image contrast and all kinds of requests are subject to change radiologist. This is the most important advantages of digital mammography.

Many of analog mammography, digital mammography systems. Digital mammography systems, image acquisition, presentation and storage is done independently, and each of these three elements can be adjusted according to the optimal conditions. However, the limits of the masses, the high resolution required for detection of microcalcifications and their characters, not provided enough digital mammography devices. The earliest sign of breast cancer and 30-50% of the cases followed microcalcifications, microcalcifications appear overkill extends to the evaluation is critical to have high spatial resolution and high contrast sensitivity. The use of digital imaging in the breast it was delayed due to technical difficulties in obtaining.

The first studies on clinical uses of computed radiographs were published in the first half of the 90s. Digitized films, the experience obtained by conventional, full-field digital mammography images, the spot has been integral to the transition. Spot or spot transactions stereotactic digital images since 1992 Full field digital mammography, the routine use of magnification used in imaging has been possible only recently.

Advantages of the conventional mammogram with the digital mammographic

1. Expose wider range can be made.

2. Even the smallest differences in contrast can be easily detected and amplified, exposure errors can be minimized.

3. Computer manipulation can be done all kinds of images have been digitized.

4. Images can be more easily stored and transferred between centers.

5. The patient is less than 30-50% of the radiation.

6. Allows for computer-aided diagnosis.

Digital mammography, dense breast tissue of the superior features:

a) Has a wide dynamic range. Thus, without loss of image information of a lower dose can increase the contrast resolution. With this method, without loss of diagnostic information in 50-70% of dose savings can be achieved. Does not need to re-exposure.

b) the processing of data is possible to have different options. Different gray values, contrast, density, noise, such as the use provides many options. In other words, a variety of data presentation can be the same.

c) Digital systems are "dual energy subtraction" (DES) studies of the development is suitable. This system develops more easily, and diagnostic accuracy rate of detection of calcifications by subtraction will be higher. DES directly show calcification. High-and low-energy when the two images subject calcification is monitored only.

d) Again, the contrast of digital subtraction method, which is difficult to follow because of the heavy-heterogeneously dense parenchyma feature benefit-risk patients.

e) The real digital systems, identification of suspicious calcification clusters and the detection and diagnosis of lesions noncalcification help radiologist and artificial intelligence systems to improve the quality of the image allows you to increase the diagnostic power.


a) Limited spatial resolution. Digital mammography has been exceeded in recent years, technical difficulties encountered in clinical practice and promising opportunities provided. Superiority of the method accepted in many centers, routine has been introduced (89).

b) And the contrast of neighboring structures, the display of artifacts that can occur if too much difference.

c) Yet the system cost is high. Evidence of two primary breast cancer, microcalcifications and irregular bordered mass

lesions. The entire breast area in order to detect microcalcifications and mass lesions 00:15 calcifications smaller than the background to distinguish it from the complex pattern of breast tissue should be superior contrast resolution. They have been provided to 4.5 cm thick compressed, 50/50 ratio of glandular / adipose tissue patterns in the breast of a given dose of radiation must be less than 3.0.

Breast Imaging Methods

Breast Ultrasound: U.S., ultrasonic waves, and transducers that make up the image obtained by means of a diagnostic method. Ubiquitous, easy to administer, inexpensive, radiation-free. Breast examination should be used on high-resolution linear transducers. Five-twelve MH probe provides enough penetration. U.S. examination of the sagittal and transverse plane should be screened in all quadrants. Radiopaque lesions detected with mammography, U.S. evaluation of the internal structures of a method of unquestionable superiority. For this reason, today has to complement mammography. In addition, and without a palpable mass in women younger than 35 years should be chosen as the primary imaging method. U.S. examination of the breast is used for the following purposes.

1. Help prevent unnecessary biopsies.

2. Helps prevent unnecessary short-term follow-up.

3. Guidance for interventional procedures.

4. Asymmetric localization was detected with mammography, the mass density used to be ruled out.

5. Used in the evaluation of all the contours of the lesions can not be seen with mammography.

What is magnetic resonance imaging: MRI is a powerful magnetic field, radio frequency waves are sent into the tissues to vibrate from the image conversion is based on signals received from the tissues. Mammography in the diagnosis of breast cancer is not yet the desired sensitivity. This failure led to the new orientation and the study of breast MRI has been used. MR have a high contrast spatial resolution, multiplanar images, ability to receive, does not include ionizing radiation, due to the dynamic contrast-enhanced imaging features such as allowing in addition to mammography and U.S. in particular can be applied in selected cases has become the diagnostic and problem solver. In several studies the use of intravenous contrast material enhancement was evident in breast carcinomas with a secret. MR dynamic contrast-enhanced lesion with contrast enhancement are important criteria to rule out malignancy in the absence. MRI, breast malignant lesions of the highest sensitivity in detecting breast imaging modality. In addition, high sensitivity for invasive breast cancer imaging,% 85-100,% 30-95 has a low specificity. MRI, diagnostic difficulties dens captured breasts, scar tissue resulting from surgery and radiation therapy with tumor differentiation recurrent, the evaluation of breast implant, breast-conserving surgery in patients with multifocal tumors, to be applied in determining the chest wall are used in the assessment of invasion into surrounding tissue masses was settled. Contrast enhancement pattern of morphologic findings and evaluation of a combination of conventional and selected cases of breast MR spectroscopy, diffusion and perfusion sequences, such as the addition of a special rate of false-positive diagnoses raise and lower the specificity.

Nuclear medicine: Breast scintigraphy in the diagnosis of breast cancer in a noninvasive imaging technique using a variety of radionuclides. Gallium 67, m Tc 99m methylene diphosphate (MDP), and somatostatin analogues in breast cancer, breast scans are routinely used today. Tc-99m (MIBI) breast scintigraphy to have high sensitivity and specificity of mammography in the diagnosis of breast cancer screening as a way of elevating the value of breast cancer continues to protect the display. These tests also may be palpable breast mass is further enhanced in patients with benign pathologies provide additional information to distinguish malignant pathologies. Fluorine-18-fluorodeoxyglucose-positron emission tomography (F-18-FDG-PET) is not only the primary tumor but also to demonstrate the presence of lymph node and distant metastases, breast tissue density due to the interference than other imaging methods are valuable. But the images purpose is to detect disease at an early stage. For this reason, the biggest limiting factor in this small breast cancers were evident on the inability to detect. This inability to limit the use of screening for breast cancer in asymptomatic women.

Thermography: Thermography infrared heat emitted by the radiation-sensitive breast tumors are based on recording with a camera. Neoplasms other than benign conditions such as inflammation, and hyperplasia in the breast will cause a temperature rise is not specific for the method. Due to the high rate of false negative and false positive values ​​are not used for routine screening.

What is Galactography: galactography, used to assess patients with nipple discharge, a special catheter through the nipple duct after administration of contrast material into the method of mammographic examination. Patients with nipple discharge is the only method that allows the identification of intraductal pathology. This method of partial or complete obliteration of the duct, a very small mass lesions identified by mammography or clinical examination may. However, in cases where the presence of cancer research is completely normal features, such as benign and malignant lesions is not sufficient to show discrimination. Exact localization of the lesion with intraductal Galactography main purpose is to help making the correct surgical choice.

Muir Syndrome

Multiple skin tumors and multiple benign and malignant tumors of the gastrointestinal tract is a rare autosomal dominant syndrome characterized by. In this syndrome, including the period after menopause in women is very high risk of developing breast cancer. There are factors that increase the risk of developing breast cancer in women.

Breast cancer is one hundred times more frequently in women than men are. If breast cancer is rare under the age of twenty. Gradually increase in incidence after 20 years and makes a plateau between the ages of 45-55. Rapid increase in incidence observed after the age of 55. Especially in women with a family history of breast cancer in mother or sisters have a higher risk. The disease an average of 10 - 12 years earlier exits.

Against the risk of developing breast cancer in breast cancer patients has increased significantly. The increased incidence of breast cancer in families with bilateral breast cancer cases. Especially families with bilateral breast cancer seen at a young age increases the risk of getting breast cancer. Pre-cellular atypia in breast biopsies, atypical ductal hyperplasia, lobular neoplasia, increased risk of breast cancer in women in the juvenile papillomatosis.

Blood group (0) in those with benign breast disease, ovarian cysts and breast cancer have been observed at a young age. Many studies have shown that delayed menarche decreased the risk of breast cancer by 1/3-1/2. 2-fold increase in the incidence of menarche 12 years ago. Early menarche is a risk factor for the development of breast cancer. No birth increased incidence in women. The first pregnancy after age 30 in women with breast cancer risk than those with a first pregnancy after the age of 18. Also be observed as an increased incidence of late post-menopausal women.

High estrogen and progesterone hormone levels increase the risk of breast cancer was observed. Low-dose hormone replacement therapy in postmenopausal period showed no significant increase in risk. However, more long-term use of high-dose hormone 10-15 years and 2-3 times increased risk of breast cancer was observed. 25% of women taking hormone replacement therapy in postmenopausal women increase in breast density were determined. 36% of cases, breast pain, hormone replacement therapy induces 17-32% cases of mammographic changes are tracked. Significant difference between the geographic regions in terms of the incidence of breast cancer is seen in the Netherlands 24.19 per hundred thousand, hundred thousand in the United States 21:38, while the Japanese women was calculated as 3.76 per hundred thousand. Environmental factors that enabled the U.S. to increase in incidence was observed in women who immigrated to Japan. Those exposed to pesticides increases the risk of breast cancer (63). Dietary fat and cholesterol intake is very important. Per capita has a direct correlation between fat consumption and breast cancer. This relationship is post-menopausal women, more severe than in premenopausal women. Postmenopausal obesity and chronic alcohol use increases the risk (63). Radiation risk factor in breast cancer. Exposed to ionizing radiation after the atomic bomb survivor, who applied to radiotherapy due to postpartum mastitis, followed by fluoroscopy with the cause of tuberculosis patients exposed to radiation and increased risk of breast cancer has been observed in animal models (64). In recent years, genetic studies, especially genetic factors in the etiology of premenopausal breast cancer showed that had come forward. Those with the mutated BRCA1 and BRCA2 genes significantly increased risk of breast cancer. These genes are 17 and 13 genes located on chromosomes and those with breast cancer is approximately 85%. 5% of all breast cancers in BRCA1 and BRCA2 genes were found positive.

Retinoblastoma tumor suppressor gene is a recessive gene on chromosome 13, premenopausal breast cancer that is caused by loss of chromosome heterogeneity. As with colon cancer, 17 chromosome suppressor gene p53 is an important development in the breast cancer gene, the gene is shown to be correlated with loss of breast cancer. Again, erb-B2 oncogene shown that important information in determining the prognosis of breast and ovarian cancer.

Major risk factors for breast cancer, family history, previous breast cancer, the story is, as a genetic predisposition, and BCAC2 BCRA1 carry genes, previously passed to other benign breast diseases.

Postoperative Mammography

Breast surgery method chosen until the 1970s, when radical mastectomy, modified radical mastectomy, taken in later years to be implemented, and better cosmetic results of breast conserving surgery methods have been used more frequently. Breast-conserving surgery and radiotherapy, tumor recurrence in early stage, there is widespread use brought about the necessity of (36).

And radiotherapy after breast-conserving treatment is 3-6 months after the first mammogram. Basic control mammography mammography after 6 months, and if more then 1 year monitoring is sufficient. As a routine craniocaudal (CC) and mediolateral oblique (MLO) radiographs taken. Main objective is to fully display the surgical scar area. Magnifiye radiographs are very useful, especially the evaluation of microcalcifications. The basic purpose of mammography after treatment to determine the new mammographic pattern. Is well known that long-term changes after radiotherapy of breast cancer. These radiation pneumonitis and fibrosis, myocardial infarction, pericardial effusion, brachial plexus neuropathy, bone and skin, with necrosis and fractures, radiation, and complications of secondary malignant neoplasms (13.91). In the breast after lumpectomy and radiation therapy followed collections of fluid between mammographic changes, scar tissue, breast, and breast skin edema, thickening, increased breast density, fat necrosis secondary to punctate and pleomorphic calcifications (36).

General Information on Mammography

Mammography is a method for revealing changes in the breast and soft tissue. Which is the primary imaging method for breast screening and diagnostic mammography to be used in two ways, after the 1960s, the overkill extends through screening nonpalpable breast lesions more often and began to be encountered in earlier periods. Indications for mammography;

1. Routine breast cancer screening as an early diagnostic method

2. Curriculum Vitae, or family history of breast cancer patients,

3. Hardness in the breast of a new, mass, swelling, redness, nipple retraction, pain, nipple discharge at the beginning, the symptoms of mastitis, breast skin changes, clinical, nonpalpable mass lesions in patients with non-detection of symptoms, those with a palpable mass audience with the assessment of U.S.

4. Estrogen therapy or hormone replacement therapy areas

5. Risks of major or minor in terms of breast cancer risk in patients with one or more of the

6. Ta is a palpable mass in patients with a diagnosis of cancer by biopsy, multicentric tumors, or that the detection of focal, the investigation of intraductal component, tumor size determination, evaluation of the breast against the

7. Assessment of response to neoadjuvant chemotherapy treatment of breast cancer patients receiving radiation therapy before surgery postoperative controls, in terms of relapse after completion of therapy, the long-term follow-up, and the detection of local recurrences.

Opacities were detected with mammography, irregular contours or irregular contours of the masses seen in U.S. cytological and / or histologic evaluation should be done with a needle biopsies.

According to the American Cancer Society recommendations of the Base-Line's first mammogram should be taken between 35-40 age, 40-49 years of age or women, mammography should be taken once every two years. Women over fifty years of age and mammography should be taken once a year. In addition, women at least once a month should be given the training needed to carry out breast examinations using mammography for screening, early diagnosis of breast cancer mortality due to chance of approximately 1 / 3 ratio decreases, but is not available because of low sensitivity in patients under the age of 40.

Positions used in mammographic

Routine mammograms should be made ​​in two positions. Craniocaudal and lateral oblique, the standard projections. Assess the need for additional positions within the specific areas of the breast.

Craniocaudal (CC) Position: standard transverse position of the breast.

Mediolateral oblique (MLO) Position: This position in the lower part of the breast and pectoralis major muscle and axillary tail of the breast may appear to include the whole tape is a 30-degree angle, the patient goes back to the same side as the right side. In this position, the pectoralis major muscle and the chest wall is the easiest way forward is pulled, the rear portions of the breast provides the best display of

Mediolateral (ML) Position: ML sagittal image of a real image. Upper-inner quadrant lesions in the upper parts of the oblique position shows better. In addition, deep near the chest wall, or are already breast inferomedial or inferolateral lesions at the show better.

In addition, the position medial oblique, (overstated) CC position, the position of the spot compression, axillary position, magnification X-rays, patients must be taken in addition to routine positions.

Breast Anatomy

Adult female breast on top, the upper limit of the second rib or rib starts third. At the bottom of the sixth rib at the level ends. Internal border of the sternum at the edge, the outer limit of the middle or anterior axillary line. The upper outer quadrant of the breast, armpit and extends from the pectoralis major muscle at the bottom edge (the axillary tail of Spence). This extension is sometimes palpable, visible or even create a mass. The main mass of breast tissue is usually settled in the upper outer quadrant. Deep plan, nearly three-quarters of the breast m. located on the pectoralis major. On the outside m. serratus anterior, the lower part of m. serratus anterior and external oblique muscle, the inner cover the upper part of the rectus sheath. Is located in the superficial fascia in the anterior chest wall, breast. Immediately below the dermis or subcutaneous layer of superficial fascia superficial. This fibrous layer of fibers from the skin and the breast goes back to the press. They are at the top of the breast is more advanced forms. Cooper ligaments and superficial fascia superficial layer of skin that lies between and surrounding breast parenchyma, directions that are perpendicular to the skin and breast tissue that separates the fibrous bands.

Cooper ligaments as a result of the infiltration of malignant tumors due to fibrosis or shortened for any reason to retreat into the causes and characteristics of the skin (orange-peel appearance). That is why the skin and upper secondary signs of cancer. The desmoplastic reaction in response to cancer also thickens the walls of adjacent ducts. Their mamogramlarda, traction causes compression of the breast. Calcification of ligaments and arteries of the breast cancers seen in overkill extends Cooper important. Breast tissue is normally a bilateral and symmetrical. Symmetry breaking may be a sign of breast cancer.

Breast arteries and veins

Arterial circulation of the breast comes from three sources.

1.İnternal thoracic artery in two, three and four perforating branches of the anterior chest wall of the sternum by piercing the edge of the medial and middle parts of the breast feeds. These are the largest veins of the breast. Greatly swollen during lactation.

2. Posterior intercostal arteries, the lateral branches: two, three, four and fifth intervals, posterior intercostal branches of the intercostal arteries give mammarian. Parenchyma to the front and lateral branches, while infusing the skin of the breast, the back goes to the branches to the muscles. Swollen during lactation.

3. More branches of the axillary artery feeds the upper quadrant, and the tail of the breast. Lateral thoracic artery, superior thoracic artery, the pectoral branch of the artery, including artery has four main branches. We export% 60 of the breast is approximately perforating branches of internal thoracic artery, lateral thoracic artery in 30% of the feed. However, all arteries are common among the anastomoses.

Veins of the breast

Axillary venous flow in general is true of the breast. Anastomotic veins around the nipple ring in a 'circulus venosus' form. Hematogenous metastasis of breast tumors is through the veins, venous structures is of great importance in this respect. Superficial and deep veins of the breast is divided into two groups. Superficial veins, located just below the superficial fascia. Both breast and internal mammary veins, superficial veins do with each other anastomosis senescence. Deep veins are discussed in three groups. Perforating branches of internal mammary vein is the largest group. These veins, Vena Innominata poured into the same party. This road is one way of lung metastatic embolism. The second group because of the deep breast, pectoral muscles and the chest wall is from the branches, vena ancillaries senescence. In this way the second way is responsible for lung metastatic embolism. Intercostal veins, the superior vena cava via the vena azigosa and from there a third way which embolilerini metastatic lung.

Another way to metastasis of breast carcinoma vertebral vein (Batson plexus). This plexus extends from the base of skull vertebrae surrounding the sacrum. Thoracic, abdominal and pelvic organs, with veins of this plexus of venous channels in each direction of blood flow. This metastatic emboli through blood vessels and central nervous system reaches the vertebrae. The internal mammary veins, the axillary and subclavian vein and intercostal veins also drained through the system.

Superficial and deep venous system to form anastomoses with each other within the breast parenchyma.

Breast lymphatics

Lymphatic drainage of the breast are three main ways.

1. Axillary lymph nodes

a. Externa mammary lymph nodes

b. Scapular lymph nodes

c. Central ganglia

d. Interpectoral ganglia (Ganglia Roter)

2. Parasternal (axillary) lymph nodes, breast, lymphatic flow of 3-25% percent is.

3. Posterior intercostal lymph nodes of breast lymphatics interlobular or perilobuler regions drainage begin.

Intramammar subdermal and subareolar breast lymph nodes in the region form an anastomosis. Takes place mainly in the right axillary lymphatic drainage of the breast. Axillary lymph ganglia, anatomically, according to the pectoralis minor muscle are divided into three groups looking at placements. Pectoralis minor muscle, lateral, or inferior to the lower limit of the Level I called lymph ganglia. This group of external mammarian, enters the axillary vein and the scapular lymph ganglion groups. Pectoralis minor muscle, posterior ganglia Level II group is settled, and a central part of this group includes a group of lymphatic ganglion. Level III lymph ganglia are located medial to the pectoralis minor muscle and the superior of the upper limit and cover a group of lymphatic ganglia. In addition, parallel to the internal mammary and intercostal sternum ganglionic chains and consists of drainage through the supraclavicular lymph nodes.

The role of the lymphatic drainage of the breast due to the spread of malignant tumors is of great importance clinically. Outer quadrant cancers, axillary, middle and inner quadrant of cancers seen in their internal mammary lymph nodes metastasis. Superficial lymphatics or the anterior abdominal wall along the middle line through the contralateral breast are drained.

Lymph nodes were also found in breast tissue. Mammography Intramammary lymph nodes (IMLN) at least 5% of normal women can be seen.

Anatomy of the breast ultrasound

Breast ultrasound examination, the correct depth from the surface of skin, subcutaneous fatty tissue, glandular and fibrous layer, fat layer, composed of muscle fascia and muscle layers. Hyperechoic in U.S. is skin, breast thickness increases closer to the beginning. Normal breast skin thickness does not exceed two to three millimeters. Subcutaneous fat layer in the form of a band is hypoechoic ovoid configuration, compared to the surrounding glandular tissue, hypoechoic, echogenic a nidus is formed by the connective tissue of the plant. The thickness of this band, the patient will vary according to age. Young women with dense breasts, and the subcutaneous fat layer is so thin to be seen. Breast tissue, a pattern usually shows a homogeneous echogenity. However, increases fatty involution increases, hypoechoic areas.

Glandular structure, occupies a large portion of breast glandının. Higher than the upper outer quadrant and axillary region. With connective tissue are seen as heterogeneous. Hypoechoic layer of fat and muscle layer. Ribs are hypoechoic image in the field, creates the posterior parts of the acoustic shadow. Ducts of the breast milk, breast showing convergence toward the beginning and the expanding diameter of 1-8 mm is seen as anechoic tubular structures. The nipple is moderately echogenic, acoustic shadowing is seen on the posterior. Physiological characters and the axillary lymph nodes IMLN long, ovoid hypoechoic structures in configuration and are usually seen as echogenic fat.

Mammographic Breast Anatomy

Reflect pathological changes in the soft tissue of the breast and mammography, the primary imaging method. Basic radiographic breast adipose tissue, soft tissue and calcium forms.

Mammographic breast; cutaneous structures (skin, areola, the nipple), the subcutaneous fat layer and the glandular layer is monitored in three sections. Areola, the nipple, skin and breast parenchyma all soft tissue. Subcutaneous fat tissue, and support, creates fat density.

Veins, subcutaneous tissue, 2-4 mm wide and long fatty breast tissue can be seen better. Venous pattern is usually symmetrical in both breasts, each patient is different. Contain calcification and atherosclerotic arteries because they are curved with the middle-aged or elderly women can be monitored. Overkill extends lymphatic vessels can not be seen.

The nipple and areola, which is projected by the appropriate technique is gained from the overkill extends to the front is seen as a soft tissue density. Some women collapsed as the variational, or import retracted. Normally at the plant and the leading soft-tissue density is seen as the areola. Skin, soft tissue surrounding the breast density is seen as a thin line. Mammography and normal skin thickness from 0.7 to 2.7 mm. The medial and inferior parts of the thickest skin of the breast. Normal breast parenchyma surrounding the fatty tissue under the skin has. This should be a uniform density along their length. Of fat lobules, extending to the inner surface of the skin, breast parenchyma and fibrous septa which curved course (Cooper ligaments) are available. They are as mammography is the best in the subcutaneous fat tissue.

Breast Diseases

Settlement and involvement in breast diseases can be grouped according to their localization.

Breast skin diseases, epidermal and sebaceous cysts, neurofibromatosis, Mondor's disease, steatositoma multiplex, inflammatory carcinoma, skin necrosis, pyoderma gangrenosum, candidal intertrigo, herpes zoster infection (shingles), syphilis, and melanoma.

The nipple-areola complex diseases, dermatitis, nipple adenoma, hidradenitis suppurativa, leiomyoma, Paget's disease.

Major subareoler ducts, ductal ectasia, solitary papillomas, papillary carcinoma. Terminal ducts, ductal hyperplasia, multiple peripheral papillomas, radial scar and complex sclerosing lesions, ductal adenoma, ductal carcinoma in situ, invasive ductal carcinoma, tubular carcinoma, mucinous carcinoma, medullary carcinoma, invasive cribriform carcinoma, adenoid cystic carcinoma, squamous cell carcinoma, metaplastic carcinoma and secretory carcinoma can be seen.

Breast disease, cysts, galactose, juvenile papillomatosis, and complex Fibroadenomas Fibroadenomas, filloides tumor, tubular adenoma, lactating adenoma, sclerosing adenosis, lobular neoplasia and invasive lobular carcinoma is considered.

The stroma of the breast, fat necrosis, lipoma, fibroadenolipom (hamartoma), fibrosis, mastitis and breast abscesses, calcification of the suture, hemangioma, diabetic fibrous breast disease, Extra abdominal desmoid tumor, lymphoma, and metastatic breast diseases.

Benign Breast Disease

Fibrocystic disease: The most common disease of the breast. A very wide spectrum of clinical pathology, this is a big part of women after puberty is a change in the developing parenchymal. The patients may be asymptomatic, in breast pain, tenderness or masses of various sizes can come up with a complaint. An excessive proliferation of fibrous connective tissue, fibrocystic disease, duct epithelial hyperplasia and such changes can be seen lobules. They can be found separately or all in one. Fibrocystic mammography findings in disease is seen in the following ways. Forms are in the forefront of the cysts, cysts radiologically smooth, round, ovoid-shaped and sharp. Lobulated multiloculated cysts. Many small cysts, epithelial and fibrous proliferation in the pattern when the overkill extends to form a nodular. Calcifications in the wall of the cysts can be monitored in the form of half-moon. Simple cysts in U.S., sharply contoured, completely anechoic, thin-walled, internal echo, or lesions that do not contain septa. Breast cysts may change shape compression. Posterior acoustic cysts observed exacerbation. Suggesting a complicated hydatid cyst is a finding seen in the eco-particles. This view proteinaceous material, may be due to infection or bleeding. Intracystic papilloma in the solid component to be a cyst, hemorrhagic cyst or suggestive of papillary carcinoma. Such lesions, fine-needle aspiration biopsy or tru-cut biopsy is indicated. Breast cysts are 35 to 50 years between the perimenopausal period is fairly common lesions. Breast cysts are fluid-filled lesions caused by breast lobules. As with most common component of fibrocystic disease, a solitary cysts are also seen. Fibrous forms are in the forefront of changes and dense breast parenchyma is homogeneous. Epithelial hyperplasia was significant ways (the terminal ductal hyperplasia and lobular hyperplasia), sclerosing adenosis advanced stage of the so-called increase in breast density associated with diffuse nodular are scattered small calcifications. This form is seen less often. Often bilateral and symmetrical, although there are localized and can mimic malignancy.

Fibroadenoma: Young women are prime candidates is the most common benign breast nipple. Fibroadenomas after puberty and usually before the age of 25-30 as a slow-growing benign tumors that depend on the activity of estrogen. % 10-20, although multiple lesions may also occur bilaterally. Size increases during pregnancy and lactation, menopausal back then. Fibroadenomlarda result shows coarse calcifications. Which is typical for soft-tissue component of the disappeared back Fibroadenomas degenerate "in the pop-corn" type remains amorphous and coarse calcifications.

Juvenile fibroadenoma: after puberty, and very fast-growing giant Fibroadenomas seen. Histological and radiological features similar to other fibroadenomlara. Sometimes you can reach giant proportions. Even though they have come with the rapid growth of malignant potential.

Sistosarkoma filloides: Usually solitary and unilateral. Potentially malignant, large, lobulated, well circumscribed, homogeneous-heterogeneous echo structure of a solid mass. Fibroadenomdan difference in size and cell number. In the form of a large cavernous structures filloides Sistosarkoma cystic areas of degeneration and foci of hemorrhage include. Most are less than 5% rate of malignant transformation may develop a benign character. Sistosarkoma, when there is a small clinic and radiology as fibroadenoma. There is a significant radiological criteria other than size in the differential diagnosis. Fibroadenoma of the tumor the size of a similar six-to eight centimeters (cm) exceeds the sistosarkoma filloides be considered good.

Intraductal papilloma: Mostly ducts in the breast closer to the top, subareolar region develops. Hyperplastic proliferation of ductal epithelium and ductal system, and many can be seen everywhere in. Papillomdur the most common benign papillary neoplasm of the breast. Solitary intraductal papilloma occurs frequently Gradient nipple. The most common cause of PND serous or bloody. Malignant papillary lesions of the papillary ductal carcinoma in situ and invasive papillary carcinoma. Intraductal papilloma can be seen at any age, although most often seen in late reproductive and postmenopausal period.

Lipoma: Asymptomatic, slow growing, well-defined, mobile masses. Lipomlarda calcification is monitored very rare.

Fibroadenolipom (hamartoma): a rare variant of lipoma. Adenomatous tissue and fibrous tissue proliferation in available. The lesion is surrounded by a thin capsule.

Fat necrosis of the breast: breast fat necrosis usually develops secondary to trauma. Had a breast biopsy or surgery are often seen. In such cases, a cavity containing fat cells secondary to the release of lipids and around the fibrous tissue. Mammographic appearance of fat necrosis may vary. Well-defined fatty cyst forms, which vary irregularly contoured to have audience. Eggshell calcifications in the form of oil capsules contain cysts. Retraction and thickening of the skin lesions caused by fat necrosis, and irregular contours, giving rise to parenchymal distortion may mimic breast cancer. Limited fat necrosis of the posterior acoustic shadow, and aggravation in U.S. shows an irregular, heterogeneous, with the oil co echogenity seen as small focal lesions.

Hematoma: Hematoma most frequently seen in the breast after the surgery or biopsies. The surrounding stromal tissue density mass with irregular contours with mammography, a monitored increase. In more advanced stages, or hemorrhagic cyst becomes a well-defined audience. Coarsening of trabecular pattern with thickening of the skin may also occur. Hematoma are usually in place within a few weeks to disappear, leaving scar tissue, or distortion. Calcified hematoma, or the scar tissue is rare. In U.S. appearance of a hematoma depends on the stage. Early in the apparent contour is the area hyperechoic scratch. Late in the aggravation of the well-defined posterior acoustic echo showing an anechoic lesion showing the structure becomes homogeneous.

Mastitis and Abscess: Acute mastitis is an infection of the breast is usually seen in lactation. Abscesses and other chronic illnesses related. Radiologic mimics the appearance of inflammatory carcinoma. Widespread increase in parenchymal density, skin thickening, and findings of axillary lymphadenopathy detected. Respond quickly to antibiotic treatment of acute abscesses. Abscess in the irregular contours of mammographic mass, thickening of the skin around and is seen as a distortion. Abscess in U.S. irregular contours, with solid and cystic components with posterior acoustic shadowing, which, heterogeneous, echogenic, and a lesion containing areas. Chronic mastitis, breast aseptic inflammatory lesion seen in elderly women. This disease is called plasma cell mastitis. The condition of secretion in the ducts, periductal connective tissue occurs after infiltration. Radiologically, the typical rough, linear, circular and oval calcifications seen. At the same time there is increased density subareolar region. Granulomatous mastitis (granulomatous) of unknown etiology, clinically mimic breast cancer, a rare inflammatory disease of the breast. Often seen in young women, and within six years after pregnancy. To as mammographic appearance of breast cancer that mimic the disease in U.S. (multiple hypoechoic tubular lesions in groups, sometimes large hypoechoic masses) is suggestive.

Lactating breast abscess usually occurs in patients, mainly localized in the retroareoler. Irregular in U.S. limited, mixed eco patterninde or relatively well-defined, low in the mass seen as strengthening the school and posterior acoustic.

Adenosis: a lesion of the breast glandular describes the elements of interest. Mammography and benign calcifications are observed. Adenosis and sclerosing adenosis mikroglandüler two types are defined.

Galactose: In breast milk-filled cysts. Lactating or pregnant women are monitored palpable mass, after lactation can be seen for many years. Multiple, can be uni or bilateral. Diagnosis is made ​​based on aspiration. Properly seen as rounded masses of different density mammography. The appearance of a well-defined anechoic cyst in U.S.. Posterior acoustic shadowing of the amplification and there.

Fibroma and leomyoma: Fibroma of the breast is a benign pathology, the breast glandular tissue and are located properly. Is one of the rare tumors of the breast. At the periphery of developing breast nipple vessel (vascular) or smooth muscle in the skin (superficial-cutaneous) more likely to develop. Breast parenchyma are very rare.

Ductal ectasia (plasma cell mastitis): collecting ducts in the breast subareoler inflammatory reaction and fibrosis is characterized by dilatation and around them. PND's first complaint. And consists of dark-colored discharge. Periductal fibrosis and inflammatory infiltration of lymphocytes occurs as the disease progresses. Palpation can be felt with the enlarged ducts. Nipple retraction due to fibrosis developing in advanced stages can be seen as a hyperechoic in U.S. and dilated ducts, periductal fibrosis subareoler monitored.

Hemangioma: the stromal vascular lesion of the breast. With mammography, a well-defined, punctate calcifications monitored along with the mass and the rate is 1.2 to 11%.

Radial Scar (benign sclerosing ductal lesion) and complex sclerosing lesions:

Sclerosing variant of adenosine is thought to be a radial scar. Central sclerosis and varying degrees of epithelial proliferation, apocrine metaplasia, and papilloma is characterized by the formation. Radial scar, complex sclerosing lesion takes its name from the size of one centimeter above. Composed of tubular structures extending from the center of a sclerotic line. Ducts periphery of the lesion show fibrocystic changes. Radial scar with tubular breast cancer, the radiological significance due to the great similarity. Some publications of the pathology of these two together, and that the removal of radial scars necessarily advocates. Other distinguishing characteristics of spiculated malignant lesions, radial scar with central radiolucent zone, including the skin and nipple retraction. However, they eliminate the need for biopsy in the presence of malignancy in terms of clinical suspicion.

Focal breast fibrosis: scarring of the breast with focal fibrosis or diabetes, related. For the breast may occur after interventional procedures. Fibrosis is often seen as mammography, and in U.S..

Flariazis Lymphatic: Lymphatic filaryazis by a nematode parasite Wuchereria bancrofti occurs. Very rare in the breast. However, breast involvement is not a place familiar.

Malignant Breast Diseases

Breast cancer is the most common cancer in women and constitutes 17% of cancer-related deaths. In women, deaths due to breast cancer, lung cancer and colon-rectal cancers are the third place. 180000 a year in European countries, 182,000 new cases detected annually in the United States. In the United States, the most frequent cancer in women with breast cancer and is in second place among the causes of cancer death in 1997, 180,200 women died of breast cancer was found and these 43900'ü this disease. Increased incidence of breast cancer incidence with age, with a slight increase from the 1940s until the 1980s. However, between the years 1980-1987, this increase has been three times and has continued at the same level until 1992. To determine the decrease in the rate of late stage breast cancer, screening, early-stage breast cancer detection rate of this increase. Unfortunately, there is no statistical information is yet available on this issue in our country. Approximately one million new cases worldwide each year are diagnosed with breast cancer. Over the life of one of every nine women at risk of getting breast cancer.

With age is directly related to the risk of developing the disease, the incidence of disease increases progressively with increasing age. Breast cancer is rare before age 30, the age that follows shows a rapid acceleration in the reproductive years. Following a slight decline during the years after menopause Menopause is an ongoing slow increase in slope occurs. Therefore, each of the nine women in one of 85-year-old is expected to develop breast cancer. As the incidence of age-related increases in mortality and 80-year-old woman 155 every 100,000 die from breast cancer. Mortality from breast cancer varies from country to country in the world, England and Wales, the highest, lowest in Japan and Thailand.

The most effective method of early diagnosis of breast cancer treatment. Early diagnosis and appropriate treatment methods, significantly prolonged survival of patients with timely initiation increased the importance of these diagnostic methods. Early diagnosis of malignant and benign breast lesions is important to distinguish lesions. Non-palpable tumors are small and have a better prognosis. The first method is referred to the early diagnosis of breast cancer patient's own examination of the breasts. Multi-disciplinary approach to diagnosis and treatment of breast disease is a serious and surgeon-radiologist-pathologist, medical and radiation oncologists must collaborate with the psychiatrist. Hereditary breast cancer incidence is increased in the presence of some syndromes.

Anatomy of Upper Urinary Tract

The kidneys, the abdominal cavity at the rear, on both sides of the vertebral The twelfth thoracic and first three lumbar vertebrae are located at the level. Retroperitoneal located 11 cm in length, 6 cm wide, and about 3 cm thick organ weights 150 grams. According to Poller the upper to the lower pole is closer to the midline, 1 cm. Here is a little more because of the left kidney, right kidney liver. Hilum contains the inner edges are slightly concave. L1-3, right kidney, left kidney lies between T12-L3 vertebrae. Shows the rotation of 30 ° anteriorly to transverse the kidneys. Coronal plane through the upper Poller, shifted forward in the sagittal plane lower Poller.

Kidneys from the inside out, the fibrous capsule, perirenal fat tissue (Capsula adiposa), Gerota's fascia (fascia renalis), pararenal fat tissue (corpus adiposum pararenal) are surrounded by. Perirenal fatty tissue with a thick layer of fat and muscle tissue adjacent to where plain films can be distinguished from more radiolucent. Kidneys, pararenal fat through the abdominal wall and sit back. From front to back vein, artery and is located in the pelvis. Pelvis, major calyx 2-3 main, they are also many minor calyx divided into papillary ending. Necks, called a calyx infundibulum. Sine in the renal pelvis, and sometimes completely (intra-renal pelvis), and sometimes it is beyond the kidney calices entirely due to the long (extrarenal pelvis).

The kidneys are seen as hypodense on CT. Gerato's fascia, perirenal adipose tissue is located outside and gets into the adrenaline. Front and rear leaves, lateral, medial and superiorly unite, six are welcome. Observed as hyperdense on CT.

Renal parenchyma, including the cortex and medulla is two parts. The medulla consists of 8-18 pieces striped-looking pyramid. Looks at the base of the pyramids at the cortex. Heights takes its name from the papilla and the minor calyces opens. The surface of the papilla of 7 main collector channel opens (Bellini ducts), and because of this appearance is called kribroza area. The number of papillary and different location may vary between 5-11. Therefore, the calyx and the pelvis is highly variable in appearance. Papillae surrounding the minor calices, stuck on where the angle (fornices), normally sharp appearance. Infection or obstruction is blunted, losing the sharpness of the angles.

Renal artery and vein, the level of L2, the aorta and inferior vena Javanese (VCI) interests. The right renal artery, the posterior is VCI. Renal artery and vein may be variations of 25-40%. The most common variation is the increased number of renal artery. Excess of the renal artery on the right side from left, are more common in the upper pole in the lower pole. Renal artery, 5 is a segmental branch. Segmental distribution, the posterolateral part of the kidney generates a line of avascular. Segmental arteries in each pyramid will continue for the lobar artery and 2-3, they left interlobar artery extends from the cortex between pyramids.

Corticomedullary interlobar artery in the region, turning parallel to the arcuate artery is called the base of the pyramid. Arcuate artery, interlobular artery is a number. The main branches of interlobular arteries and afferent glomerular artillery they generate is distributed to one or many glomeruli. After the formation of the glomerular capillary network, the efferent arteriolar, peritubular capillary network does. This capillary plexus, combined with venous poured into interlobular veins.

Of the kidney veins, arteries, and his followers are the same name. The right renal vein is usually single and very short. The left renal vein is longer. Inferior phrenic, adrenal and gonadal 3 lumbar drain the veins. The right kidney and right paracaval interaortokaval draining lymph nodes, while the lateral para-aortic lymph nodes in the left kidney is drained.

T12-L2 level of the kidneys from renal pleksusa a group formed by the nerve cell is innervated. Kidney cortex, and afferent fibers from the T11-L2 level to reach the vicinity of the capsule, followed the same path with a small part of the Vagus Nerve. Autonomic afferent fibers in the kidney, inguinal and femoral region when they enter the spinal cord due to the same region of the somatic fibers, subcostal pain often spreads to the region and abdomen.

The ureters, renal pelvis urine in the bladder, peristaltic movements, carrying 22-30 cm long, hollow organs. Lumen is usually 3 mm in diameter. The ureter from the top down, in front of retroperitoneal region, adherent to the peritoneum as the Romans. Switches to the back of the gonadal vessels. External and internal arteries bifurcation level iliac vessels crossing pelvis enters. When the base of the bladder through the bladder into the back of the superior vesical artery. In women, uterine artery crosses the front. Abdominal and pelvic parts. Abdominal ureter, renal pelvis between the iliac vessels, pelvic ureter, bladder, iliac veins lying between. Ureter, proximal renal artery, the aorta, iliac and gonadal artery, distal internal iliac artery and branches (superior vesical, uterine, middle rectal, vaginal, inferior vesical arteries) is fed. Feeding in the upper parts of the medial ureter, the pelvic ureter is the lateral branches.

Mirrored the distribution of arterial venous distribution. Lymphatic drainage of the upper end of the renal pelvis and ureter, renal lymph nodes is. Abdominal ureter, lymph drainage of the right side, right paracaval aortocaval lymph nodes and lymph drainage while the left is the left para-aortic lymph nodes. Pelvic lymph drainage of the ureter of the internal, external and common iliac lymph nodes. In providing the spinal segments T10-L2 sympathetic innervation of the ureter Preganglionic postganglionik nerves, Aorticorenal, the superior and inferior hypogastric plexus autonomic interests. Parasympathetic innervation is S2-4. Ureter allowing the intrinsic smooth muscle contraction. The ipsilateral testis in the upper ureteral obstruction, obstructions on the right McBurney point in the middle ureter, the pain may be felt on the left McBurney point symmetry. Edema of the ureteral orifice and ureter stones, bladder irritation due to inflammation of the findings, while the pain in the scrotal (labial women) can be heard in the region.

Urinary Tract Stone Disease

The frequency of urinary tract stone disease in all populations, although the rate of 4-10%, especially between the ages of 30-60 is a common disorder seen.

Urological applications in Western countries 16% of all hospital admission and 1-only 2%. In Turkey, 14.8% incidence of stone is. Prevalence by region with the most common region of southeastern Anatolia.

In developed countries, decreased the incidence of bladder stones is increasing the frequency of the upper urinary tract stones. Stone disease, the cause of the increase in the world, protein and carbohydrate-rich, high-fiber is thought to be a result of poor nutrition.

In the United States is the cornerstone of calcium oxalate stones, 70%. This half of the pure calcium oxalate stones, stone (monohydrate and dihydrate), while the remaining part of a larger mixed with calcium phosphate types. If other kinds of stones of pure calcium phosphate (6-10%) (mainly apatite, rare Brushite), magnesium ammonium phosphate (10-15%), uric acid (8%) and cystine (1-3%) blocks. Indinavir, xanthine, and adenine stones more rare.

Types of Kidney Stones

Structures of the types of stone

Calcium oxalate stones: The most common of all stones are stones and an average of 1 / 3 of the pure oxalate stones, and an average of 1 / 3 of a mixture of calcium oxalate and apatite stones creates. In this case, approximately 70% of urinary oxalate in the blocks of stones. Calcium oxalate stones, calcium phosphate and calcium carbonate stones are stones after the intense third-degree beam.

The formation of calcium oxalate stones are usually more than one risk factor effect. Risk factors of calcium oxalate in the urine by increasing, crystallization inhibitory activity are effective in reducing or increasing the crystallization promoter activity.

Metabolic risk factors, hypercalciuria, hyperoxaluria, hypocitraturia, can be considered as hypo magnesium. In addition, macromolecules, several microorganisms and diet play a role as risk factors for stone formation. Calcium oxalate stones in 50% of patients with hypercalcemia, hypercalciuria and unbound (idiopathic hypercalciuria) has. This is more than most of the patients intestinal calcium absorption and urinary excretion of more calcium is available. Excessive release of calcium from the bones more or less a part of the primary calcium excretion by the kidneys and monitored.

Hypercalcemia and hypercalciuria seen in 10% of patients with calcium oxalate stones. Hyperparathyroidism, sarcoidosis, vitamin D intoxication, diseases such as Cushing's syndrome arises as a consequence. 20% of patients with calcium oxalate stones hyperuricosuria, hyperoxaluria was found in 5%, 15% in 20, not available with any metabolic disorder. Calcium oxalate stones CaOMNH (Whewellite) or CaODH (Weddellite) can be structured. Weddellite stones, according to those who Whewellite structure, better stone-free rates with ESWL and intracorporeal lithotripsy techniques can be obtained from fragmentation can be achieved more easily. Calcium oxalate monohydrate or dihydrate structure, the formation of stones is not fully understood causes. Building stones, the stones, hyperoxaluria, hypercalciuria with Weddelite Whewellite structure, and these stones are shown to be associated with differences in patient groups that have been reported.

Objective in the treatment of recurrent urinary stone disease by correcting the risk factors to eliminate disturbances in the structure, thus to prevent new stone formation and growth of existing stones.

Calcium phosphate stones: calcium phosphate, calcium phosphate stones most common causes of balance disorders, renal tubular acidosis and urinary tract infection. Urine pH of calcium phosphate stones are two main types depending on. These brushite (calcium hydrogen phosphate trihydrate) and carbonate apatite (oxalate triphosphate) blocks. And the risk of recurrence of stones is a very fast Brushite high (30-60%) (13). Brushite stones, the pH of acidic urine ranging between 6.5 and 6.8, occurs in the presence of high amounts of calcium and phosphate.

Carbonate apatite stones in the urine alkaline (pH> 6.8), develops in the presence of high calcium and low citrate concentration.

Carbonate apatite, or infection is easy to break stones with ESWL. However, monotherapy with the stone-free rates and low risk of recurrence is high. Brushite stones in the phosphate stones are stones with the most intense and hard. ESWL is very difficult with the fragmentation and stone-free rate is low.

Therefore, percutaneous procedures are often applied, and in some cases, open surgery would be preferable.

Magnesium ammonium phosphate (MgNH3PO4) stones (struvite, infection) stones: Mixed or pure variety. Ray density is lower than that of calcium in the stones. Phosphate containing stones, urinary tract stones is 15%. Chief among these are struvite. Chronic infections, especially urinary pH and ammonium concentrations of urea-splitting bacteria such as Proteus, can cause an increase in the formation of struvite stones may prepare the ground. Is the rapid growth of phosphate stones tend to fill the entire renal pelvis and calyceal system. This type of deer horn, stone formation resembles "staghorn" is defined as a stone.

Proteus species of microorganisms that break down urea and the urine becomes alkaline, magnesium ammonium phosphate stones occur. More women appear. The main reason for this less than bacterial infection, struvite stones in women. There are bacteria living in the stones.

The main aim of treatment of infection stones in the urinary system is to purify these stones. Conservatively while monitoring the reported mortality of up to 28%

Stones of the urinary tract will serve arınmasına methods ESWL, percutaneous nephrolithotomy, open nephrolithotomy or ESWL and percutaneous nephrolithotomy include combined. The first step is composed of staghorn stone treatment with percutaneous nephrolithotomy.

Calcium carbonate stones: Usually found in combination with phosphate stones. Light intensity is very high.

Cystine Kidney Stones

Cystine stones: the enzyme due to a lack of cystinuria and cystine stone formation is increased excretion occurs. Is 1-2%. Cystine stones, urinary relatively acidic properties. Primary and secondary hyperoxaluria and stone formation can also be seen as a result.

1.5 cm, small stones had been recommended to be treated with ESWL or percutaneous nephrolithotomy and ureteroscopy for stones larger than 1.5 is recommended. However, 73% of patients relapse within 5 years, have been reported.

Xanthine stones: Very rare stones. Is the result of metabolic disorders. The enzyme xanthine oxidase, xanthine stones in an autosomal recessive Deficiency occurs. Radio opaque a large part of the stones. Cystine stones, xanthine and uric acid stones.

Matrix stones: These stones are calcifications scattered in places. In the presence of stones is collecting views on the system mass matrix. Take place where the format, create view.

The causes of stone formation is still unclear. There are various theories about the formation of stones. These crystallization, epitaxy, matrix, and combined with the lack of inhibitory theories.

Analysis of Urinary Tract Stones

Today, the prevalence of urinary tract stones between 5 to 12% with the prevalence and recurrence rates levels increased remarkably in recent years indicated. Stone disease within one year after the first admission of 10%, 35% within 5 years and 10 years, 50% repeats. However, the 1980's, after the expansion of a pulsed, solid device technology in addition to the methods of endoscopic lithotripsy is a minimally invasive method, the body outside the shock waves to break stones in the treatment of urological disease in the introduction of a fundamental progress has been made ​​of stone. But the underlying reason for the non-recurrence rates of these treatments have no effect. Today, as surgical treatment of the stone, then the second step, in order to prevent recurrences do. With the underlying metabolic-anatomic causes of these studies, the introduction and then start the appropriate prophylactic treatment for the patient is an absolute necessity to know the analysis of the stone. Stone analysis, urinary tract, "biochemical biopsy" is sometimes defined as the identification of specific components and custom stone may indicate a metabolic diagnosis.

For example, cystine stones as a result of analysis to arrive, pre-diagnosis of hereditary cystinuria or calcium oxalate stones determination, related to the metabolism of calcium and oxalate in primary hyperparathyroidism, hypercalciuria, renal tubular acidosis, primary hyperoxaluria, in many disorders such as gastro-intestinal diseases. Many of these crystalline form. According to the results of stone analysis is the most common components, respectively, of calcium oxalate (monohydrate or dihydrate-Wheweelite-Weddellite), calcium hydrogen phosphate (Brushite), calcium phosphate (hydroxyapatite / Dahllite), cystine, magnesium ammonium phosphate (struvite) and uric acid building blocks. Many of the stone in the mucopolysaccharide and proteins are usually found in small amounts. However, their clinical significance is still understood. Urinary system stones natural as long a grows and shows the time period itself. Some crystalline forms, appears as the product of reduction of other forms. For example, calcium monohydrate, dihydrate form is the product of dehydration. Therefore, close to the kernel at the periphery of the stone has a higher incidence of monohydrate form. There are many different methods the study of urinary tract stones. These X-ray diffraction crystallography, infrared spectroscopy, electron microscopy, thermogravimetric analysis, polarizing microscopy and chemical spot tests. Compared to these methods, the methods by about 30% of all the stone was the wrong diagnosis was obtained.

Chemical analysis, is still the most widely used today, but also has the highest error rate methods. These methods provide insufficient results, especially for small amounts of stone and blends. Most of error are cystine stones. If it contains phosphate in detection rate of cystine stones than 70% to 58% may go up.

In all methods of analysis for both common and rare components of the most accurate results were given by the infrared spectroscopy.

Stone analysis is done correctly is very important to assess the changing risk factors. Stone analysis indicates that within the urinary environment. For example, as a result of the analysis in a patient with magnesium ammonium phosphate, with the start of crystallization and stone formation, urinary tract infection, followed by secondary, resulting in storage of magnesium ammonium phosphate. These results suggest that infected urinary environment. Similarly, recurrent stones, each time changes occur in the composition of the stone. For example, cystine, or uric acid stone was originally a combination of stone, and then be sent for example as a result of magnesium ammonium phosphate. At this point, stone analysis, the presence of intercurrent infection, pointing to a urology specialist treatment plan may require making changes. Depending on the treatment given the observed changes in the composition of the stone is in the same patient. Cystine, or uric acid stones in patients with calcium phosphate stones may occur after the alkali treatment. In recent years, increasing the pre-operative analysis of the components of the stone and the treatment plan according to the results of various studies that are done.

Urate, calcium oxalate monohydrate, calcium phosphate stones and cystine stones ESWL for the treatment at the first step to answer in general is lower.

Tested different methods for prediction of the possible components of the stone before surgery. Among these, according to the results of the previous stone analysis to determine the treatment plan, urinary pH, urine microscopy, KUB, conventional and spiral CT, magnetic resonance, X-ray diffraction and is located in bone mineral densitometry.

In one study, X-rays have been reported with the 39% accuracy.

In another study conducted in-vivo with spiral CT as the only correct analysis be made ​​of calcium oxalate and uric acid stones have been reported.

T1-weighted magnetic resonance imaging studies done in the separation of struvite and apatite stones have been reported.

Although promising, even though some of these studies, yet there is a method to ensure an accurate assessment of the stone exactly as in vivo.

Today, analysis of urinary tract stones in each stone must be done for patients and to determine the treatment plan as well as an overview of which is very important in the prevention of duplication. Currently, many different techniques used in the laboratory are often not reliable, and working with high error rates. Therefore, especially in reference to some of the advanced centers should be preferred. Analysis of the foundation stone is connected to the correct diagnosis and treatment of high-quality stone, but the analysis can assist the clinician.

Intravenous pyelography (IVP)

Circulation, the concentration of the contrast agent intravenously in the kidneys and urinary collecting system, disposal system, based on the basic diagnostic method. The current main indication hematuria, urinary tract calculus, ureteral strictures and fistulas, and to investigate the complex urinary tract infections. In addition, renal trauma, gynecological and colorectal malignancy operations before the ureters, kidneys transplant used to evaluate the donor. A day before the examination two hours after a light dinner, giving the patient a laxative cleaning is provided. Directly examine the abdominal X-ray, commencing with lying. Low-or high-water-soluble contrast studies of intravenous iodinated contrast media used. After injection, the kidneys, ureters and bladder in order to see the usually 3-5, 7-15 and 20-30. three minutes to obtain the X-ray. If necessary, spot X-ray is taken to the patient for the urinary bladder after micturition.

After 24 hours with one hour intervals radiographs can be taken if necessary.

Allergic reaction to contrast agents used during IVP make 5-10%, borderline diabetic patients with renal failure or renal failure caused by 25% be, pregnancy, and factors that restrict the use IVP thyrotoxicosis.

Retrograde urography

Cystoscopy catheters inserted into the ureters and calyces giving an opaque substance, is to fill the pelvis and ureters. Cystoscopy is performed under sterile conditions and catheterisation. Contrast material should be diluted and should be under fluoroscopic control. İVP not be done with multiple myeloma, high urea, in cases of acute failure and can not be seen İVP' pelvicaliceal is the purpose of demonstrating the system. The method of infection, sepsis, complications are common, such as renal papillary necrosis and extravasation.

Antegrade pyelography

To be shown on IVP and retrograde pyelography is not possible with the best, especially in patients with obstructive, is to show the location of the obstruction. Deposited in the patient prone. Under U.S. or fluoroscopic control with the stylus directly by entering the lumbar region, pelvis and calyceal system in the opaque material is enlarged. Opaque material falls down to his feet only after the patient was removed from the site of obstruction is determined.

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