Mammography

Mammography

Mammography in two planes and ultrasonography are the first line investigations for imaging the breast. Magnetic resonance imaging (MRI) is a valuable adjunctive diagnostic tool because of its high sensitivity for breast pathology . Mammography is also used as an initial screening tool f or asymptomatic women in population-based programmes. Radiographs are taken by placing the breast in direct contact with ultrasensitive film and exposing it to low-voltage, high-amperage x-rays. The dose of radiation is approximately 1 /uni00A0 mGy per film ( Figure 58.7 Mammography should be the first investigation in older women who present with breast symptoms. Mammographic features of cancer are shown in Figure 58.8 . Ancillary signs of malignancy such as lymphadenopathy , breast oedema and skin or areolar thickening or retraction may be seen in advanced cases. The mammographic and ultrasonographic features are not diagnostic of cancer; biopsy is required for definitive diagnosis in lesions with a Breast Imaging Reporting and Data System (BI-RADS) score of 4 or 5 ( Table 58.1 ). Mammography reporting The American College of Radiology has developed guide lines – BI-RADS – to achieve uniformity and objectivity in the interpretation and reporting of mammograms and ultrasound. The mammographic assessments are ca tegorised from BI-RADS 0 to BI-RADS 6 ( Table 58.1 ). Gy is short for Gray , the SI unit for the absorbed dose of ionising radiation. Louis Harold Gray , 1905–1965, Director, British Empire Cancer Campaign Research Unit in Radiobiology , Mount V ernon Hospital, Northwood, UK. - ).

(b) Use the pad of three /f_i ngers and (c) the dial of a clock method Figure 58.5 Fibroadenoma. Ultrasonography shows a well-circum

scribed, solid mass suggestive of /f_i broadenoma in a young woman. Breast Imaging Reporting and Data System (BI-RADS) score 3 ( Table 58.1 ). Figure 58.6 Imaging features of breast carcinoma on ultrasonogra

phy. This shows a solid, irregular-shaped mass, taller than wider, with angular irregular margins. Breast Imaging Reporting and Data System (BI-RADS) score 5 ( Table 58.1 ).