# 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
).