Breast

Published on 12/06/2015 by admin

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Last modified 12/06/2015

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17

Breast

Mammography

Indications

1. Focal signs in women aged >40 years in the context of triple (i.e. clinical, radiological and pathological) assessment at a specialist, multidisciplinary diagnostic breast clinic

2. Following diagnosis of breast cancer, to exclude multifocal/multicentric/bilateral disease

3. Breast cancer follow-up, no more frequently than annually or less frequently than biennially for at least 10 years

4. Population screening of asymptomatic women with screening interval of 3 years, in accordance with NHS Breast Screening Programme policy:

5. Screening of women with a moderate/high risk of familial breast cancer who have undergone genetic risk assessment in accordance with National Institute for Health and Clinical Excellence (NICE) guidance

6. Screening of a cohort of women who underwent the historical practice of mantle radiotherapy for treatment of Hodgkin’s disease when aged <30 years. These women have a breast cancer risk status comparable to the high-risk familial history group1

7. Investigation of metastatic malignancy of unknown origin.

Equipment

Conventional film-screen mammographic technology has largely been superseded by full-field digital mammography (FFDM) which has a higher sensitivity in:

Ongoing developments of FFDM include:

1. Tomosynthesis which creates a single three-dimensional image of the breast by combining data from a series of two-dimensional radiographs acquired during a single sweep of the X-ray tube. Ongoing studies suggest that this technique may improve diagnostic accuracy in screening of the order of 30%, reduce recall by an estimated 40% and has a radiation dose of approximately 50% of that of a single mammographic exposure

2. Contrast-enhanced digital mammography, i.e. angiomammography. Two approaches are being developed: temporal sequencing (in which images pre and post contrast are subtracted with a resultant angiomammogram) and dual energy imaging (in which imaging at low and high energies detailing, respectively, parenchyma and fat with and without iodine are obtained. The subsequent views can then be subtracted

3. Computer-aided detection (CAD) software can assist film reading by placing prompts over areas of potential mammographic concern. There is evidence that, even in the screening setting, single reading in association with CAD may offer sensitivities and specificities comparable to that of double reading.4

If conventional film-screen mammographic imaging is to be carried out, it should be performed on a dedicated unit which includes in its specification:

Technique

Standard mammographic examination comprises imaging of both breasts in two views, namely the mediolateral oblique (MLO) and craniocaudal (CC) positions. Screening methodology is bilateral, two-view (MLO and CC) mammography at all screening rounds.

Additional views may be required to provide adequate visualization of specific anatomical sites:

Compression of the breast is an integral part of mammographic imaging resulting in:

Adaptation of the technique can provide additional information:

Further Reading

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