Breast imaging plays an integral role in breast cancer screening and diagnosis. Screening mammography is performed in an asymptomatic woman in order to detect clinically occult breast carcinoma. Diagnostic mammography is performed to evaluate a questioned abnormality, detected either on clinical evaluation or on mammographic screening.
This section will review screening and diagnostic mammography, the role of additional mammographic views and other imaging modalities, the mammogram report using the terminology of the Breast Imaging Reporting and Data System (BI-RADS™) lexicon, needle localization and image-guided percutaneous breast biopsy.
Mammography and breast magnetic resonance imaging (MRI) are currently the best available tools for detecting early breast cancer. Mammography may fail to detect some breast cancers. Importantly, mammography may miss some breast cancers in younger women. This is of concern because much of the BRCA1- and BRCA2-related breast cancer occurs before age 50.
In postmenopausal women, it is easier to detect a cancer by mammography, which appears as a white mass, or associated with white calcium spots, contrasted against a dark background. Before menopause, a woman’s breasts are made up of relatively more supporting tissue (which appears “dense” or white on a mammogram) and less fatty tissue (which appears “radiolucent” or dark).
Computer-assisted mammography reading and digital mammography are now being studied as ways to improve the accuracy of mammography interpretation. Annual breast MRI, an imaging technique that does not involve radiation exposure, is now rountinel recommended as a way to improve detection of early breast cancers when screening women at high genetic risk of breast cancer.
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Laura Liberman and Timothy L. Feng
Breast cancer detection demonstration project: five-year summary report. CA 2003