There are three stages or phases of mammography and each have a different role in the detection of abnormalities in the breast tissue. Diagnostic mammography comes after the screening, if it is necessary.
After a screening mammogram, some results or images may have areas of concern which can't be resolved with only the information presented from the screening. These patients would be called back for a diagnostic mammogram. This phrase basically means it’s a secondary, problem-solving mammogram.
It should be stressed that most abnormalities found during a mammogram are NOT breast cancer.
However, many women who have regular screening mammograms need additional tests to investigate any abnormalities that may be found to view these areas in more detail or through a more targeted test for that area.
Diagnostic mammograms take a little longer than screening mammograms because they involve more x-rays in order to obtain views of the breast from several different angles. The technician may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis.
At this point, other forms of radiograph tests may be used rather than a simple X-ray to get a better picture of the area in question. Ultrasound, ductography, positron emission mammography (PEM), and magnetic resonance imaging (MRI) are often performed in addition or with mammography.
Ultrasound is typically used for further evaluation of masses found on mammography or palpable masses not seen on mammograms. This technique has become a valuable aid, when used together with mammography, to diagnose breast cancer in the last few years because it is widely available and is less expensive than other cancer diagnosis options. The ultrasound technique is usually used after a mammogram has located a specific area of concern. Ultrasound’s main advantage is distinguishing between cysts and solid masses and between benign and malignant tumors.
Ductograms are still used in some institutions for evaluation of bloody nipple discharge when the mammogram is non-diagnostic. This technique involves inserting a plastic tube in the opening of the duct at the nipple and injecting a certain amount of contrast substance. The contrast substance will help outline the shape of the duct and will locate any mass inside the duct on an x-ray image. This technique is used to determine the cause of bloody nipple discharge.
A Breast MRI can be useful for further evaluation of questionable findings as well as for screening pre-surgical evaluation in patients with known breast cancer to detect any additional lesions that might change the surgical approach, for instance from breast-conserving lumpectomy to mastectomy.
ABOVE: Three angles of mammograms - Cranialcaudal, Mediolateral Oblique and Mediolateral view - all from the same chest.
ABOVE: Single MRI (or MR) image taken of breast - the MRI version of a mammogram.
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