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5 Breast Imaging

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Key Points

Mammography

Prospective randomized controlled trials (RCT) have demonstrated reduced breast cancer mortality of approximately 30% associated with mammography screening (strong evidence). Evaluations of mammography screening in community settings have shown greater mortality reductions associated with participating in screening (moderate evidence). Women aged 40–54 years should be screened at intervals of 12–18 months in order to achieve similar mortality reductions compared with women who are 55 years of age and older due to faster tumor growth in younger women (moderate evidence).

Ultrasound

Data from single center studies of screening ultrasound suggest that it has a detection benefit as a supplement to screening mammography in patients with dense (at least 50% of the breast is not fatty) breast parenchyma (moderate evidence). Reports from single-institution studies found that a high percentage (91%) of breast cancers identified on supplemental screening sonography are stage I invasive cancers. Detecting this subset of breast cancers is most likely to reduce breast cancer mortality (moderate evidence). In patients with dense breast parenchyma, mammography and sonography appear complementary, in that ductal carcinoma in situ (DCIS) is better depicted by mammography and small, <1 cm, invasive breast cancers are better detected sonographically (moderate evidence). Women with dense breast parenchyma on mammography, contemplating a supplemental sonographic screening examination, should consider the risk of a false-positive sonogram, possibly resulting in the recommendation for a breast biopsy (moderate evidence). Sonography is appropriate in the evaluation of palpable breast masses (moderate evidence). Sonography is appropriate in the evaluation of mammographically circumscribed, obscured, or indistinctly marginated masses and focal asymmetries (moderate evidence). The combination of mammography and sonography depicts 96–97% of palpable breast cancer and 92% of nonpalpable breast cancer (moderate evidence). Sonography can help identify the invasive component of mixed invasive and intraductal carcinoma and guide optimal percutaneous biopsy (limited evidence). Sonography is a useful supplement to mammography in depicting the extent of invasive carcinoma in dense breasts (moderate evidence). Sonography is useful in the evaluation of the patient with nipple discharge (limited evidence).

Biopsy

Percutaneous image-guided breast biopsy is not indicated for ­nonpalpable lesions classified as BIRADS 3. For these lesions, short-term interval follow-up, generally at 6-month intervals, is recommended (strong evidence). For BIRADS 4 and 5 lesions, image-guided percutaneous biopsy is cost-effective as the initial strategy for diagnosing nonpalpable breast lesions (strong evidence).

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Authors and Affiliations

  1. Department of Radiology, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, 200 Hawkins Drive, 3966 JPP, Iowa City, IA, 52240, USA

    Laurie L. Fajardo

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  2. Wendie A. Berg
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  3. Robert A. Smith
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Correspondence to Laurie L. Fajardo .

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Editors and Affiliations

  1. , Department of Radiology, Miami Children's Hospital, SW 114 Street 7420, Miami, 33156, Florida, USA

    L. Santiago Medina

  2. Harborview Medical Center, Department of Radiology, University of Washington, Ninth Avenue 325, Seattle, 98104-2499, Washington, USA

    C. Craig Blackmore

  3. , Department of Radiology, Emory University School of Medicine, 1364 Clifton Road, NE Suite D112, Atlanta, 30322, USA

    Kimberly Applegate

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Fajardo, L.L., Berg, W.A., Smith, R.A. (2011). 5 Breast Imaging. In: Medina, L., Blackmore, C., Applegate, K. (eds) Evidence-Based Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-7777-9_5

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  • DOI: https://doi.org/10.1007/978-1-4419-7777-9_5

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  • Publisher Name: Springer, New York, NY

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