Breast imaging is fraught with unique challenges in decision making and patient management. The objective of not missing early-stage disease so as to fulfill the prime goal of diagnosing nonpalpable cancers to be balanced with keeping false positives low presents unique practice patterns and challenges. The list of controversies in breast imaging is long; some of the important ones are discussed in this chapter: inappropriate indications for mammography, breast intervention (intraductal masses, follow-up after concordant biopsy results, cytology of cyst aspirates), dense breast law, double reads, clinical breast exam during screening, imaging the male breast, overdiagnosis of breast cancer with screening mammography, and isolated abnormal axillary nodes.
- Breast Cancer
- Dense Breast
- Recall Rate
- Male Breast
- Male Breast Cancer
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, access via your institution.
Tax calculation will be finalised at checkout
Purchases are for personal use onlyLearn about institutional subscriptions
Di Maggio C. State of the art of current modalities for the diagnosis of breast lesions. Eur J Nucl Med Mol Imaging. 2004;31 Suppl 1:S56–69.
Shiffman MA. Mammograms in cosmetic breast surgery. Indian J Plast Surg. 2005;38:100–4.
Perras C. Fifteen years of mammography in cosmetic surgery of the breast. Aesthetic Plast Surg. 1990;14(2):81–4.
Kroll SS, Schusterman MA, Tadjalli HE, Singletary SE, Ames F. Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy. Ann Surg Oncol. 1997;4(3):193–7.
Sim YT, Litherland JC. The use of imaging in patients post breast reconstruction. Clin Radiol. 2012;67(2):128–33.
Destounis S, Morgan R, Arieno A, Seifert P, Somerville P, Murphy P. A review of breast imaging following mastectomy with or without reconstruction in an outpatient community center. Breast Cancer. 2011;18(4):259–67.
Helvie MA, Wilson TE, Roubidoux MA, Wilkins EG, Chang AE. Mammographic appearance of recurrent breast carcinoma with TRAM flap breast reconstructions. Radiology. 1998;209:711–5.
Helvie M, Bailey J, Roubidoux M, Pass H, Chang A, Pierce L, et al. Mammographic screening of TRAM flap breast reconstructions for detection of non-palpable recurrent cancer. Radiology. 2002;224:211–6.
Howard MB, Battaglia T, Prout M, Freund K. The effect of imaging on the clinical management of breast pain. J Gen Intern Med. 2012;27(7):817–24.
Lumachi F, Ermani M, Brandes AA, et al. Breast complaints and risk of breast cancer. Population-based study of 2,879 self-selected women and long-term follow-up. Biomed Pharmacother. 2002;56(2):88–92.
Smith RL, Pruthi S, Fitzpatrick LA. Evaluation and management of breast pain. Mayo Clin Proc. 2004;79(3):353–72.
Duijm LEM, Guit GL, Hendriks JHCL, Zaat JOM, Mali WPTM. Value of breast imaging in women with painful breasts: observational follow up study. Br Med J. 1998;317(7171):1492–5.
Chang JM, Moon WK, Cho N, Han W, Noh DY, Park IA, Jung EJ. Risk of carcinoma after subsequent excision of benign papilloma initially diagnosed with an ultrasound (US)-guided 14-gauge core needle biopsy: a prospective observational study. Eur Radiol. 2010;20(5):1093–100.
Liberman L, Tornos C, Huzjan R, Bartella L, Morris EA, Dershaw DD. Is surgical excision warranted after benign, concordant diagnosis of papilloma at percutaneous breast biopsy? AJR Am J Roentgenol. 2006;186:1328–34.
Kim WH, Chang JM, Moon WK, Cho N, Yi A, Koo HR, Kim SJ. Intraductal mass on breast ultrasound: final outcomes and predictors of malignancy. AJR Am J Roentgenol. 2013;200(4):932–7.
Shin S, Schneider HB, Cole Jr FJ, Laronga C. Follow-up recommendations for benign breast biopsies. Breast J. 2006;12(5):413–7.
Daly CP, Bailey JE, Klein KA, Helvie MA. Complicated breast cysts on sonography: is aspiration necessary to exclude malignancy? Acad Radiol. 2008;15(5):610–7.
Ciatto S, Cariaggi P, Bulgaresi P. The value of routine cytologic examination of breast cyst fluids. Acta Cytol. 1987;31(3):301–4.
Berg WA, Campassi CI, Ioffe OB. Cystic lesions of the breast: sonographic-pathologic correlation. Radiology. 2003;227(1):183–91.
Sanders LM, Lacz NL, Lara J. 16 year experience with aspiration of noncomplex breast cysts: cytology results with focus on positive cases. Breast J. 2012;18(5):443–52.
Gottlieb S. Ultrasound plus mammography may detect more early cancers. BMJ. 2002;325:678.
Stomper PC, D’Souza DJ, DiNitto PA, Arredondo MA. Analysis of parenchymal density on mammograms in 1353 women 25–79 years old. AJR Am J Roentgenol. 1996;167:1261–5.
Boyd NF, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356:227–336.
Berg WA, Blume JD, Cormack JB, et al. Combined screening with ultrasound and mammography vs mammography alone in women at elevated risk of breast cancer. JAMA. 2008;299:2151–63.
Weigert J, Steenbergen S. The Connecticut experiment: the role of ultrasound in the screening of women with dense breasts. Breast J. 2012;18(6):517–22.
Parris T, Wakefield D, Frimmer H. Real world performance of screening breast ultrasound following enactment of Connecticut Bill 458. Breast J. 2013;19(1):64–70.
Hooley RJ, Greenberg KL, Stackhouse RM, Geisel JL, Butler RS, Philpotts LE. Screening US in patients with mammographically dense breasts: initial experience with Connecticut Public Act 09–41. Radiology. 2012;265(1):59–69.
Dinnes J, Moss S, Melia J, Blanks R, Song F, Kleijnen J. Effectiveness and cost-effectiveness of double reading of mammograms in breast cancer screening: findings of a systematic review. Breast. 2001;10(6):455–63.
Duijm LE, Groenewoud JH, Hendriks JH, de Koning HJ. Independent double reading of screening mammograms in The Netherlands : effect of arbitration following reader disagreements. Radiology. 2004;231(2):564–70.
Gilbert FJ, Astley SM, McGee MA, Gillan MG, Boggis CR, Griffiths PM, Duffy SW. Single reading with computer-aided detection and double reading of screening mammograms in the United Kingdom National Breast Screening Program. Radiology. 2006;241(1):47–53.
Taylor P, Potts HW. Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer. 2008;44(6):798–807.
Bennett RL, Blanks RG, Moss SM. Does the accuracy of single reading with CAD (computer-aided detection) compare with that of double reading?: A review of the literature. Clin Radiol. 2006;61(12):1023–8.
Brown J, Bryan S, Warren R. Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammograms. BMJ. 1996;312(7034):809–12.
Cairns J, Van Der Pol M. Cost-effectiveness of non-consensus double reading. Breast. 1998;7(5):243–6.
Chiarelli AM, Majpruz V, Brown P, Thériault M, Shumak R, Mai V. The contribution of clinical breast examination to the accuracy of breast screening. J Natl Cancer Inst. 2009;101(18):1236–43.
Bancej C, Decker K, Chiarelli A, Harrison M, Turner D, Brisson J. Contribution of clinical breast examination to mammography screening in the early detection of breast cancer. J Med Screen. 2003;10(1):16–21.
Feigin KN, Keating DM, Telford PM, Cohen MA. Clinical breast examination in a comprehensive breast cancer screening program: contribution and cost. Radiology. 2006;240(3):650–5.
Nguyen C, Kettler MD, Swirsky ME, Miller VI, Scott C, Krause R, Hadro JA. Male breast disease : pictorial review with radiologic-pathologic correlation. Radiographics. 2013;33(3):763–79.
Günhan-Bilgen I, Bozkaya H, Ustün E, Memiş A. Male breast disease: clinical, mammographic, and ultrasonographic features. Eur J Radiol. 2002;43(3):246–55.
Adibelli ZH, Oztekin O, Gunhan-Bilgen I, Postaci H, Uslu A, Ilhan E. Imaging characteristics of male breast disease. Breast J. 2010;16(5):510–8.
Chen L, Chantra PK, Larsen LH, Barton P, Rohitopakarn M, Zhu EQ, Bassett LW. Imaging characteristics of malignant lesions of the male breast. Radiographics. 2006;26(4):993–1006.
Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300.
Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012;367(21):1998–2005.
Gur D, Sumkin JH. Screening for early detection of breast cancer: overdiagnosis versus suboptimal patient management. Radiology. 2013;268(2):327–8.
Lanitis S, Behranwala KA, Al-Mufti R, Hadjiminas D. Axillary metastatic disease as presentation of occult or contralateral breast cancer. Breast. 2009;18(4):225–7.
Patel T, Given-Wilson RM, Thomas V. The clinical importance of axillary lymphadenopathy detected on screening mammography: revisited. Clin Radiol. 2005;60(1):64–71.
Rosen PP, Kimmel M. Occult breast carcinoma presenting with axillary lymph node metastases: a follow-up study of 48 patients. Hum Pathol. 1990;21(5):518–23.
Shetty MK, Carpenter WS. Sonographic evaluation of isolated abnormal axillary lymph nodes identified on mammograms. J Ultrasound Med. 2004;23(1):63–71.
Görkem SB, O’Connell AM. Abnormal axillary lymph nodes on negative mammograms: causes other than breast cancer. Diagn Interv Radiol. 2012;18(5):473–9.
de Bresser J, de Vos B, van der Ent F, Hulsewé K. Breast MRI in clinically and mammographically occult breast cancer presenting with an axillary metastasis: a systematic review. Eur J Surg Oncol. 2010;36(2):114–9.
Editors and Affiliations
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Shetty, M.K. (2015). Challenges in Breast Imaging. In: Shetty, M. (eds) Breast Cancer Screening and Diagnosis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1267-4_14
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-1266-7
Online ISBN: 978-1-4939-1267-4