Imaging Mammography

Mammography (soft tissue radiography) involves having two radiographs taken of the breast: cranio-caudal and oblique views of each breast. The total X-ray dose is usually less than 1 mGy. This technique is most useful when the breasts contain little of dense glandular tissues and are

Figure 17.5. Normal mammogram.
Figure 17.6. Mammogram showing dense breast tissue.
Figure 17.7. Mammogram demonstrating benign microcalcification.

composed predominantly of fat (Fig. 17.5). Therefore, in younger women (with dense glandular elements in the breasts) it is less accurate and reliable (Fig. 17.6). In general, mammography is reserved for women over the age of 35 years but should be carried out in younger women if there is a good clinical indication (e.g. suspicion of cancer).

The mammographic features of malignancy include: (i) microcalcification, comprising multiple particles of irregular size and density (see Figs 17.7 and 17.8 for examples of benign and malignant microcalcification); (ii) an opacity with characteristically irregular or spiculated margins (Fig. 17.9) and (iii) an area of distortion of the normal breast architecture

Figure 17.8. Mammographie appearances of microcalcification associated with malignancy.

(Fig. 17.10). These can be compared with the appearances of a breast cyst shown in Fig. 17.11. In some patients, axillary lymph nodes may also be visible, whilst in others thickening (oedema) and retraction of the skin of the breast can be seen. The sensitivity of mammography ranges from 75% to 90%, whilst its specificity varies from 70% to 85%.

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