Radiologists perform mammography specifically to find evidence of abnormal mammograms, such as cancerous or benign (noncancerous) growths. Any abnormalities or changes over time are considered suspicious, at least at first, and require further testing with additional mammographic views or ultrasound.
Depending on your age, risk factors, and family history, you may be advised to have a unilateral diagnostic mammogram. This procedure will be a highly magnified, in-depth screening of a potential abnormality from different angles. If the unilateral diagnostic views confirm a suspicious growth, your diagnostic radiologist may next suggest an ultrasound or a biopsy for definitive tissue characterization.
Abnormal Calcifications on Mammograms
Abnormal calcifications or microcalcifications (small deposits of calcium) can signify breast cancer. Radiologists assess the size, shape, and number of calcifications to determine whether they are benign or cancerous. Small segmental, branching, clustered, or linear microcalcifications suggests breast cancer. These findings warrant more in-depth diagnostic mammography and/or sonography, typically followed by a breast biopsy.
Left breast spot magnification mammograms demonstrating abnormal variably-sized (pleomorphic) breast calcifications. This mammogram is coded as a BIRADS 4 (findings suspicious for malignancy - recommend biopsy). This was later biopsy-proven to be ductal carcinoma in situ (DCIS), which is frequently associated with breast cancer
Abnormal Mass on Mammograms
Masses or lumps are findings that require diagnostic workup to exclude abnormalities. If your radiologist finds a mass on your exam, s/he will assess its shape, density and margins to determine whether it is suspicious. Masses with irregular (“spiculated”) borders or sharp, star-like edges are concerning for breast cancer, especially if they are new since the most recent prior study. These abnormal mammogram findings warrant more in-depth diagnostic mammography and/or sonography, typically followed by a breast biopsy.
Left breast spot compression mammogram demonstrates a fan-shaped spiculated mass that is persistent despite application of pressure. This mammogram is coded as a BIRADS 5 (findings highly suspicious for malignancy - recommend biopsy). This lesion was later biopsy-proven to be an aggressive breast cancer (infiltrating ductal carcinoma)
Abnormal Breast Density on Mammograms
Fatty tissue appears black on a mammogram, while fibroglandular (normal breast gland and connective tissue) appears white. Radiologists carefully assess the amount and distribution of “white areas” on mammography because breast cancer also appears as white on the exam. If there is asymmetric dense/”white” tissue between both breasts, especially an area that has become more dense over time, you may be advised to have unilateral diagnostic views performed to better evaluate the region of increased density and to ensure that no potential breast cancer is being hidden by normal tissue. Any persistent density warrants more in-depth diagnostic mammography and/or sonography, which may be followed by a breast biopsy.
Bilateral craniocaudal (CC) view mammograms with abnormal asymmetric breast density with the right breast subareolar region that is much greater than the otherwise predominantly fatty tissue in both breasts. This density must be assessed by spot compression mammograms to ensure that it is not a persistent mass such as breast cancer (versus focal overlap of benign breast tissue)
Architectural distortion is an abnormal mammogram finding where no specific growth is found but there is an indentation, disruption, or thickening in the imaged breast tissue. This is especially notable if this appears within only one breast (unilaterally) and not the other. If there is no obvious reason for the distortion, such as a previous surgery, injury, or infection, you may be advised to have more in-depth diagnostic mammography and/or sonography that may be followed by a breast biopsy.
Bilateral mediolateral oblique (MLO) view mammograms demonstrating asymmetric subareolar right breast architectural distortion. The patient had undergone prior partial mastectomy for breast cancer as well as radiation treatment that produced focal fibroglandular element and skin thickening