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Understanding Breast TOPICS

BENIGN BREAST
Imaging ISSUES

BREAST IMAGING &

DIAGNOSIS

RISK, PREVENTION &

GENETICS

BREAST CANCER

MEN, WOMEN &

CHILDREN

BREAST SURGERY

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Following are explana ons of terms your physician may use when answers
discussing your breast imaging op ons and results: about breast
Screening imaging (screening mammograms)—Screening imaging issues:
consists of series of x-ray tests of the breast (tradi onally 2
mammogram views per breast) that are used to look for evidence of a  Benign Breast

Issues Privacy - Terms

breast cancer in women who are not having any symptoms of breast
cancer.  Breast Imaging

Diagnos c imaging—Diagnos c imaging consists of a series of

& Diagnosis
addi onal imaging tests that are done to be er evaluate a specific
problem that has been iden fied in a woman’s breast, such as:  Risk,

A palpable lump Preven on &

Bloody nipple discharge
A focal, persistent area of pain
Gene cs
An abnormality seen on screening imaging
 Breast Surgery
These tests typically include addi onal mammogram views,
ultrasound, and/or MRI. They are performed to help the radiologist
iden fy the problem and determine whether or not a biopsy is
 Breast Cancer

necessary. They are done at the discre on of the doctor ordering the
test and/or the radiologist. (www.acr.org)
 Latest News

BI-RADS® classifica on—Every me a woman gets an imaging test

of the breast, the radiologist will score it according to what is known
as the BI-RADS® classifica on system. This is a way for the Recent
radiologist and other physicians to communicate about what they are Ar cles
seeing on the imaging and whether or not addi onal workup or
biopsy is necessary.

BIRADS classifica ons range from 0 to 6:

BI-RADS® 0—Inconclusive (needs addi onal imaging)

BI-RADS® 1—Normal
How Breast Cancer
BI-RADS® 2—Benign finding(s) (such as a known cyst)
Pa ents Should Proceed
BI-RADS® 3—Probably benign (addi onal imaging in 6 months)
During the Coronavirus
BI-RADS® 4—Suspicious abnormality (biopsy should be
Pandemic
considered)
BI-RADS® 5—Highly sugges ve of malignancy (biopsy needed)
BI-RADS® 6—Biopsy-proven malignancy

Breast density—Breast ssue density described on mammograms

refers to the glandular ssue of the breast. The glandular ssue is
maintained by the hormones produced by the ovaries as a part of
menstrual cycles. Generally, younger women who have func onal Phyllodes Tumors of the

ovaries will have denser breast ssue than postmenopausal women. Breast
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That said, there is a lot of variability from one woman to the next.
Forty to forty-five percent of all women will be described as having
dense breast ssue on mammogram. Denser breast ssue makes it
more difficult for the radiologist to see abnormali es on
mammogram. In addi on, some newer studies suggest that women
who have dense breast ssue may be at a slightly higher risk for
developing breast cancer in the future (ACRIN 6666 Trial). Self-Care and Spiritual
Wellness for Cancer
View more on breast density (video presenta on by Dr. Kevin Pa ents
Hughes)

Digital mammograms—A digital mammogram is a two-dimensional x-

ray used to detect abnormali es in the breasts. Using these two
views, the radiologists are able to “reconstruct” a three-dimensional
view of the breast. Overall, mammograms are quite accurate in
detec ng breast cancers. They will iden fy 78% of breast cancers
present. This test is, however, significantly limited by how dense a
woman’s breast ssue is. The greater the density of the breast ssue, Is Thermography an
the more difficult it is for the radiologist to accurately interpret the Alterna ve to
mammogram and rule out the existence of a breast cancer. Mammograms?

Digital tomosynthesis—This newer technology has been developed

to minimize some of the limita ons of tradi onal two-dimensional
mammograms. It combines the tradi onal two views of a regular
mammogram with a second camera that sweeps in a 15-degree arc
(similar to the panoramic x-rays done at the den st) to “look around
the corner,” giving the radiologist a 3-dimensional view of the breast. What is Enhanced
Studies show that this technique is more accurate in differen a ng Recovery A er Surgery
dense breast ssue from breast cancers. It has resulted in a 30% (ERAS) for Mastectomy?
reduc on in the number of women who need to return for addi onal
mammograms and ultrasounds to determine what the radiologists
are seeing. This test is also one that can be used as an adjunct to 2-
dimensional mammograms for women with dense breast ssue.

Breast ultrasound—Breast ultrasound is an imaging test that uses

sound waves to look for abnormali es in the breast. Because it uses
sound waves, there is no radia on exposure. Tradi onally, this test
has been used in cases where a woman and/or her physician has felt
a lump in the breast or when an abnormality seen on mammogram
could be a mass. Therefore, this has been tradi onally used as a
diagnos c test and not a screening test.
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Screening breast ultrasound—Recently, as we have begun to explore
the significance of breast density, there has been an increased
interest in looking at ultrasound as a screening tool for the en re
breast. Several techniques have been developed. In one, an
ultrasound technician or a radiologist scans each breast in its
en rety. However, it is dependent on the experience and technique
of the person performing the test. It also is limited by the size of the
breast and the volume and depth of ssue that has to be evaluated.
More recently automated machines have been developed, providing
more uniformity of the test throughout various loca ons where it is
u lized. However, these automated ultrasound exams also results in
large volumes of images that must be reviewed and can take a
significant period of me to interpret.

Screening breast ultrasound has been suggested as an adjunct to

mammography in women with dense breast ssue. Studies have
shown that using this technique has the capability of detec ng more
abnormali es and cancers. This detec on, in turn, increases the
number of biopsies performed. However, upon biopsy many of these
abnormali es are found to be benign (non-cancerous). And of the
cancers detected by screening breast ultrasound alone, it is not
known whether these cancers would have developed into something
of significance or had a bearing on the pa ent’s outcome or life
expectancy.

Breast MRI—Breast MRI is a sophis cated test that u lizes a

combina on of magnets and intravenous dye to find evidence of
breast abnormali es. It looks for anatomic abnormali es (masses) and
blood flow abnormali es that have been shown to be characteris c
of breast cancers. The pros and cons of this test are as follows:

Pros—Studies show that breast MRI is more accurate than

mammography at detec ng invasive breast cancers and
aggressive forms of noninvasive breast cancer (with 91%–93%
accuracy). It has been shown to be a good screening tool for
women in high-risk groups (BRCA muta ons carriers, very
strong family history of breast and ovarian cancer, women with a
history of mantle radia on, and women with a calculated
life me risk of developing breast cancer at 20%–25% or more).
MRI should not replace the use of mammography in these Privacy - Terms
 women. The recommended screening pa ern should incorporate
mammography and MRI, each once per year, spaced 6 months
apart.

Cons—Studies show that breast MRI is not as good as

mammography for detec ng atypical lesions or lesser aggressive
noninvasive breast cancers. It is also known for false posi ves
(detec ng lesions that are not breast cancers but must be
biopsied to prove that). It is a much more expensive test, o en
cos ng thousands of dollars. Finally, it is also involves the use of
an intravenous Gadolinium dye.

Related Posts

Beneath the Surface: A Breast Cancer Screening

Guide to Breast Imaging 101

Screening Mammography
and MRI

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