Diagnostic Imaging Pathways - Breast Symptom (New)
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This pathway provides guidance on the imaging of adult female patients presenting with new breast symptoms.
Date reviewed: January 2012
Date of next review: January 2015
Published: January 2012
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The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
|SYMBOL||RRL||EFFECTIVE DOSE RANGE|
|Minimal||< 1 millisieverts|
- Imaging of a new breast symptom is dependant on the age of the woman and whether she is currently preganant or lactating
- Young (<35), pregant and lactacting females should have a breast ultrasound
- For women over 35, depending on further clinical symptoms a Mammogram and/or a breast ultrasound may be the initial imaging modalities of choice
- Standard mammography involves two views: cranio-caudal and medio-lateral oblique
- The diagnostic accuracy of mammography is enhanced through the use of magnification views (magnified, coned compression views), which visualise only a small area of breast tissue but gives better contrast resolution and spatial detail
- Abnormalities on mammography are generally categorised as
- Mass lesions
- Asymmetric densities
- Architectural disturbances
- A combination of these
- Although it is an excellent tool for evaluating breast lesions, mammography does have an inherent false-negative rate
- Mammography is not as sensitive in detecting abnormal lesions in dense breast tissue and for this reason, ultrasound is preferred over mammography in women younger than 35
- The radiation exposure and hence risk of malignancy secondary to mammography is believed to be extremely low
Imaging a New Breast Symptom
- Is an important diagnostic tool in the evaluation of breast lesions
- Often used complementary to mammography but may be the initial and only imaging modality required for women younger than 35
- Is the preferred initial imaging modality in pregnant and lactating women
- Situations where ultrasound is useful include
- For evaluating palpable masses not seen on mammography
- For further evaluation of indeterminate lesions seen on mammography
- For detection of any underlying mass or altered architecture associated with calcification or asymmetric densities seen on mammography
- For implant evaluation
- For guidance of percutaneous biopsy
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Breast imaging: a guide for practice. National Breast Cancer Centre, 2002. (Review article)
- Echlund GW. The art of mammographic positioning, in radiological diagnosis of breast diseases. Berlin: Springer, 1997
- Faulk RM, Sickles EA. Efficacy of spot compression-magnification and tangential views in mammographic evaluation of palpable breast masses. Radiology. 1992;185:87-90. (Level III evidence)
- Feig SA. The importance of supplementary mammographic views to diagnostic accuracy. AJR Am J Roentgenol. 1988;151:40-1. (Review article)
- Berkowitz JE, Gatewood OM, Gayler BW. Equivocal mammographic findings: evaluation with spot compression. Radiology. 1989;171:369-71. (Level IV evidence)
- Foxcroft LM, Evans EB, Joshua HK, Hirst C. Breast cancers invisible on mammography. Aust N Z J Surg. 2000;70:162-7. (Level III evidence)
- Feig SA, Hendrick RE. Radiation risk from screening mammography of women aged 40-49 years. J Natl Cancer Inst Monogr. 1997;22:119-24. (Review article)
- NHMRC National Breast Cancer Centre. The investigation of a new breast symptom: a guide for general practitioners. Woolloomooloo (NSW): NHMRC National Breast Cancer Centre, 1997. (Evidence based guideline)
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