Mammography - description of the procedure, indications and interpretation of mammogram results

Mammography: description of the procedure, indications, transcript

Mammography is a highly accurate type of diagnostics of breast diseases.
Thanks to the examination, doctors at the Zdorovye clinic identify pathological changes in the structure of the breast even in the early stages of development. Cancer, fibroadenomatosis, cysts or other pathologies are diagnosed in a similar way. Breast mammography is recommended for both diagnostic and preventive purposes. The procedure is recommended for annual use for all women over 40 years of age.

Differences between contrast mammography and other diagnostic methods

1. Unlike classical X-ray mammography, contrast mammography has a higher sensitivity (probability of detecting pathological changes) in detecting formations of small sizes and early stages, especially with a dense radiographic background (when there is a lot of glandular and/or fibrous tissue).
2. The combination of visualization of changes detected during conventional mammography and data on pathological accumulation of a contrast agent reduces the rate of false-positive (there was a formation, but due to the structural features of the mammary gland it was not detected) conclusions, which reduces the number of unnecessary additional examinations and unfounded biopsies.
3. The method is less expensive, faster to perform and interpret compared to breast MRI with comparable sensitivity and specificity.

The price of the study is indicated in the price list. Or you can check by calling our contact center.

Types of mammography

There are several methods of mammography. Among them:

1. Film. The results are recorded on x-ray film. This type has a number of disadvantages and is rarely used due to its low information content. Film mammography has a higher radiation dose than other types of examination. Finished photographs are issued in a single copy.
2. Digital. Has greater resolution. Thanks to digital mammography, it is possible to diagnose even minor changes in the structure of breast tissue.
3. Electrical impedance. The study is performed in 3D mode.

The preferred method is digital mammography. An image of the area being examined is shown on the computer screen. This allows you to adjust their resolution, clarity and contrast. Photos can be taken in several copies. The result is considered more informative. In addition, the radiation dose with the digital method is significantly lower compared to other types of examination.

At what age is a mammogram prescribed?

Despite the high information content of mammography, women under the age of 40 are recommended to carry out this diagnostic method only if a malignant nodule is suspected, since at an earlier age, due to the high density of the gland, its structure is poorly visualized in the images and the results will be uninformative.

If there was no need for mammography before the age of 40, it is recommended that every woman undergo it at this age in order to:

1. assess the nature of the mammary gland tissue,

2. have an idea of ​​their initial condition during follow-up and repeated mammographic examinations.

The practice of regular mammography has been introduced in a number of foreign countries, which significantly increases the detection rate of early breast cancer and reduces mortality from it.

What can be revealed

Mammography can diagnose the following changes:

• Cysts. Common type of change. A cyst is a neoplasm that is filled with fluid. It is not a sign of a malignant tumor.
• Fibroadenoma. A benign neoplasm that tends to grow rapidly. For fibroadenoma, surgical intervention is necessary.
• Calcifications. They are an accumulation of calcium salts. It is noteworthy that calcifications are not detected by palpation.
• Fibrocystic mastopathy. A commonly diagnosed change. Develops against the background of hormonal imbalance. Depending on the stage, drug or surgical treatment is suggested.
• Tumor. A malignant neoplasm characterized by uncontrolled and rapid growth. Tumor cells grow into nearby organs and tissues. When a tumor is detected, the need for surgical intervention is decided.

If any changes are detected, diagnostic doctors are ready to give recommendations on visiting specialized specialists.

Benefits of Mammography

The diagnostic method allows:

1. clearly identify the epithelial and connective tissue structures of the gland,
2. identify the presence of focal or diffuse pathology.
3. determine the type of mastopathy,
4. determine the extent of compaction spread,
5. identify areas of calcium deposits in the gland tissue.
6. determine the presence of a benign tumor in the mammary gland,
7. determine the presence of a malignant tumor and the degree of damage to the gland (including at the stage when the diameter of the cancer node does not exceed 1 cm).

Mammography also helps:

• assess the dynamics of fibrocystic disease,
• monitor the effectiveness of mastopathy treatment,
• predict a possible decrease or increase in the risk of breast cancer.

If there is a risk of breast cancer, it is assessed using scanning densitometry mammograms, which will allow:

• measure the density of the X-ray image (a decrease in the density of mammograms as a result of treatment of mastopathy or preventive measures indicates a decrease in the risk of breast cancer),
• objectively evaluate and characterize the dynamic processes occurring in pathological areas and surrounding tissues,
• carry out timely adjustments to treatment taking into account the identified changes.

Based on mammography data, the doctor sees the nature of changes in the mammary gland before and after treatment. Usually several studies are carried out at certain intervals, since radiation is harmful to the body. The doctor decides on their frequency. Additional procedures are prescribed if delay can cause serious complications.

When to do it

For preventive purposes, mammography of the mammary glands is recommended to be performed annually on all women over 40 years of age. This is due to changes in hormonal levels, which increases the risk of developing cancer. Women under 40 years of age should undergo testing if they have the following symptoms:

• pain in the mammary glands;
• pathological discharge from the nipples;
• the presence of compactions or nodules that are determined by palpation;
• change in shape;
• enlargement of nearby lymph nodes;
• examination before surgery;
• monitoring the condition during the rehabilitation period.

A referral for a mammogram can be given by a gynecologist, therapist or mammologist.

Contraindications

There are few contraindications to mammography. The main ones are:

• established or suspected pregnancy;
• lactation period;
• presence of breast implants;
• violation of the integrity of the skin of the mammary glands;
• nipple damage.

Doctors at the Zdorovye clinic are ready to give a detailed consultation, during which they will determine the presence or absence of contraindications to the examination. You can make an appointment for a consultation by phone.

Preparation

Having a mammogram requires some preparation. It is necessary to obtain the clearest and most revealing images.

The optimal option for undergoing the study is 5-10 days of the menstrual cycle. During this period, the mammary glands are in a calm state, not enlarged and not sensitive. Other preparatory recommendations include:

• Avoid taking products containing caffeine several days before the procedure. The restriction is due to the fact that caffeinated products can increase anxiety and increase breast sensitivity.
• Avoid using antiperspirants on the day of the examination. Substances contained in personal care products may be perceived as tissue calcification of the breast.
• Give preference to separate underwear. This will allow diagnostics to be carried out in more comfortable conditions.
• Remove all jewelry immediately before the diagnostic procedure.

Preparation, indications, contraindications for mammography

Indications for mammography

The World Health Organization recommends mammography for women 50 years of age and older (every two years), as well as women 35–40 years old if there is a family history of breast cancer or a mutation of the BRCA1 and BRCA2 genes. Women aged 40–49 years old undergo mammography once every two years, women aged 35–40 years old undergo one initial mammogram. If no pathology is detected, the next mammogram should be performed after 40 years. If a malignant tumor is suspected, the examination is carried out at any age.

How is a mammography examination performed?

During the study, a woman stands in front of a mammograph. The breast is placed between two plastic plates (an X-ray emitter and a detector). During the examination, the patient will feel some pressure on the breast as it is compressed by the mammograph.

A mammographic image is taken for each breast in two projections: straight and oblique. After a mammogram, the resulting images are described by a qualified radiologist.

Who examines mammography results?

A radiologist, a doctor who has special qualifications in performing and interpreting X-ray examinations, analyzes the resulting images and forms a report. Currently, mammography is the best tool for detecting breast cancer, but it does not detect all cases of breast cancer 100%. In addition, a small percentage of mammograms give an incorrect (false positive) result. If mammography reveals suspicious or questionable results that need clarification, the doctor may prescribe additional mammographic diagnostics (for example, targeted images, ductography, etc.), ultrasound, MRI, or recommend a control study. Subsequent examination will help assess the development of the pathological process over time.

Benefits and Risks

Taking images of the breast allows the doctor to detect even small tumors. In the early stages of cancer, treatment is very likely to be successful. Mammography is the only reliable way to detect such changes.

The use of X-rays has no side effects in conventional diagnostic procedures. The benefits of making an accurate diagnosis far outweigh the risk of x-ray exposure. The effective dose of radiation for this procedure is low. Modern X-ray systems are equipped with radiation control systems to minimize radiation.

If a tumor is detected in the mammary gland, a biopsy is performed to confirm the result.

Advantages of X-ray diagnostics for detecting breast tumors.

To date, there is no universal research and analysis with a 100% guarantee of detecting breast cancer. So far, substances characteristic only of tumor tissue and absent in healthy people have not been found either in tumor cells or in biological fluids of patients with malignant tumors. Therefore, the determination of tumor markers, which have become so widespread, is not a method of primary diagnosis of diseases.

Interpreting mammogram results can be challenging because normal breasts can look different in different women and at different ages. Not all breast cancers can be seen with mammography. In addition, a small percentage of mammograms give an incorrect (false positive) result. However, X-ray methods are the most informative for identifying breast pathology.

How to prepare for a mammogram

Mammography at the Mediscan clinic is performed by appointment. Before the study, you must inform your doctor about previous surgical interventions in the mammary glands.

You should not schedule a mammogram a week before the start of your period, since during this period the mammary glands tend to become more sensitive. If you are pregnant or suspect that you are pregnant, you must notify the radiologist.

Additional recommendations:

- Do not use deodorant, antiperspirant, talcum powder or lotion on the day of your mammogram. The axillary area should be clean and free of these and other personal hygiene products; - describe the symptoms or problems that were found in the mammary glands to the specialist who performs the mammography; - if you have the results of previous mammograms, provide them to your doctor or specialist who performs mammography; — check when the mammography results will be ready.

When is a mammogram performed?

It is recommended to carry out mammography at the beginning of the menstrual cycle from 5 to 12 days from its beginning. During this period of the cycle, the mammary glands are not tense, the study is less sensitive and more informative for the doctor.

Contraindications to mammography

There are no absolute contraindications for mammography. Relative contraindications include age under 35 years (since during this period the breast tissue is dense and mammography often does not give good results) and pregnancy.

FAQ

Many women are concerned about how a mammogram is done and what sensations accompany the procedure. The impact of the device is minimal, so there should be no unpleasant sensations. It is possible to develop discomfort during compression only if there is a formation in it or an inflammatory process occurs.

Patients are also concerned about the question of how to do mammography with small breast size. The effectiveness of mammography is not affected by the size of the mammary glands. Competent diagnosticians at the Zdorovye clinic install the plates in such a way that the procedure is carried out accurately and quickly.

Is the procedure dangerous? The medical facility has modern equipment that provides minimal radiation exposure. As a result, the benefits of performing the procedure significantly outweigh the risk of radiation exposure.

Decoding the results

Based on the results of the study, the doctor assesses the condition of the lymph nodes, ducts, vessels, and tissue structure. In accordance with the standards, conclusions after mammography are divided into 7 categories:

• Category 0. The diagnosis cannot be made due to the lack of necessary information. This requires repeated imaging.
• Category 1. There are no pathological changes in the structure of the mammary glands. This indicates that the woman is healthy. Category 1 – accepted norm.
• Category 2. A benign neoplasm is diagnosed. This could be a fibroadenoma, calcification, or an enlarged lymph node.
• Category 3. A benign formation has been diagnosed, which requires additional examination. In this case, the woman should be observed at the dispensary by a mammologist. Repeated images are taken after 6 months.
• Category 4. The description indicates identified seals of an unknown nature. The woman is advised to undergo a biopsy. In category 4, the following levels of risk of developing a malignant neoplasm will be distinguished: low (4A), intermediate (4B), moderate (4C).
• Category 5. Tumor formations have been diagnosed that are most likely malignant. A biopsy is done to confirm.
• Category 6: Previously confirmed cancer. The procedure is performed to monitor the course of the disease.

(Radiation diagnostic news 2001 1-2: 29-31)
Mammography in the complex diagnosis of breast cancer.

Ilkevich A. G.

Research Institute of Oncology and Medical Radiology named after. N.N.Alexandrova, Minsk.

At the Institute of Oncology and Medical Radiology named after. N.N. Alexandrova has used mammography for many years to diagnose breast tumors. However, due to technical reasons, the information content of the images taken on the TUR device was insufficient.

Currently, the institute uses a progressive technique for studying the mammary glands, which allows not only to identify a malignant disease at an early stage of its development, but also to morphologically verify the diagnosis, even if the pathological formation is not clinically determined.

Mammography is highly sensitive: the images can detect about 81-96% of all pathological changes. X-ray examination of the mammary glands is carried out in a special room on an X-ray installation - a mammograph "Mammomat - 3000" from Siemens, equipped with a tube with a molybdenum anode, as well as molybdenum and rhodium filters ( Fig. 1

). This combination ensures optimal radiation and obtaining the most informative image. The mammography room is also equipped with special cassettes with one intensifying screen of increased resolution and a special film coated on one side with photosensitive material. The process of photographic film processing is carried out in a developing machine.

Great attention is paid to the quality of image production, the entire technological process is strictly controlled - from the correct placement of the mammary gland, the choice of exposure mode to the operating parameters of the developing machine, which allows you to obtain high-quality images with minimal radiation exposure.

The radiographic appearance of the breast is extremely variable and multifaceted, with many symptoms present, most of which are not pathognomonic of cancer alone ( Fig. 2

). Direct X-ray signs of breast cancer are the presence of a shadow of the tumor itself and calcifications characteristic of a malignant disease.

The radiant shadow symptom is well known and its interpretation is usually not difficult. Most often, such a shadow reflects the infiltrative spread of a malignant tumor. Calcifications in breast cancer, on the contrary, reflect intraductal non-infiltrative growth of cancer cells, and therefore interpretation of the nature of calcifications is increasingly important.

We divide all calcifications detected on mammograms into macrocalcifications, larger than 0.5 mm, and microcalcifications, smaller than 0.5 mm. The former are more often observed in benign processes and do not present difficulties in assessment. The most difficult interpretation is microcalcifications. At the institute we use the modern classification of microcalcifications by M. Le Gal, according to which all microcalcifications are divided into 5 types ( Fig. 3

).

It is important to distinguish the types of microcalcifications on mammograms because the probability of detecting cancer in various calcifications ranges from 1% to 96% ( Fig. 4

).

Indirect symptoms of breast cancer include the following: 1. Fibrous reaction of the stroma - convergence of connective tissue bundles or disorganization of tissue architectonics. In the early stages of tumor development, the fibrous reaction of the stroma may be the only element that manifests the presence of initial cancer. 2. “Tent symptom” (tent symptom) – retraction of the edge of the glandular triangle. If this sign is present, it is necessary to supplement the study with tangential images to identify thickening and retraction of the skin. 3. Swelling of the breast tissue - may correspond to a violation of lymphatic drainage and a secondary inflammatory process, tumor infiltration with a fairly superficial location of the cancer node.

If, after performing a standard mammography, the diagnosis remains unclear or only symptoms suspicious of cancer are detected, additional methods of X-ray examination are used, in particular, targeted radiography with local compression of the mammary gland, radiography in an oblique projection. In a significant proportion of cases, these measures make it possible to clarify the true nature of the nosological process.

In unclear cases, cases of clinical and radiological discrepancy, with high radiodensity of the breast tissue, ultrasound examination of the breast is used, which is carried out using conventional ultrasound machines equipped with sensors with a signal frequency of 7.5 MHz or 10 MHz. In this case, it is possible to determine the structure (liquid or tissue) of the shadow revealed by radiography, in particular, to differentiate cysts and tumors, visualize intracystic growths, identify some X-ray negative focal formations and other changes in the structure of the mammary gland that are not visible on radiographs ( Fig. 5

). This method has positive qualities - the speed and simplicity of the examination technique, the ability to perform targeted thick- and fine-needle puncture biopsy under ultrasound control, which in some cases significantly simplifies the examination of the patient. However, the ultrasound diagnostic method has a number of disadvantages that do not allow it to be used as the only or primary research method, because approximately 30% of cancers are not detected by ultrasound.

If a suspicious shadow identified on a mammogram is not palpable and is not detected by ultrasound examination and, accordingly, the diagnosis cannot be verified morphologically by puncture under ultrasound guidance, a puncture biopsy is performed under X-ray control - the so-called stereotactic puncture biopsy.

The procedure is carried out on a special attachment to the mammograph. The study begins with targeted mammography of the same area of ​​the breast with a pathological shadow, at angles of + and - 10 degrees. Based on the displacement of the shadow of the formation relative to the center of rotation, the coordinates of the target location are calculated. Then, a puncture needle is inserted using special holders, its position is radiologically controlled, and a puncture biopsy is performed 4-5 times to obtain a column of tissue 1.5 mm thick and 2 cm long for histological examination.

Recently, due to the identification of an increasing number of suspicious shadows and accumulations of microcalcifications, it is necessary to more often perform interstitial preoperative markings under X-ray control. It is carried out on a regular mammograph using a compression board with holes and special needles containing metal harpoons. Methodologically, this is a fairly simple manipulation. First, an X-ray of the breast is taken in one of the projections. A needle is inserted into a deliberately greater depth through the pathological formation. A control photograph is taken at an angle of 90 degrees to the first one and the depth of needle insertion is adjusted based on it. If the needle is in satisfactory position, it is removed, leaving a harpoon in the mammary gland ( Fig. 6

). Marking is immediately followed by surgery to remove a section of breast tissue with a harpoon and subsequent pathological examination.

Based on the experience gained, the algorithm for examining patients was refined depending on the patient’s age, the nature of the pathology, the localization of changes, previous treatment and a number of other factors. Typically, in women over 35 years of age, after palpation of the mammary glands, mammography is first performed, supplemented, if necessary, with ultrasound. When examining women under 35 years of age. After the clinical examination, an ultrasound examination is performed. This is due to the high x-ray density of mammary gland tissue in women of this age and, as a result, the low information content of x-rays.

Which is better: ultrasound or mammography?

Indications are determined by the treating physician. Mammography of the mammary glands allows you to diagnose various diseases even at an early stage of development. Ultrasound diagnostics does not always allow early detection of initial changes. According to statistics, more than 80% of women prefer mammography, considering this method more informative and reliable. In some cases, your doctor may order both tests. As a result, this will improve the quality of diagnosis, which in turn is necessary for a correct conclusion.

You can get a mammogram at the Zdorovye multidisciplinary clinic. The center is equipped with modern medical equipment. It provides minimal radiation exposure, which makes the procedure safer. The results obtained are interpreted by qualified doctors with many years of experience in X-ray diagnostics. Registration for examination is carried out by telephone.

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What diseases does mammography detect?

The information content of the mammography method makes it possible to identify tumor-like formations of a benign or malignant nature in the early stages. Using a mammographic examination, tumors can be identified in more than 86% of cases. But the most important advantage of this method is the detection of cancer in the early stages in more than half of cases, when the mammologist is not able to detect the tumor by palpation, and the woman herself does not feel any changes. And yet, in 14% of cases, mammographic examination cannot detect signs of tumors, and then the mammologist prescribes additional research through pneumocystography or ductography.