Fig. 2.2. (a) Schematic lateral view of female breast. (b) A mediolateral-oblique (MLO) projection of the breast demonstrating anatomic structures: (A) pectoralis muscle, (B) nipple, (C) adipose tissue, (D) glandular tissue, (E) blood vessel, (F) lymph nodes, (G) Cooper's ligaments, (H) latissimus dorsi muscle.
Breast cancer arises in the glandular tissue. Obviously, then, mammography's goal should be to image the glandular tissue with as much contrast and detail as possible within the limitations of acceptably low radiation exposure. The distribution of breast cancer is approximately proportional to the amount of glandular tissue in each quadrant of the breast (Figure 2.3). Nearly half of the breasts total glandular tissue is in the upper outer quadrant and 45 percent of all breast cancers develop in that same upper outer quadrant. Choosing the views that best delineate the glandular tissue of the breast is crucial to good mammography. Performing extra views, whenever necessary, is an indispensable part of a complete mammographic study.
Ectopic (misplaced) glandular tissue commonly develops in the low axillary region (Figure 2.4). On physical examination, this area may feel firm, finely nodular, or grainy. Frequently, one side contains more ectopic tissue than the other. The mammogram should always include the low-axillary region, because on rare occasions, ectopic tissue in this area may be harboring a cancer.
There is no consensus regarding the optimal method to position the mammogram on the viewbox for interpretation. This lack of consensus is unfortunate because radiologists who become familiar
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