Viewing a Mammogram

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Fig. 2.3. Distribution of breast cancer by location.
Fig. 2.4. To visualize possible ectopic glandular tissue (arrows), the mammogram should always include the low-axillary region.

with one method have difficulty adapting to different methods when they move to a new facility. Surgeons have similar difficulties, because when they review mammograms with radiologists, there are variations in the way in which individual radiologists position the films while discussing the case. Therefore, even though there is no single method that will suit all radiologists, one possible arrangement of mammograms is shown in Figure 2.5. In this position the oblique views are visualized in the same anatomic position in which chest, abdomen and extremity radiographs are visualized, as if the radiologist were facing the patient. The right and left mammograms are easily able to be compared for asymmetry. Each mammographic image can also be compared with prior studies.

If no old films are available to compare for asymmetries, the right breast is contrasted with the left, but fortunately, most patients today do have old films for comparison. Comparing each view with a previous study of the same breast is much more accurate than comparing the right to the left breast. The oldest mam-mogram of good quality is placed adjacent to the current studies. If the patient has had more than two studies, the most recent previous mammograms should also be compared with the current study. If the appearance of the breast has changed for any reason, whether from a biopsy, reduction or augmentation mammoplasty, or beginning estrogen replacement therapy, the first mammogram after the altering event becomes the new baseline ("oldest") study. In pinpointing the location of a mass on the study, the radiologist faces the patient and regards each breast as though it were the face of a clock: the location of the lesion corresponds to its "time" on this imaginary clock.

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