Monitoring Guidelines

Breast Imaging

Mammography

non-palpable lesions

palpable lesions

Mammography is the only imaging tool acceptable for screening. Screening is the process of evaluating healthy people with no symptoms to detect early signs of disease. The purpose of a screening or baseline mammogram is to establish a record of healthy breast tissue appearance against which later changes in breast tissue can be compared.

Mammography is also used for diagnostic imaging when the woman has a symptom or an abnormal physical examination of the breast. The mammogram can detect tiny, nonpalpable or pre-clinical abnormalities, both benign and malignant.

When tumors are palpable (usually greater than 1 x 1 centimeter), mammograms are useful in characterizing the lesion and detecting unsuspected, nonpalpable changes in the same breast or in the opposite breast. Women who have a history of radiation therapy to the breast or who have breast implants need special attention to mammographic technique to maximize accuracy in monitoring.

Because a palpable lesion may not always be visible on mammography (even if it is large), it is important that a qualified health professional evaluate any visual, palpable or mammographic finding in the context of the entire clinical situation. Some findings warrant clinical follow-up; some, fine-needle aspiration; and some, surgical biopsy. A dominant nodule not visible on mammogram mandates follow-up, possibly with needle aspiration or biopsy.

What Happens When a Lump is Found or an Abnormal Mammogram Report Occurs? (Diagnostic Alternatives)

Ultrasound

Ultrasound is an imaging method that uses sonography or "sound waves" to detect changes in breast tissue. It is not effective as a screening tool but it is a useful adjunct to mammography. Ultrasound is used to determine if a mass detected by palpation or mammography is solid or cystic (containing fluid). Cystic lesions are usually benign and do not require biopsy. Ultrasound is also useful in localizing a nonpalpable lesion for biopsy and sometimes reveals rupture of an implant despite a normal mammogram.

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging (MRI) is a sophisticated method of imaging the breast without radiation. It is not used as a screening tool and its diagnostic usefulness is being evaluated. MRI may prove valuable as a secondary test to evaluate abnormalities detected by mammography, ultrasound or palpation. Currently, it is used most often to rule out implant rupture and is rarely used as a means of breast cancer screening.