Nicole S. Winkler, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Asymmetry: Area of asymmetric fibroglandular tissue density seen on only 1 mammographic view
Usually due to overlapping normal tissue (summation artifact)
Expected to have been included in both projections (i.e., not excluded due to posterior or far lateral location)
Focal asymmetry: Small collection of fibroglandular tissue density that is asymmetric from same location in contralateral breast with similar shape on 2 views involving < 1 quadrant
Lacks convex borders, conspicuity, and 3-dimensionality of mass
May be found to be mass on diagnostic work-up
Global asymmetry: Large area of fibroglandular tissue density involving ≥ 1 quadrant that is asymmetric from same location in contralateral breast
Usually represents normal variant
Developing asymmetry: Focal asymmetry that is new, larger, or more conspicuous compared to previous imaging studies
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Giess CS et al: Ultrasound features of mammographic developing asymmetries and correlation with histopathologic findings. AJR Am J Roentgenol. 210(1):W29-W38, 2018
Chesebro AL et al: Developing asymmetry at mammography: Correlation with US and MR imaging and histopathologic findings. Radiology. 279(2):385-94, 2016
Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography, 5th ed. Reston, American College of Radiology, 2013
Lourenco AP et al: Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. 274(2):337-42, 2015
Tagliafico A et al: One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol. 22(3):539-44, 2012
Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
Youk JH et al: Asymmetric mammographic findings based on the fourth edition of BI-RADS: types, evaluation, and management. Radiographics. 29(1):e33, 2009
Leung JW et al: Developing asymmetry identified on mammography: correlation with imaging outcome and pathologic findings. AJR Am J Roentgenol. 188(3):667-75, 2007
Sickles EA: The spectrum of breast asymmetries: imaging features, work-up, management. Radiol Clin North Am. 45:765-71, 2007
Gozzi G et al: Screening mammography interpretation test: more frequent mistakes. Radiol Med (Torino). 109(3):268-79, 2005
Shah NR et al: Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis. Menopause. 12(6):668-78, 2005
Samardar P et al: Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 22(1):19-33, 2002
Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
Varas X et al: Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 179:691-5, 2002
Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
Cheung KL et al: Palpable asymmetrical thickening of the breast: a clinical, radiological and pathological study. Br J Radiol. 74(881):402-6, 2001
Colacurci N et al: Effects of different types of hormone replacement therapy on mammographic density. Maturitas. 40(2):159-64, 2001
Rutter CM et al: Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA. 285(2):171-6, 2001
Vizcaino I et al: Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 219:475-83, 2001
Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
Pearson KL et al: Efficacy of step-oblique mammography for confirmation and localization of densities seen on only one standard mammographic view. AJR Am J Roentgenol. 174(3):745-52, 2000
Hussain HK et al: The significance of new densities and microcalcification in the second round of breast screening. Clin Radiol. 54(4):243-7, 1999
Lee CH et al: Clinical usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. AJR Am J Roentgenol. 173(5):1323-9, 1999
Sickles EA: Findings at mammographic screening on only one standard projection: outcomes analysis. Radiology. 208(2):471-5, 1998
DiPiro PJ et al: Seat belt injuries of the breast: findings on mammography and sonography. AJR Am J Roentgenol. 164(2):317-20, 1995
Cyrlak D et al: Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. AJR Am J Roentgenol. 161(6):1177-83, 1993
Harvey JA et al: Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award. AJR Am J Roentgenol. 161(6):1167-72, 1993
Mendelson EB: Evaluation of the postoperative breast. Radiol Clin North Am. 30(1):107-38, 1992
Helvie MA et al: Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield. Radiology. 178:155-8, 1991
Sickles EA: Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 179:463-8, 1991
Kopans DB et al: Asymmetric breast tissue. Radiology. 171:639-43, 1989
Mendelson EB et al: Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation. AJR Am J Roentgenol. 153(2):265-71, 1989
Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163(3):709-11, 1987
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Asymmetry: Area of asymmetric fibroglandular tissue density seen on only 1 mammographic view
Usually due to overlapping normal tissue (summation artifact)
Expected to have been included in both projections (i.e., not excluded due to posterior or far lateral location)
Focal asymmetry: Small collection of fibroglandular tissue density that is asymmetric from same location in contralateral breast with similar shape on 2 views involving < 1 quadrant
Lacks convex borders, conspicuity, and 3-dimensionality of mass
May be found to be mass on diagnostic work-up
Global asymmetry: Large area of fibroglandular tissue density involving ≥ 1 quadrant that is asymmetric from same location in contralateral breast
Usually represents normal variant
Developing asymmetry: Focal asymmetry that is new, larger, or more conspicuous compared to previous imaging studies
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
Image-Guided Biopsy
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Giess CS et al: Ultrasound features of mammographic developing asymmetries and correlation with histopathologic findings. AJR Am J Roentgenol. 210(1):W29-W38, 2018
Chesebro AL et al: Developing asymmetry at mammography: Correlation with US and MR imaging and histopathologic findings. Radiology. 279(2):385-94, 2016
Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography, 5th ed. Reston, American College of Radiology, 2013
Lourenco AP et al: Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. 274(2):337-42, 2015
Tagliafico A et al: One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol. 22(3):539-44, 2012
Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
Youk JH et al: Asymmetric mammographic findings based on the fourth edition of BI-RADS: types, evaluation, and management. Radiographics. 29(1):e33, 2009
Leung JW et al: Developing asymmetry identified on mammography: correlation with imaging outcome and pathologic findings. AJR Am J Roentgenol. 188(3):667-75, 2007
Sickles EA: The spectrum of breast asymmetries: imaging features, work-up, management. Radiol Clin North Am. 45:765-71, 2007
Gozzi G et al: Screening mammography interpretation test: more frequent mistakes. Radiol Med (Torino). 109(3):268-79, 2005
Shah NR et al: Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis. Menopause. 12(6):668-78, 2005
Samardar P et al: Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 22(1):19-33, 2002
Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
Varas X et al: Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 179:691-5, 2002
Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
Cheung KL et al: Palpable asymmetrical thickening of the breast: a clinical, radiological and pathological study. Br J Radiol. 74(881):402-6, 2001
Colacurci N et al: Effects of different types of hormone replacement therapy on mammographic density. Maturitas. 40(2):159-64, 2001
Rutter CM et al: Changes in breast density associated with initiation, discontinuation, and continuing use of hormone replacement therapy. JAMA. 285(2):171-6, 2001
Vizcaino I et al: Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 219:475-83, 2001
Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
Pearson KL et al: Efficacy of step-oblique mammography for confirmation and localization of densities seen on only one standard mammographic view. AJR Am J Roentgenol. 174(3):745-52, 2000
Hussain HK et al: The significance of new densities and microcalcification in the second round of breast screening. Clin Radiol. 54(4):243-7, 1999
Lee CH et al: Clinical usefulness of MR imaging of the breast in the evaluation of the problematic mammogram. AJR Am J Roentgenol. 173(5):1323-9, 1999
Sickles EA: Findings at mammographic screening on only one standard projection: outcomes analysis. Radiology. 208(2):471-5, 1998
DiPiro PJ et al: Seat belt injuries of the breast: findings on mammography and sonography. AJR Am J Roentgenol. 164(2):317-20, 1995
Cyrlak D et al: Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. AJR Am J Roentgenol. 161(6):1177-83, 1993
Harvey JA et al: Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award. AJR Am J Roentgenol. 161(6):1167-72, 1993
Mendelson EB: Evaluation of the postoperative breast. Radiol Clin North Am. 30(1):107-38, 1992
Helvie MA et al: Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield. Radiology. 178:155-8, 1991
Sickles EA: Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 179:463-8, 1991
Kopans DB et al: Asymmetric breast tissue. Radiology. 171:639-43, 1989
Mendelson EB et al: Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation. AJR Am J Roentgenol. 153(2):265-71, 1989
Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163(3):709-11, 1987
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