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Asymmetries
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

                                      1. Giess CS et al: Ultrasound features of mammographic developing asymmetries and correlation with histopathologic findings. AJR Am J Roentgenol. 210(1):W29-W38, 2018
                                      2. Chesebro AL et al: Developing asymmetry at mammography: Correlation with US and MR imaging and histopathologic findings. Radiology. 279(2):385-94, 2016
                                      3. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography, 5th ed. Reston, American College of Radiology, 2013
                                      4. Lourenco AP et al: Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. 274(2):337-42, 2015
                                      5. Tagliafico A et al: One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol. 22(3):539-44, 2012
                                      6. Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
                                      7. Youk JH et al: Asymmetric mammographic findings based on the fourth edition of BI-RADS: types, evaluation, and management. Radiographics. 29(1):e33, 2009
                                      8. 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
                                      9. Sickles EA: The spectrum of breast asymmetries: imaging features, work-up, management. Radiol Clin North Am. 45:765-71, 2007
                                      10. Gozzi G et al: Screening mammography interpretation test: more frequent mistakes. Radiol Med (Torino). 109(3):268-79, 2005
                                      11. Shah NR et al: Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis. Menopause. 12(6):668-78, 2005
                                      12. Samardar P et al: Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 22(1):19-33, 2002
                                      13. Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
                                      14. Varas X et al: Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 179:691-5, 2002
                                      15. Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
                                      16. Cheung KL et al: Palpable asymmetrical thickening of the breast: a clinical, radiological and pathological study. Br J Radiol. 74(881):402-6, 2001
                                      17. Colacurci N et al: Effects of different types of hormone replacement therapy on mammographic density. Maturitas. 40(2):159-64, 2001
                                      18. 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
                                      19. Vizcaino I et al: Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 219:475-83, 2001
                                      20. Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
                                      21. 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
                                      22. 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
                                      23. 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
                                      24. Sickles EA: Findings at mammographic screening on only one standard projection: outcomes analysis. Radiology. 208(2):471-5, 1998
                                      25. DiPiro PJ et al: Seat belt injuries of the breast: findings on mammography and sonography. AJR Am J Roentgenol. 164(2):317-20, 1995
                                      26. Cyrlak D et al: Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. AJR Am J Roentgenol. 161(6):1177-83, 1993
                                      27. 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
                                      28. Mendelson EB: Evaluation of the postoperative breast. Radiol Clin North Am. 30(1):107-38, 1992
                                      29. Helvie MA et al: Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield. Radiology. 178:155-8, 1991
                                      30. Sickles EA: Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 179:463-8, 1991
                                      31. Kopans DB et al: Asymmetric breast tissue. Radiology. 171:639-43, 1989
                                      32. Mendelson EB et al: Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation. AJR Am J Roentgenol. 153(2):265-71, 1989
                                      33. 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

                                                                          1. Giess CS et al: Ultrasound features of mammographic developing asymmetries and correlation with histopathologic findings. AJR Am J Roentgenol. 210(1):W29-W38, 2018
                                                                          2. Chesebro AL et al: Developing asymmetry at mammography: Correlation with US and MR imaging and histopathologic findings. Radiology. 279(2):385-94, 2016
                                                                          3. Sickles EA et al: Breast Imaging Reporting and Data System: BI-RADS, Mammography, 5th ed. Reston, American College of Radiology, 2013
                                                                          4. Lourenco AP et al: Changes in recall type and patient treatment following implementation of screening digital breast tomosynthesis. Radiology. 274(2):337-42, 2015
                                                                          5. Tagliafico A et al: One-to-one comparison between digital spot compression view and digital breast tomosynthesis. Eur Radiol. 22(3):539-44, 2012
                                                                          6. Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
                                                                          7. Youk JH et al: Asymmetric mammographic findings based on the fourth edition of BI-RADS: types, evaluation, and management. Radiographics. 29(1):e33, 2009
                                                                          8. 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
                                                                          9. Sickles EA: The spectrum of breast asymmetries: imaging features, work-up, management. Radiol Clin North Am. 45:765-71, 2007
                                                                          10. Gozzi G et al: Screening mammography interpretation test: more frequent mistakes. Radiol Med (Torino). 109(3):268-79, 2005
                                                                          11. Shah NR et al: Postmenopausal hormone therapy and breast cancer: a systematic review and meta-analysis. Menopause. 12(6):668-78, 2005
                                                                          12. Samardar P et al: Focal asymmetric densities seen at mammography: US and pathologic correlation. Radiographics. 22(1):19-33, 2002
                                                                          13. Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
                                                                          14. Varas X et al: Revisiting the mammographic follow-up of BI-RADS category 3 lesions. AJR Am J Roentgenol. 179:691-5, 2002
                                                                          15. Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
                                                                          16. Cheung KL et al: Palpable asymmetrical thickening of the breast: a clinical, radiological and pathological study. Br J Radiol. 74(881):402-6, 2001
                                                                          17. Colacurci N et al: Effects of different types of hormone replacement therapy on mammographic density. Maturitas. 40(2):159-64, 2001
                                                                          18. 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
                                                                          19. Vizcaino I et al: Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology. 219:475-83, 2001
                                                                          20. Kushwaha AC et al: Primary inflammatory carcinoma of the breast: retrospective review of mammographic findings. AJR Am J Roentgenol. 174(2):535-8, 2000
                                                                          21. 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
                                                                          22. 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
                                                                          23. 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
                                                                          24. Sickles EA: Findings at mammographic screening on only one standard projection: outcomes analysis. Radiology. 208(2):471-5, 1998
                                                                          25. DiPiro PJ et al: Seat belt injuries of the breast: findings on mammography and sonography. AJR Am J Roentgenol. 164(2):317-20, 1995
                                                                          26. Cyrlak D et al: Mammographic changes in postmenopausal women undergoing hormonal replacement therapy. AJR Am J Roentgenol. 161(6):1177-83, 1993
                                                                          27. 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
                                                                          28. Mendelson EB: Evaluation of the postoperative breast. Radiol Clin North Am. 30(1):107-38, 1992
                                                                          29. Helvie MA et al: Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield. Radiology. 178:155-8, 1991
                                                                          30. Sickles EA: Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases. Radiology. 179:463-8, 1991
                                                                          31. Kopans DB et al: Asymmetric breast tissue. Radiology. 171:639-43, 1989
                                                                          32. Mendelson EB et al: Infiltrating lobular carcinoma: mammographic patterns with pathologic correlation. AJR Am J Roentgenol. 153(2):265-71, 1989
                                                                          33. Adler DD et al: Accessory breast tissue in the axilla: mammographic appearance. Radiology. 163(3):709-11, 1987