Ethan O. Cohen, MD; Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Laterally exaggerated CC view (XCCL)
Medially exaggerated CC view (XCCM)
CC view with top of breast rolled medially (CCRM)
CC view with top of breast rolled laterally (CCRL)
Definitions
Mammographic finding seen only on either CC or MLO projection
Most common one-view findings
Asymmetry, usually summation of normal tissue
Ca⁺⁺, usually dermal
Architectural distortion
Developing asymmetry: New or enlarging focal asymmetry
7-13% malignant at screening
Masses or Ca⁺⁺ seen on only one view possibly due to location: Axillary tail, upper posteromedial, inframammary fold
Step obliques: Images obtained in gradually increasing obliquity (e.g., 15°, 30°) for lesion seen only on CC view
Posterior nipple line: Measurement from nipple perpendicular to anterior aspect of pectoralis muscle on MLO or posterior aspect of CC image
Compare measurements: If > 1 cm shorter on CC view, then technical repeat CC or as XCCL indicated for posterior tissues
IMAGING
General Anatomic Considerations
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Cohen EO et al: Screening mammography findings from one standard projection only in the era of full-field digital mammography and digital breast tomosynthesis. AJR Am J Roentgenol. 211(2):445-51, 2018
Cohen E et al: Problem-solving MR imaging for equivocal imaging findings and indeterminate clinical symptoms of the breast. Magn Reson Imaging Clin N Am. 26(2):221-33, 2018
Raj SD et al: Pseudoangiomatous stromal hyperplasia of the breast: multimodality review with pathologic correlation. Curr Probl Diagn Radiol. 46(2):130-5, 2017
Ratanaprasatporn L et al: Strengths and weaknesses of synthetic mammography in screening. Radiographics. 37(7):1913-27, 2017
Korhonen KE et al: Strategies to increase cancer detection: review of true-positive and false-negative results at digital breast tomosynthesis screening. Radiographics. 36(7):1954-65, 2016
Price ER et al: The developing asymmetry: revisiting a perceptual and diagnostic challenge. Radiology. 274(3):642-51, 2015
Giess CS et al: Interpreting one-view mammographic findings: minimizing callbacks while maximizing cancer detection. Radiographics. 34(4):928-40, 2014
Gennaro G et al: Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol. 23(8):2087-94, 2013
Zuley ML et al: Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology. 266(1):89-95, 2013
Demirpolat G, Oktay A, Bilgen I, Isayev H. Mammographic features of the sternalis muscle. Diagn Interv Radiol. 2010 Dec; 16(4): 276-8.
Lopez JK et al: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 29(1):165-76, 2009
Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 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
Ikeda DM et al: Computer-aided detection output on 172 subtle findings on normal mammograms previously obtained in women with breast cancer detected at follow-up screening mammography. Radiology. 230(3):811-9, 2004
Ikeda DM et al: Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening. Radiology. 226(2):494-503, 2003
Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
Butler RS et al: Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 172(2):325-30, 1999
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
Goergen SK et al: Characteristics of breast carcinomas missed by screening radiologists. Radiology. 204(1):131-5, 1997
Bradley FM et al: The sternalis muscle: an unusual normal finding seen on mammography. AJR 166:33-6, 1996
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
Brem RF et al: Template-guided breast US. Radiology. 184(3):872-4, 1992
Berkowitz JE et al: Equivocal mammographic findings: evaluation with spot compression. Radiology. 171(2):369-71, 1989
Sickles EA: Combining spot-compression and other special views to maximize mammographic information. Radiology. 173(2):571, 1989
Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988
Swann CA et al: Localization of occult breast lesions: practical solutions to problems of triangulation. Radiology. 163(2):577-9, 1987
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Laterally exaggerated CC view (XCCL)
Medially exaggerated CC view (XCCM)
CC view with top of breast rolled medially (CCRM)
CC view with top of breast rolled laterally (CCRL)
Definitions
Mammographic finding seen only on either CC or MLO projection
Most common one-view findings
Asymmetry, usually summation of normal tissue
Ca⁺⁺, usually dermal
Architectural distortion
Developing asymmetry: New or enlarging focal asymmetry
7-13% malignant at screening
Masses or Ca⁺⁺ seen on only one view possibly due to location: Axillary tail, upper posteromedial, inframammary fold
Step obliques: Images obtained in gradually increasing obliquity (e.g., 15°, 30°) for lesion seen only on CC view
Posterior nipple line: Measurement from nipple perpendicular to anterior aspect of pectoralis muscle on MLO or posterior aspect of CC image
Compare measurements: If > 1 cm shorter on CC view, then technical repeat CC or as XCCL indicated for posterior tissues
IMAGING
General Anatomic Considerations
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Cohen EO et al: Screening mammography findings from one standard projection only in the era of full-field digital mammography and digital breast tomosynthesis. AJR Am J Roentgenol. 211(2):445-51, 2018
Cohen E et al: Problem-solving MR imaging for equivocal imaging findings and indeterminate clinical symptoms of the breast. Magn Reson Imaging Clin N Am. 26(2):221-33, 2018
Raj SD et al: Pseudoangiomatous stromal hyperplasia of the breast: multimodality review with pathologic correlation. Curr Probl Diagn Radiol. 46(2):130-5, 2017
Ratanaprasatporn L et al: Strengths and weaknesses of synthetic mammography in screening. Radiographics. 37(7):1913-27, 2017
Korhonen KE et al: Strategies to increase cancer detection: review of true-positive and false-negative results at digital breast tomosynthesis screening. Radiographics. 36(7):1954-65, 2016
Price ER et al: The developing asymmetry: revisiting a perceptual and diagnostic challenge. Radiology. 274(3):642-51, 2015
Giess CS et al: Interpreting one-view mammographic findings: minimizing callbacks while maximizing cancer detection. Radiographics. 34(4):928-40, 2014
Gennaro G et al: Combination of one-view digital breast tomosynthesis with one-view digital mammography versus standard two-view digital mammography: per lesion analysis. Eur Radiol. 23(8):2087-94, 2013
Zuley ML et al: Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology. 266(1):89-95, 2013
Demirpolat G, Oktay A, Bilgen I, Isayev H. Mammographic features of the sternalis muscle. Diagn Interv Radiol. 2010 Dec; 16(4): 276-8.
Lopez JK et al: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 29(1):165-76, 2009
Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 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
Ikeda DM et al: Computer-aided detection output on 172 subtle findings on normal mammograms previously obtained in women with breast cancer detected at follow-up screening mammography. Radiology. 230(3):811-9, 2004
Ikeda DM et al: Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening. Radiology. 226(2):494-503, 2003
Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
Butler RS et al: Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 172(2):325-30, 1999
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
Goergen SK et al: Characteristics of breast carcinomas missed by screening radiologists. Radiology. 204(1):131-5, 1997
Bradley FM et al: The sternalis muscle: an unusual normal finding seen on mammography. AJR 166:33-6, 1996
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
Brem RF et al: Template-guided breast US. Radiology. 184(3):872-4, 1992
Berkowitz JE et al: Equivocal mammographic findings: evaluation with spot compression. Radiology. 171(2):369-71, 1989
Sickles EA: Combining spot-compression and other special views to maximize mammographic information. Radiology. 173(2):571, 1989
Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988
Swann CA et al: Localization of occult breast lesions: practical solutions to problems of triangulation. Radiology. 163(2):577-9, 1987
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