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Breast
Lesion Imaging Characteristics
Additional Findings
One-View-Only Findings
One-View-Only Findings
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

                    1. 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
                    2. 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
                    3. Raj SD et al: Pseudoangiomatous stromal hyperplasia of the breast: multimodality review with pathologic correlation. Curr Probl Diagn Radiol. 46(2):130-5, 2017
                    4. Ratanaprasatporn L et al: Strengths and weaknesses of synthetic mammography in screening. Radiographics. 37(7):1913-27, 2017
                    5. 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
                    6. Price ER et al: The developing asymmetry: revisiting a perceptual and diagnostic challenge. Radiology. 274(3):642-51, 2015
                    7. Giess CS et al: Interpreting one-view mammographic findings: minimizing callbacks while maximizing cancer detection. Radiographics. 34(4):928-40, 2014
                    8. 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
                    9. Zuley ML et al: Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology. 266(1):89-95, 2013
                    10. Demirpolat G, Oktay A, Bilgen I, Isayev H. Mammographic features of the sternalis muscle. Diagn Interv Radiol. 2010 Dec; 16(4): 276-8.
                    11. Lopez JK et al: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 29(1):165-76, 2009
                    12. Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
                    13. 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
                    14. 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
                    15. 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
                    16. Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
                    17. Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
                    18. Butler RS et al: Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 172(2):325-30, 1999
                    19. 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
                    20. 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
                    21. Sickles EA: Findings at mammographic screening on only one standard projection: outcomes analysis. Radiology. 208(2):471-5, 1998
                    22. Goergen SK et al: Characteristics of breast carcinomas missed by screening radiologists. Radiology. 204(1):131-5, 1997
                    23. Bradley FM et al: The sternalis muscle: an unusual normal finding seen on mammography. AJR 166:33-6, 1996
                    24. 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
                    25. Brem RF et al: Template-guided breast US. Radiology. 184(3):872-4, 1992
                    26. Berkowitz JE et al: Equivocal mammographic findings: evaluation with spot compression. Radiology. 171(2):369-71, 1989
                    27. Sickles EA: Combining spot-compression and other special views to maximize mammographic information. Radiology. 173(2):571, 1989
                    28. Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988
                    29. Swann CA et al: Localization of occult breast lesions: practical solutions to problems of triangulation. Radiology. 163(2):577-9, 1987
                    Related Anatomy
                    Loading...
                    Related Differential Diagnoses
                    Loading...
                    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

                                      1. 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
                                      2. 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
                                      3. Raj SD et al: Pseudoangiomatous stromal hyperplasia of the breast: multimodality review with pathologic correlation. Curr Probl Diagn Radiol. 46(2):130-5, 2017
                                      4. Ratanaprasatporn L et al: Strengths and weaknesses of synthetic mammography in screening. Radiographics. 37(7):1913-27, 2017
                                      5. 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
                                      6. Price ER et al: The developing asymmetry: revisiting a perceptual and diagnostic challenge. Radiology. 274(3):642-51, 2015
                                      7. Giess CS et al: Interpreting one-view mammographic findings: minimizing callbacks while maximizing cancer detection. Radiographics. 34(4):928-40, 2014
                                      8. 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
                                      9. Zuley ML et al: Digital breast tomosynthesis versus supplemental diagnostic mammographic views for evaluation of noncalcified breast lesions. Radiology. 266(1):89-95, 2013
                                      10. Demirpolat G, Oktay A, Bilgen I, Isayev H. Mammographic features of the sternalis muscle. Diagn Interv Radiol. 2010 Dec; 16(4): 276-8.
                                      11. Lopez JK et al: Invasive lobular carcinoma of the breast: spectrum of mammographic, US, and MR imaging findings. Radiographics. 29(1):165-76, 2009
                                      12. Venkatesan A et al: Positive predictive value of specific mammographic findings according to reader and patient variables. Radiology. 250(3):648-57, 2009
                                      13. 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
                                      14. 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
                                      15. 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
                                      16. Shetty MK et al: Sonographic evaluation of focal asymmetric density of the breast. Ultrasound Q. 18(2):115-21, 2002
                                      17. Brenner RJ: Asymmetric densities of the breast: strategies for imaging evaluation. Semin Roentgenol. 36(3):201-16, 2001
                                      18. Butler RS et al: Sonographic evaluation of infiltrating lobular carcinoma. AJR Am J Roentgenol. 172(2):325-30, 1999
                                      19. 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
                                      20. 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
                                      21. Sickles EA: Findings at mammographic screening on only one standard projection: outcomes analysis. Radiology. 208(2):471-5, 1998
                                      22. Goergen SK et al: Characteristics of breast carcinomas missed by screening radiologists. Radiology. 204(1):131-5, 1997
                                      23. Bradley FM et al: The sternalis muscle: an unusual normal finding seen on mammography. AJR 166:33-6, 1996
                                      24. 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
                                      25. Brem RF et al: Template-guided breast US. Radiology. 184(3):872-4, 1992
                                      26. Berkowitz JE et al: Equivocal mammographic findings: evaluation with spot compression. Radiology. 171(2):369-71, 1989
                                      27. Sickles EA: Combining spot-compression and other special views to maximize mammographic information. Radiology. 173(2):571, 1989
                                      28. Sickles EA: Practical solutions to common mammographic problems: tailoring the examination. AJR Am J Roentgenol. 151(1):31-9, 1988
                                      29. 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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