In the course of a breast clinic, patients often come with their mammogram reports for consultation. Often, patients are very nervous to ask questions with the report, and they are even confused and frightened because they cannot read so much English. We would like to provide a little reference for science.
However, it is important to emphasize that the report must be shown to the doctor, and the radiology report is only for the doctor’s reference, the diagnosis and treatment should be based on the doctor’s opinion. It is difficult to get a comprehensive understanding of breast disease with just a mammogram report. Clinicians need to combine physical examination, medical history, ultrasound, etc. to get a comprehensive understanding of the overall situation of the breast.
I. Basic knowledge of mammography
The use of soft X-rays for projection imaging of breast tissue was commonly used in the past for direct film imaging, but is now rarely used. Now, due to the rapid development of digital imaging technology, breast mammography is basically digital imaging after film printing, and the image quality has made a qualitative leap. For example, the latest generation of digital mammography machines currently in use at our hospital have added many new features (such as stereotactic puncture), and the high definition of the mammograms they produce is unmatched by previous mammograms, which can detect breast nodules up to 0.2 cm in diameter.
Mammograms are different from ordinary X-rays. In general X-ray machines, the palladium side of the anode of the bulb is tungsten, which produces a wavelength of 0.008 – 0.031 nm, a short wavelength with strong penetrating power, and is a hard ray. The wavelength of molybdenum and palladium is 0.063—0.071nm, which is long and has weak penetrating power, and it is soft ray. It has high resolution to the fine density difference of soft tissue, and can obtain good breast image, and clearly show the gland, duct, fiber interval, skin, subcutaneous tissue, vascular structure, lesion lump and fine calcification of breast.
Second, the examination position and projection position is generally taken in the standing position.
Axial position and lateral oblique position are commonly used for projection direction, so it is usually taken four times. The following letters will be marked on the film: left breast, right breast, axial position, and lateral oblique position.
(MLO)
Third, grasp the general direction of the mammogram report
1. What is BI-RADS? (This is the most common abbreviation for mammography reports, and many people are not sure what it means)
In 1992, the American College of Radiology published the guiding document: Breast Imaging Reporting Data System. It standardizes the diagnostic reporting of all normal and abnormal imaging of the breast as a whole organ, using uniform terminology, standard diagnostic categorization and examination procedures, so that radiologists have rules to follow in their diagnoses, and also strengthens the coordination and tacit understanding between radiology and other relevant clinical departments, so that clinical treating physicians will know what to do next once they look at the radiologist’s report.
2.BI-RADS classification (not classification)
BI-RADS 0 category: need to combine with other examinations.
BI-RADS Category 1: Negative.
BI-RADS Category 2: benign.
BI-RADS category 3: benign possible, requiring short-term follow-up.
BI-RADS category 4: suspicious for malignancy, biopsy recommended.
4A: Low suspicion.
4B: Moderately suspicious.
4C: High but not certain.
BI-RADS Category 5: Highly malignant.
BI-RADS category 6: already pathologically confirmed malignant.
4. Approximate understanding of the description on the mammogram report (patients should not take the bull by the horns and leave the job of biting the words to the clinician)
Signs of breast cancer mammography include lumps, calcifications, peri-cancerous changes, nipple and skin changes, and so on. Generally, the images of the tumor itself (lump shadow and calcification) are called direct signs of breast cancer; the images of the secondary changes around the cancer are called indirect signs.
The direct signs of breast cancer on X-ray mainly include mass nodules and microcalcifications. Malignant masses are often irregular, with burrs on the edges and higher density than the surrounding glands. Microcalcifications are of great clinical importance in the early diagnosis of breast cancer. However, not all microcalcified foci on mammogram are malignant. Calcified spots in breast cancer usually appear as mucoid, clustered or distributed along ductal segments. If there are more than 15 tiny calcified spots per square meter, breast cancer is often considered.
V. Suggestions
In order to achieve early detection of breast cancer, regular mammograms are a proven method. Since women under 35 years of age have denser breast, mammography is not easy to detect the lesions; moreover, breast tissue is more sensitive to radiation damage at this time. Therefore, mammography is generally not suitable for women under the age of 35. For women over the age of 50, we recommend annual bilateral mammograms. For women with high risk factors for breast cancer, such as family history of breast cancer, previous history of breast cancer, benign tumors and biopsies, or before the age of 13 years for the first menstruation, after 30 years for the first full-term birth, or after 55 years for menopause, it is recommended that annual mammography should be started at the age of 40-49 years. Regular mammography can be combined with monthly self-examinations and regular clinical checkups.