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Breast Positioning during Mammography: Mistakes to be Avoided.

Popli MB, Teotia R, Narang M, Krishna H - Breast Cancer (Auckl) (2014)

Bottom Line: On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%.There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%.In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.

ABSTRACT

Aims and objectives: Breast positioning is the key factor affecting a mammogram. If care is taken during positioning, it maximizes the amount of breast tissue being imaged, eliminates most of the artifacts, and increases sensitivity of the mammogram. This retrospective study was carried out in our department to assess correctness, and also the incorrectness of breast positioning, which need to be avoided to obtain an ideal mammogram.

Material and methods: A total of 1369 female patients were included in this study. Mammography was performed on full field detector digital mammography equipment. Craniocaudal (CC) view and mediolateral oblique (MLO) view were carried out for each breast. Four views were done for 1322 patients. The remaining 47 patients had undergone a mastectomy and underwent two views for the other breast. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral-nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants.

Results: As per prescribed guidelines, mistakes in positioning were recognized in 2.879% of total mammograms. Improper positioning of the nipple was the commonest problem, seen in 3.827% of mammograms, CC view. On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%. There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%. In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

Conclusion: Positioning is the most important factor affecting the resultant mammography image. During mammography, many cases are improperly positioned and as a result the examination is inconclusive, which reduces the sensitivity of mammography.

No MeSH data available.


Related in: MedlinePlus

Rolled on nipple appearing as a space occupying lesion on an MLO view of the right breast. Ultrasound breast was normal.
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f10-bcbcr-8-2014-119: Rolled on nipple appearing as a space occupying lesion on an MLO view of the right breast. Ultrasound breast was normal.

Mentions: In our study, we found that mal-positioning of nipple was very common. Incorrect nipple positioning can sometimes be due to anatomical or pathological (retraction) reasons and not due to improper positioning. Clinical examination of the patient prior to mammography helps in avoiding fallacies. In obese patients, when compression is inadequate, the nipple tends to roll inferiorly. Also when the patient is not comfortable and moves slightly, the same happens. This can appear as a doubtful mass lesion on the resultant mammogram. A repeat mammography study may sometimes have to be carried out which results into increased radiation exposure to the patient. In addition, an ultrasound may be necessary to rule out the fallacy (Fig. 10). This results into increased workup for both the patient and the radiologist. Also, extra time and money consumed unnecessarily.


Breast Positioning during Mammography: Mistakes to be Avoided.

Popli MB, Teotia R, Narang M, Krishna H - Breast Cancer (Auckl) (2014)

Rolled on nipple appearing as a space occupying lesion on an MLO view of the right breast. Ultrasound breast was normal.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4125373&req=5

f10-bcbcr-8-2014-119: Rolled on nipple appearing as a space occupying lesion on an MLO view of the right breast. Ultrasound breast was normal.
Mentions: In our study, we found that mal-positioning of nipple was very common. Incorrect nipple positioning can sometimes be due to anatomical or pathological (retraction) reasons and not due to improper positioning. Clinical examination of the patient prior to mammography helps in avoiding fallacies. In obese patients, when compression is inadequate, the nipple tends to roll inferiorly. Also when the patient is not comfortable and moves slightly, the same happens. This can appear as a doubtful mass lesion on the resultant mammogram. A repeat mammography study may sometimes have to be carried out which results into increased radiation exposure to the patient. In addition, an ultrasound may be necessary to rule out the fallacy (Fig. 10). This results into increased workup for both the patient and the radiologist. Also, extra time and money consumed unnecessarily.

Bottom Line: On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%.There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%.In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.

ABSTRACT

Aims and objectives: Breast positioning is the key factor affecting a mammogram. If care is taken during positioning, it maximizes the amount of breast tissue being imaged, eliminates most of the artifacts, and increases sensitivity of the mammogram. This retrospective study was carried out in our department to assess correctness, and also the incorrectness of breast positioning, which need to be avoided to obtain an ideal mammogram.

Material and methods: A total of 1369 female patients were included in this study. Mammography was performed on full field detector digital mammography equipment. Craniocaudal (CC) view and mediolateral oblique (MLO) view were carried out for each breast. Four views were done for 1322 patients. The remaining 47 patients had undergone a mastectomy and underwent two views for the other breast. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral-nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants.

Results: As per prescribed guidelines, mistakes in positioning were recognized in 2.879% of total mammograms. Improper positioning of the nipple was the commonest problem, seen in 3.827% of mammograms, CC view. On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%. There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%. In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

Conclusion: Positioning is the most important factor affecting the resultant mammography image. During mammography, many cases are improperly positioned and as a result the examination is inconclusive, which reduces the sensitivity of mammography.

No MeSH data available.


Related in: MedlinePlus