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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.


An ideal MLO view (i) nipple in profile, (ii) pectoralis muscle margin well visualized, (iii) edge of pectoralis muscle below the level of PNL, and (iv) inframammary angle (arrow).
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f4-bcbcr-8-2014-119: An ideal MLO view (i) nipple in profile, (ii) pectoralis muscle margin well visualized, (iii) edge of pectoralis muscle below the level of PNL, and (iv) inframammary angle (arrow).

Mentions: An MLO view should demonstrate axilla, axillary tail, and inframammary fold with all the breast tissue (Fig. 4). On an ideal MLO view (a) breast should be pulled out with nipple in profile; (b) the pectoralis muscle margin should be well visualized; (c) the lower edge of pectoralis muscle should be at the level of pectoralis–nipple line (PNL) or below; and (d) PND must be within 1 cm of the same measurement of the MLO view. When MLO image of both breasts are viewed as mirror images, pectoralis muscle should meet in the midline and form a “V” (Fig. 5).


Breast Positioning during Mammography: Mistakes to be Avoided.

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

An ideal MLO view (i) nipple in profile, (ii) pectoralis muscle margin well visualized, (iii) edge of pectoralis muscle below the level of PNL, and (iv) inframammary angle (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f4-bcbcr-8-2014-119: An ideal MLO view (i) nipple in profile, (ii) pectoralis muscle margin well visualized, (iii) edge of pectoralis muscle below the level of PNL, and (iv) inframammary angle (arrow).
Mentions: An MLO view should demonstrate axilla, axillary tail, and inframammary fold with all the breast tissue (Fig. 4). On an ideal MLO view (a) breast should be pulled out with nipple in profile; (b) the pectoralis muscle margin should be well visualized; (c) the lower edge of pectoralis muscle should be at the level of pectoralis–nipple line (PNL) or below; and (d) PND must be within 1 cm of the same measurement of the MLO view. When MLO image of both breasts are viewed as mirror images, pectoralis muscle should meet in the midline and form a “V” (Fig. 5).

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.