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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.


(A) A well-defined lesion seen on CC view. Not well appreciated on an MLO view and (B) a cystic space occupying lesion seen on ultrasound.
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f8-bcbcr-8-2014-119: (A) A well-defined lesion seen on CC view. Not well appreciated on an MLO view and (B) a cystic space occupying lesion seen on ultrasound.

Mentions: Breast positioning is the key factor affecting a mammogram.1–5 During mammography, many cases are improperly positioned and inconclusive mammographic results are obtained.6,7 Lesion may be identified only on one mammographic view (Fig. 8). So tailoring of mammography imaging to the specific needs of individual patient is very important. Proper compression helps in spreading of the breast tissue and avoids distortion of the breast parenchyma. It also places pectoralis muscle and nipple at the same level. Compression is also helpful in differentiating between a lesion and superimposed normal structure as it spreads apart overlying islands of dense tissue. Sometimes, a spot compression device is used, with or without magnification, to better delineate the area of interest8 (Fig. 9).


Breast Positioning during Mammography: Mistakes to be Avoided.

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

(A) A well-defined lesion seen on CC view. Not well appreciated on an MLO view and (B) a cystic space occupying lesion seen on ultrasound.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f8-bcbcr-8-2014-119: (A) A well-defined lesion seen on CC view. Not well appreciated on an MLO view and (B) a cystic space occupying lesion seen on ultrasound.
Mentions: Breast positioning is the key factor affecting a mammogram.1–5 During mammography, many cases are improperly positioned and inconclusive mammographic results are obtained.6,7 Lesion may be identified only on one mammographic view (Fig. 8). So tailoring of mammography imaging to the specific needs of individual patient is very important. Proper compression helps in spreading of the breast tissue and avoids distortion of the breast parenchyma. It also places pectoralis muscle and nipple at the same level. Compression is also helpful in differentiating between a lesion and superimposed normal structure as it spreads apart overlying islands of dense tissue. Sometimes, a spot compression device is used, with or without magnification, to better delineate the area of interest8 (Fig. 9).

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.