Special investigations of the breast

Abstract 

Radiological investigations of the breast are integral to the assessment of symptomatic breast patients and fundamental to the screening programme. Mammography and ultrasound are the standard imaging modalities, supplemented by magnetic resonance imaging in appropriate situations.

Possible pathological findings on mammography include masses, architectural distortion, areas of asymmetry between the right and left breast and microcalcification. Ultrasound is the primary method of imaging the breast in younger women. It provides further information about a clinical or mammographic abnormality and can distinguish between solid, cystic or complex lesions. MRI is used in selected cases, to assist with the diagnosis and local staging of primary or recurrent breast cancer. It is also used to assess implant integrity and to screen for malignancy in high-risk women.

Image-guided biopsy enables pre-operative diagnosis in most cases of benign and malignant breast conditions. Larger cores of tissue can be obtained with a vacuum assisted biopsy, which may also be used to excise a biopsy-proven benign lesion.

As part of the triple assessment, radiological investigations must be correlated with the clinical examination and with any subsequent histology, to ensure-each member of the team is evaluating the same area of the breast. This enables appropriate reassurance to be given when the findings are normal or benign, and accuracy in the diagnosis and staging of patients with breast cancer.

Keywords: breast cancer, mammography, MRI, triple assessment, ultrasound