A diagnostic mammogram is a specialized breast imaging procedure using low-dose X-rays to investigate a specific breast concern or an abnormal finding from a prior screening mammogram. This targeted approach provides detailed images of particular areas of interest within the breast tissue, helping healthcare providers determine the nature of a known issue.
Distinguishing Diagnostic from Screening Mammograms
Screening mammograms are routine preventative tests performed on individuals who do not have any breast symptoms. They are designed to detect potential signs of breast cancer early, before any symptoms might appear.
Conversely, a diagnostic mammogram is performed when there is a specific symptom, such as a lump or pain, or when a screening mammogram yields an unclear or suspicious finding.
Screening mammograms typically involve a standard set of general views of the entire breast, usually two views of each breast. In contrast, diagnostic mammograms involve focused views, which may include additional images like magnification or spot compression views, to specifically target and examine the area of concern. A radiologist is often present during or immediately after a diagnostic mammogram to review images in real-time, guiding the technologist to take further images or perform an ultrasound if needed, allowing for immediate assessment and follow-up.
Reasons for a Diagnostic Mammogram
A doctor may order a diagnostic mammogram for several reasons. One common reason is the appearance of new breast symptoms, such as a new lump or thickening in the breast or armpit, breast pain, nipple discharge, or changes in the breast’s skin, including redness, dimpling, or changes in size or shape.
Another indication for a diagnostic mammogram is an abnormal finding on a routine screening mammogram. If a screening reveals suspicious or inconclusive findings, such as calcifications, masses, or architectural distortions, a diagnostic mammogram provides a more thorough follow-up.
Diagnostic mammograms are also used for monitoring individuals with a history of breast cancer or those with other elevated risk factors, sometimes serving as a supplemental screening. Additionally, they can be utilized for pre-biopsy planning to precisely localize an area before a tissue sample is taken.
The Diagnostic Mammogram Procedure
Patients are advised to avoid applying deodorant, antiperspirant, powders, lotions, creams, or perfumes under their arms or on their breasts on the day of the exam. These products can contain substances that may show up on X-ray images, potentially interfering with results. Patients may find it more comfortable to wear a top and bra that are easily removable, as clothing above the waist will need to be removed for the procedure.
During the exam, the technologist positions one breast at a time on a flat plate. A plastic paddle gently compresses the breast, which helps spread out the tissue for clear images and reduces radiation. The technologist takes standard views, and depending on the area of concern, may also take additional spot compression or magnification views. A radiologist often reviews images in real-time, allowing for immediate additional views or an ultrasound if further investigation is needed. This targeted approach means a diagnostic mammogram typically takes longer than a screening mammogram.
Understanding Diagnostic Mammogram Results
After a diagnostic mammogram, patients often receive preliminary feedback on the same day. A detailed formal report is then sent to the referring physician.
Radiologists use a standardized system called the Breast Imaging-Reporting and Data System (BI-RADS) to categorize findings.
The BI-RADS system assigns a score from 0 to 6, providing a consistent way to communicate findings and recommend next steps. For example, a BI-RADS 0 indicates an incomplete assessment requiring additional imaging, while a BI-RADS 1 or 2 generally means no signs of cancer were found. Higher scores, such as BI-RADS 3 (probably benign), 4 (suspicious abnormality), or 5 (highly suggestive of malignancy), indicate increasing levels of concern and typically lead to recommendations for short-term follow-up, further imaging like an ultrasound or MRI, or a biopsy. These next steps are tailored to the specific BI-RADS category to ensure appropriate and timely follow-up care.