A diagnostic mammogram is a specialized breast imaging procedure. It investigates specific breast concerns or further evaluates findings from a routine screening mammogram. This targeted examination helps medical professionals gather detailed information to determine the nature of a breast change.
Diagnostic Versus Screening Mammography
Mammography encompasses two primary types: screening and diagnostic, each serving a distinct purpose in breast health. A screening mammogram is a routine examination for women without breast symptoms. Its aim is to detect potential breast changes early, often before they can be felt. Typically, screening mammograms involve two standard X-ray views of each breast: one from top to bottom and one from the side.
A diagnostic mammogram is conducted when a specific breast concern requires further investigation. This can arise from a new symptom or an unclear finding on a prior screening mammogram. During a diagnostic mammogram, the technologist may capture more images than a screening exam, focusing on the area of concern. These additional views often include specialized techniques like magnification or spot compression to obtain a clearer, more detailed picture of the targeted region.
A radiologist, a physician specializing in medical imaging, may be present during a diagnostic mammogram to review images in real-time. This allows for immediate adjustments or additional imaging if needed. While a screening mammogram generally takes about 10 to 15 minutes, a diagnostic mammogram may require more time due to the increased views and the radiologist’s involvement.
Indications for a Diagnostic Mammogram
A healthcare provider may order a diagnostic mammogram to investigate breast changes. One common indication is new breast symptoms, such as a palpable lump, unexplained breast pain, or nipple discharge. Other symptoms include changes in skin texture, like dimpling or thickening, or alterations in breast size or shape.
Another reason for a diagnostic mammogram is an abnormal result from a routine screening mammogram. If a screening image appears suspicious or unclear, a diagnostic mammogram provides more detailed views to clarify the finding. This further evaluation helps determine if the observation is benign or requires additional steps.
Diagnostic mammograms are also used for follow-up, particularly for individuals with a history of breast abnormalities or breast cancer. This includes monitoring previously identified benign conditions or conducting surveillance for those with an elevated risk of developing breast cancer.
The Diagnostic Mammography Process
Preparing for a diagnostic mammogram is straightforward. Patients are advised to avoid applying deodorant, antiperspirant, powders, lotions, or creams to their underarms or breasts on the day of the exam. These products can appear as white spots on X-ray images, potentially interfering with interpretation. It is also helpful to wear comfortable clothing, such as a two-piece outfit, as you will need to remove clothing from the waist up.
During the procedure, a mammography technologist will position each breast on a platform of the mammography machine. A clear plastic plate, known as a compression paddle, then gently compresses the breast tissue. This compression, which lasts for a few seconds per image, is important for spreading out the breast tissue to reduce overlapping structures and obtain clear, high-quality pictures while minimizing radiation dose. While this compression may cause some discomfort or pressure, it is generally brief.
A notable difference in a diagnostic mammogram is the potential presence of a radiologist during the exam. This allows the radiologist to immediately review the images and direct the technologist to capture additional, specialized views, such as spot compression or magnification views, if needed. This real-time assessment ensures that all necessary images are obtained before the patient leaves, and the entire process generally takes longer than a screening mammogram, often around 30 to 45 minutes, depending on the complexity of the case.
Understanding Your Results and Follow-Up
Following a diagnostic mammogram, a specialized radiologist meticulously interprets the images to identify any findings. These medical professionals are trained to assess and compare current images with any previous mammograms to detect subtle changes in breast tissue over time. This comparison is a crucial aspect of the diagnostic evaluation, aiding in the accurate characterization of any observed abnormalities.
The radiologist then assigns a Breast Imaging-Reporting and Data System (BI-RADS) category to the findings. This standardized system, ranging from 0 to 6, helps communicate the results and recommendations consistently across healthcare providers. For example, a BI-RADS 0 indicates an incomplete assessment requiring additional imaging, such as more mammogram views or an ultrasound. A BI-RADS 1 means the images are negative with no abnormalities detected, while a BI-RADS 2 suggests benign (non-cancerous) findings. Categories 3, 4, and 5 indicate increasing levels of suspicion for malignancy, with category 6 reserved for biopsy-proven cancer.
Results are typically sent to the referring physician, who then discusses them with the patient. Depending on the BI-RADS category, the next steps may vary. If the results are benign, routine follow-up mammograms may be recommended. For suspicious findings, additional imaging like an ultrasound or a magnetic resonance imaging (MRI) scan might be ordered, or a biopsy may be recommended to obtain a tissue sample for further analysis.