A diagnostic mammogram is an investigative tool ordered by a healthcare provider to further evaluate a specific area of concern. This appointment is often scheduled following an abnormal result from a routine screening mammogram, or because a patient or physician has noted a new symptom. The purpose is to gather detailed, targeted images that allow a radiologist to determine the nature of the finding. Understanding the steps involved can help manage expectations for this assessment.
Screening Versus Diagnostic Mammography
The distinction between the two types of mammography lies in their purpose and the patient’s condition. A screening mammogram is a preventative measure designed for individuals who have no symptoms and are following routine annual recommendations. It involves standard views of both breasts and aims to detect cancer early.
A diagnostic mammogram, conversely, is a targeted examination conducted when there is a specific reason for concern. This reason may be a new lump, unexplained nipple discharge, persistent breast pain localized to one spot, or a suspicious area identified on a prior screening image. The radiologist is typically present or immediately available to review the images and guide the technologist during the procedure.
Preparing for Your Diagnostic Appointment
Arriving prepared can help streamline the process and ensure the clearest possible images are obtained. It is beneficial to wear a two-piece outfit, such as a skirt or pants with a shirt, since you will only need to remove clothing from the waist up. The facility will provide a gown or wrap to wear during the examination.
You must avoid applying any deodorant, antiperspirant, powder, lotion, or cream to your chest area or underarms on the day of the exam. These products contain metallic substances that may appear as white spots on the X-ray images, causing artifacts that interfere with interpretation. If your prior mammograms or breast procedure records are at a different facility, have them sent ahead of time or bring them with you for comparison.
Navigating the Imaging Procedure
The diagnostic appointment is more comprehensive and typically takes longer than a standard screening, often lasting between 30 and 60 minutes. The procedure often begins with the standard mammography views, but the technologist will then focus on the area of concern using specialized techniques. These additional views are necessary to thoroughly evaluate the specific finding.
Spot Compression
One specialized technique is the use of spot compression, which employs a smaller paddle to apply localized pressure directly to the area in question. This increased compression helps separate overlying breast tissue. It allows the radiologist to determine if a suspected abnormality is a true mass or merely overlapping normal structures.
Magnification View
Another technique is the magnification view, which uses a magnification platform to produce a “zoomed-in” image of a small area. These views are useful for closely examining tiny calcium deposits, known as microcalcifications, to analyze their shape and pattern. The radiologist’s real-time involvement ensures all necessary images are captured before you leave, preventing the need for a separate follow-up imaging session.
Understanding Your Results and Follow-Up
A benefit of a diagnostic mammogram is that results are often reviewed by the radiologist and communicated to you before you leave the clinic. The findings are standardized using the Breast Imaging Reporting and Data System (BI-RADS), which categorizes the results on a scale from 0 to 6. This system provides a consistent way for healthcare providers to communicate the findings and recommended next steps.
A score of BI-RADS 1 or 2 indicates a negative or benign finding, meaning you can return to routine annual screening. A BI-RADS 0 means the assessment is incomplete, and additional imaging, such as an ultrasound, is immediately needed to clarify the finding. If the finding is categorized as BI-RADS 3, it is considered probably benign, and a short-interval follow-up imaging appointment, typically in six months, is recommended to confirm stability. For categories 4 and 5, which indicate suspicious findings, a tissue sample or core needle biopsy is generally the next step.