Mammography is a method of contrast-free X-ray examination of the breast, as well as regional lymph nodes. The structure of adipose tissue, connective tissue and glandular elements, the shadow of blood vessels are visualized on radiographs. The images are informative in the diagnosis of malignant tumors, mastopathy, cysts. Mammograms are represented by images in oblique, lateral and direct projections performed under conditions of compression of the gland. Survey studies can be supplemented with targeted ones.
Indications
Mammography is used for preventive screening of women over 35 years of age in order to detect early non-palpable breast cancer. Healthy women under 45 years of age are examined once every 2 years, after 45 years – annually. In the presence of dysgormanal hyperplasia of the breast, the frequency of mammography is determined individually. Diagnostic mammography is performed for pain in the mammary glands, palpable seals, discharge from the nipple, any changes in the skin of the breast, periarticular area or nipples. The study is shown in order to distinguish between breast wall tumors and breast neoplasms, to monitor the course of mastopathy, staging of primary breast cancer, dynamic assessment of the condition of breast tissues after surgery.
Calcifications, cysts, fibroadenomas, malignant neoplasms of the breast are detected by radiography of the mammary glands. In case of suspected breast cancer, the diagnosis is verified by performing a puncture biopsy of the breast or trepanobiopsy followed by cytological examination of the biopsy. Mammography is performed on the 5th- 12th day of the menstrual cycle, in menopausal women – at any time. It is not carried out for pregnant and breast-feeding women.
Methodology of conducting
During mammography, special installations are used-mammographs. To perform mammograms, a woman is asked to take off her clothes above the waist. Before the procedure, you should avoid applying perfumes, deodorants, lotions, powders to the skin of the chest and armpit areas, since the ingredients of cosmetics can give artifacts on mammograms. It is necessary to warn the doctor if there have been breast surgeries in the anamnesis, including plastic interventions for breast augmentation and endoprosthetics of the mammary glands. In the presence of breast implants for mammography, special settings of the device are selected to prevent complete compression of the endoprosthesis. The presence of a breast implant makes it difficult to visualize and qualitatively diagnose the condition of the breast.
During the review procedure, mammograms of both glands are performed in direct and lateral (oblique) projections. Each breast is alternately clamped between a special stand and a plate and X-ray irradiation is performed. Breast compression is necessary to improve the quality of mammograms. With small breast sizes, pain experienced, pronounced fibroadenomatous changes, mammography can be moderately painful. If necessary, targeted mammograms of individual areas of the breast are performed. To do this, the studied areas are marked with lead tags and a picture is taken with a narrow tube. In the presence of nipple discharge, X-ray contrast is injected into the milky ducts and ductography is performed. If you need to determine the most accurate place for puncture, use a special grid with holes. The mammography procedure takes no more than 15 minutes.
Interpretation of results
When deciphering the results of mammography, the radiologist takes into account clinical and anamnestic data. When evaluating mammograms, the structure of adipose and glandular tissue, ducts, and vessels are studied. When identifying pathological foci, their number, size, location, shape, outline, symmetry, uniformity are established. Breast tissues with different densities on mammograms have shades of white, gray and black. In the process of interpreting the results, it should be taken into account that the tissue density is higher in young women, as well as during hormone replacement therapy and decreases after menopause, oophorectomy.
Fibroadenomas and cysts are defined as oval or rounded formations that have a clear separation from healthy tissues. On the contrary, in breast cancer, the detected shadows may have unclear contours, radiant or spiked borders. Calcifications detected during mammography may be benign or accompany the development of breast cancer, therefore they always require further clarification.
Advantages and limitations of the method
Early detection of breast cancer during preventive mammography increases the survival statistics of women with this disease by 30%. In some cases, mammography can detect tumors less than 5 mm in diameter and perform organ-sparing operations. The radiation load accompanying mammography is insignificant (less than with chest radiography) and cannot provoke the development of oncology. In general, the risks of regular mammography are significantly lower than the likelihood of spontaneous development of breast cancer.
The informative value of mammography is limited in nulliparous and women under 35 years of age due to the high density of tissues, in the presence of breast endoprostheses, pronounced mastopathy. With the location of tumor changes in the thickness of the gland, mammography may not detect them and give a false negative result.
