Virginia Commonwealth University Breast Imaging

Young woman.

Diagnostic Mammography

Diagnostic mammography is recommended for women who are experiencing symptoms that may be related to breast cancer, such as:

  • A lump in the breast or under the arm
  • An area of thickening
  • Skin changes, such as redness, dimpling or thickening
  • Nipple changes, such as inversion, retraction, erosion, weeping and itching
  • Spontaneous nipple discharge
  • A change in breast size

Diagnostic mammography is also indicated for women with a possible abnormality detected on their screening mammogram and in women who have had a lumpectomy for the first seven years following radiation therapy.

Although breast cancer is rare in men, it does occur and usually presents with a palpable finding (lump). Consequently, diagnostic mammography is done to evaluate men who develop a breast lump.

About the Procedure

In conjunction with the two standard images of the breast — the craniocaudal, or CC, which is a top-to-bottom picture, and the mediolateral oblique, or MLO, which is a side-to-side view — additional images may be done using a small (spot) compression paddle alone or in combination with magnification technique.

The use of the spot compression paddle helps focus the compression to a small area of your breast to maximize separation of overlying tissue in the area being evaluated in your breast.

When evaluating microcalcifications, it is common to combine a small compression paddle with magnification technique to detail the morphology or appearance of the calcifications. This helps us distinguish calcifications not related to breast cancer from those that have a high likelihood of being associated with breast cancer. In some women microcalcifications can be the earliest sign of a breast cancer that is often contained in the milk duct — intraductal or ductal carcinoma in situ.

After the Procedure

A breast imaging radiologist is present in the facility during a diagnostic mammogram to oversee the study and determine what views are needed. Depending on the results of the diagnostic mammogram, the radiologist monitoring your study may conduct additional studies, including:

  • Physical examination
  • Ultrasound
  • Cyst aspiration
  • Ductography (in patients with spontaneous nipple discharge)

Based on the results of the completed diagnostic evaluation, the breast imaging radiologist will discuss findings, options and recommendations; answer your questions; and provide your results in writing before you leave our facility. If a biopsy or fine needle aspiration is needed, you can choose to have it done immediately or schedule it for a later date.

A mass and microcalcifications shown in a patient.

In this left mediolateral oblique view of a patient, a mass (single arrow) and microcalcifications (double arrows) are identified in the left breast. The patient is asked to return for a diagnostic evaluation that includes spot compression views of the mass (not shown here) and magnification views of the calcifications. Based on the diagnostic evaluation, biopsies of the mass and microcalcifications were done. The mass is diagnosed as an invasive ductal carcinoma and the microcalcifications are related to ductal carcinoma in situ.

The spot compression paddle.

The spot compression paddle (single arrow) shown here is used for diagnostic evaluations. After the technologist positions the breast on the bucky (double arrows), compression is applied with the smaller paddle and the image is recorded on film or a digital detector. The use of this paddle can help us distinguish normal tissue from an underlying mass or lump. If a mass is present, we can better characterize the edges (borders, margins).

A double spot compression magnification set.

In the double spot compression magnification set up, a platform (double arrow) is used to raise the breast away from the bucky; as the breast is raised closer to the x-ray tube and away from the bucky, magnification is obtained. After the technologist positions the breast on the magnification platform, compression is applied with the spot compression paddle (single arrow). Double spot compression magnification views are used primarily to evaluate microcalcifications.

A magnified view of ductal carcinoma.

In the double spot compression magnification view of ductal carcinoma in situ, the additional views demonstrate the presence of microcalcifications. Included among the calcifications are linear forms and many of these calcifications are lined up (arrows). Microcalcifications with these features require biopsy because in most patients they indicate the presence of DCIS.

“The technologist made a potentially stressful exam into an enjoyable visit. She was gentle, professional and sweet, just a gem! She kept me engaged so that my mind was not on the mechanical, which she swiftly navigated so that the exam only seemed like moments out of my day.”

– Excerpt from a VCU Breast Imaging patient satisfaction survey.

Virginia Commonwealth University Medical Center VCU Breast Imaging