Radiological assessment of the breast: what the Surgical Oncologist needs to know

Abstract

Breast imaging, as a subspeciality of radiology, has 40–70 years. Two-view mammography without physical developed since the 1980s and expanded largely as a examination is the screening modality of choice. The use result of population-based breast screening programmes. of two views and a high film density increases detection of The management of breast disease by multidisciplinary small invasive cancers compared with one-view teams including specialist surgeons, radiologists and mammography. Double reading of mammograms results pathologists has become standard practice. in an 8–73% increase in small cancer detection depending on the methods of double reading used and the number of views. The ideal screening frequency depends on the MAMMOGRAPHY lead-time of screening. The lead-time of screening for women over 50 is just over 3 years. Interval cancer rates Bilateral two-view mammography is essential for prehave been shown to increase rapidly in the third year of operative assessment of a clinically suspicious breast screening reaching 80% of the naturally occurring lump. Mammography will give information about the incidence. The majority of screening programmes size and extent of disease including the detection of therefore advocate a screening frequency of 2 years for multifocality and the presence of adjacent ductal women over the age of 50. The Malmo and Gothenberg carcinoma in situ (DCIS). It is also useful to screen the studies have shown that the lead-time of screening in contralateral breast for a clinically occult tumour. Other women under 50 is shorter. The incidence of breast indications for mammography in symptomatic women cancer in women in their 40s is also less than in the over include single duct nipple discharge, skin dimpling, recent 50s. The density of the breast tissue tends to be greater nipple retraction and persistent asymmetric thickening. in younger women and in women taking hormone Women treated with breast conservation are at risk of replacement therapy with a subsequent reduction in the developing local recurrence. This risk has been estimated sensitivity and specificity of mammography. As a result, at approximately 1% per annum. Annual ipsilateral although screening younger women almost certainly mammography and mammography of the contralateral reduces breast cancer mortality, in order to achieve this it breast every 2 years is used in conjunction with clinical is necessary to screen younger women more often (every examination as part of post-treatment surveillance. 12–18 months) to find a smaller number of cancers. This Studies have shown that locally recurrent breast cancer means that screening women under 50 will be much less tends to have similar mammographic appearances to the cost effective than screening women over the age of 50. original tumour. In women where the tumour was not seen on mammography at diagnosis the local recurrence is usually mammographically occult. ULTRASOUND Population screening with mammography has been shown to reduce breast cancer mortality in women aged High-frequency ultrasound has an established role in the assessment of palpable breast lesions, particularly in younger women, as well as being a method of evaluating mass lesions seen on mammography. For a long time Correspondence to: Dr H. C. Burrell, Nottingham International Breast ultrasound has been used to differentiate cystic from Education Centre, City Hospital NHS Trust, Nottingham, NG5 1PB, UK. solid breast masses and more recently has been shown