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Mammography is basically a screening tool. Although on USG malignant lesions show characteristic features, it may not be confirmatory.


  1. Indications for Mammography include:
    1. Before breast surgery, as it may avert an unnecessary biopsy demonstrating that the palpable mass has a characteristically benign appearance.
    2. Follow up of breast cancer patients.
    3. Work up a patient with metastases from an unknown primary.
    4. Mammographic Screening is best screening method for carcinoma breast.

The American College of Radiology recommends that women begin getting mammograms at age 40 and annually thereafter.

Mammography - 
Breast Imaging-Reporting and Data System (BI-RADS) - 3rd EDITION (2001)




Incomplete assesment –

Needs additional imaging evaluation.


Normal Mammogram


Benign finding


Probably benign finding

Short interval follow-up: 6m interval for 2 years.


Suspicious abnormality: Biopsy



Calcifications in mammography:


Mammographic findings in various Breast diseases:
  1. Ductal carcinoma in situ
    1. Comedo type = "snake skin like" dotted casting calcifications
    2. Noncomedo type = Fine granular "cotton-ball" calcifications common. However, coarse granular "crushed stone" or "broken needle lip" or arrowhead calcification can be seen.
  2. Carcinoma Breast in all:
    1. QThe most common mammographic appearance of invasive carcinoma is a spiculated mass.
    2. Other features are: Irregular border, microcalcification (30%), "Sunburst" appearance, architectural distortion and high density mass.
    3. QMicrocalcification represents the most sensitive mammographic sign of early breast cancer.
  3. QCystosarcoma phylloides:
    1. Large noncalcified mass with fluid-filled clefts with smooth lobulated margins mimicking fibroadenoma
  4. Fat necrosis of breast       
    1. Ill-defined spiculated dense mass, and calcified only in 4–7% cases when it is called as liponecrosis macrocystica calcifications (occasional eggshell/curvilinear calcificationQ)
  5. Fibroadenoma:

  1. Halo sign, "popcorn" type of calcifications (PATHOGNOMONIC).Q
  2. On USG "hump and dip" sign
  1. Mammographic features of breast cancerQ

A linear distribution of calcifications is seen and some have a branching morphology. This is highly suggestive of malignancy (Bi-RADS 5).


A Spiculated lesion is noted highly suggestive of malignancy.



Sr. no.

Primary signs

Secondary signs


High density irregular opacification

Disruption of architecture



Perifocal haziness


Mammographic lesion less in size than physically seen



The most common mammographic appearance of invasive carcinoma is a "spiculated" mass.

  1. "Microcalcifications" may be seen in 30% cases of invasive carcinoma and 95% of cases of DCIS (granular and casting).
  2. Its "sunburst" appearance readily distinguishes it from benign breast masses.

Overall detection rate of carcinoma breast by mammography is 58–69% and 8% only if < 1 cm in size. Hence, mammography is a screening modality and not the best diagnostic measure.

  1. USG breast
    Ultrasound features of breast cancer:
    1. Spiculations                 
    2. Taller than wideQ         
    3. Angular margins
    4. Acoustic shadowing              
    5. Branch pattern             
    6. Markedly hypoechoic
    7. Calcifications                
    8. Duct extension                     
    9. Microlobulation​
  2. Halo sign, peripheral, marginal ring-like calcification, "popcorn" type of calcification and pleomorphic linear or branching calcification is seen in benign lesion (fibroadenoma).
    Lymphoma is more common on right side presenting as mass with poorly defined borders but no calcification or spiculations seen, although bilateral axillary adenopathy is seen in 30–50% cases.
    Phylloides tumor is usually huge lobulated noncalcified mass.
  3. Ca Breast:
    1. Estrogen therapy is known to increase the risk of Ca breast.
    2. In an elderly female with large axillary adenopathy and mammography showing all the primary signs of malignancy including high-density mass, speculated and with pleomorphic microcalcification, the most likely diagnosis is breast carcinoma.

The BIRADS (Breast Imaging Reporting and Dictation System) lexicon was developed by the American College of Radiology to provide a clear and concise way to report mammographic results:
1 = normal, 2 = benign finding, 3 = probably benign finding (6-month follow-up mammogram recommended), 4 = suspicious finding (biopsy recommended), 5 = high likelihood of malignancy (biopsy recommended), and 6 = confirmed malignancy.

  1. MRI Breast
    QBreast magnetic resonance imaging (MRI) findings suspicious for malignancy in an enhancing lesion include avid arterial phase enhancement, washout of contrast in a delayed phase, spiculated or microlobulated margins, greater enhancement peripherally than centrally, and architectural distortion.

QMRI is preferable modality in assessment of breast with implants.

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