Breast imaging and its pitfalls

In this lecture we will describe the causes of missed breast cancers:1. dense parenchyma that obscures a lesion 2. poor positioning or technique 3. lesion location outside the field of view 4. lack of perception of an abnormality that is present 5. incorrect interpretation of a suspect finding 6. subtle features of malignancy 7. a slowly changing malignancy 8. Asymmetric tissue density has been described as a secondary sign of malignancy, but this is true only if there is a corresponding palpable abnormality. If the normal flow of structures is not interrupted, and there is no mass or architectural distortion, this type of asymmetry is normal unless it is palpable. If there is no three-dimensional density trying to form a mass, no architectural distortion, the density has not increased with time, and there are no clustered calcifications, asymmetric tissue is a normal variation. Finally we will recommend: 1. Do not rely on screening views alone to diagnose a detected abnormality; complete the evaluation with diagnostic ammography. 2. Review clinical data and use US to help assess a palpable or mammographically detected mass. 3. Be strict about positioning and technical requirements to optimize image quality. 4. Be alert to subtle features of breast cancers. 5. Compare current images with multiple prior studies to look for subtle increases in lesion size.6. Look for other lesions when one abnormality is seen. 7. Judge a lesion by its most malignant features