How do you order spot compression views with ultrasound (US) of the breast?

How to Order Spot Compression Views with Ultrasound of the Breast

To order spot compression views with ultrasound of the breast, request diagnostic mammography with spot compression views followed by targeted ultrasound of the area of concern, specifying the location of the palpable or mammographic finding. 1

Appropriate Sequencing of Imaging

When evaluating breast abnormalities requiring both spot compression views and ultrasound, follow this algorithm:

1. For women ≥40 years old:

   • Begin with diagnostic mammography including spot compression views
   • Follow with targeted ultrasound of the area of concern 1, 2

2. For women 30-39 years old:

   • Either ultrasound or mammography may be performed first (radiologist discretion)
   • If mammography is performed first, include spot compression views of the area of concern 3

3. For women <30 years old, pregnant, or lactating:

   • Begin with ultrasound as the primary imaging tool
   • Mammography with spot compression views only if ultrasound findings warrant further evaluation 3

Technical Specifications for the Order

When placing the order, include:

• Location of the finding: Specify quadrant or clock position and distance from nipple
• Clinical concern: Note if there is a palpable mass, asymmetry, or prior mammographic finding
• Request language: "Diagnostic mammography with spot compression views and targeted ultrasound of [specific location]"

Clinical Value of Spot Compression Views

Spot compression views significantly improve diagnostic accuracy by:

• Increasing imaging resolution for better visualization of calcifications, their number, and extent 1
• Spreading out overlapping tissues to better evaluate mass margins 1
• Improving characterization of equivocal findings, with studies showing accuracy increasing from 72-75% to 90-94% 4
• Reducing unnecessary biopsies by better characterizing benign findings 5

Common Pitfalls to Avoid

• Pitfall #1: Incorrect sequencing - Performing biopsy before completing imaging can alter radiologic interpretation 2
• Pitfall #2: Inadequate localization - Failure to mark the palpable area with a radio-opaque marker can lead to missing the area of concern 1
• Pitfall #3: Incomplete views - Not obtaining spot compression views in multiple projections may miss important features 1
• Pitfall #4: Overlooking magnification - Magnification views are essential for proper evaluation of microcalcifications 1

Special Considerations

• For digital breast tomosynthesis (DBT), specific DBT spot compression views can be requested, which have shown improved diagnostic accuracy and reader agreement 4
• When evaluating DCIS, magnification views are particularly important as they can identify areas of calcified tumor elsewhere in the breast that might otherwise be missed 1
• For post-treatment surveillance, specify the surgical site for targeted evaluation with both spot compression and ultrasound 1

Remember that spot compression with ultrasound is complementary - each modality provides unique information about the breast abnormality, with mammography better for calcifications and architectural distortion, while ultrasound better characterizes solid versus cystic masses 6.