Diagnostic Imaging for Bilateral Screening Mammogram with Recommendation for Further Imaging
For a 72-year-old female with a bilateral screening mammogram and right breast ultrasound recommending further imaging, a diagnostic mammogram with additional views is the next appropriate step.
Recommended Imaging Approach
- For a BI-RADS category 0 (additional imaging required) finding on screening mammogram, the National Comprehensive Cancer Network recommends a diagnostic mammogram with or without ultrasound as the next step 1
- Diagnostic mammography includes additional specialized views such as spot compression or magnification views to further investigate the area of concern identified on the screening mammogram 2
- Diagnostic mammography differs from screening mammography in that it is specifically used to evaluate positive findings such as abnormalities detected on screening mammograms 2
Rationale for Diagnostic Mammogram in This Case
- For women 40 years of age or older (which includes this 72-year-old patient), diagnostic mammography is rated as "usually appropriate" (rating of 9/9) by the American College of Radiology for initial evaluation of breast abnormalities 2
- The diagnostic workup should include comparison with prior films and additional specialized views of the area of concern 1
- Since the patient has already had an ultrasound of the right breast, the diagnostic mammogram will provide complementary information, as mammography and ultrasound are considered complementary imaging methods 2
Role of Additional Ultrasound
- If the diagnostic mammogram findings are inconclusive or suspicious, additional targeted ultrasound may be warranted for areas not previously evaluated 2
- Ultrasound is particularly valuable for distinguishing solid masses from cysts and for evaluating mammographic abnormalities 1, 3
- For dense breasts, supplemental ultrasound has been shown to detect additional cancers not visible on mammography alone 4, 5
Management Based on Diagnostic Results
- If diagnostic imaging results are classified as BI-RADS 1-2 (negative or benign), the patient can return to routine screening 2
- If results are BI-RADS 3 (probably benign), follow-up diagnostic mammograms at 6 months, then every 6-12 months for 1-2 years is recommended 2
- For BI-RADS 4-5 (suspicious or highly suggestive of malignancy), tissue diagnosis via core needle biopsy is necessary 2
Common Pitfalls to Avoid
- Delaying diagnostic evaluation when additional imaging is recommended can lead to delayed diagnosis 1
- Relying solely on ultrasound without diagnostic mammography in women over 40 may miss calcifications and other mammographically visible abnormalities 2
- Failure to ensure concordance between pathology and imaging findings can lead to missed diagnoses; discordance requires further investigation 1
Remember that diagnostic mammography with additional views is the standard next step for evaluating abnormal screening mammogram findings in a woman of this age, providing detailed assessment of the area of concern while minimizing unnecessary procedures.