What is a CC (Craniocaudal) View of the Breast?
A craniocaudal (CC) view is one of the two standard mammographic projections where the X-ray beam passes from head (cranial) to foot (caudal) through the breast, compressing it from top to bottom to image breast tissue in a superior-to-inferior orientation. 1
Technical Description
- The CC view is obtained by positioning the breast on the mammography detector with compression applied from above, creating an image that shows the breast tissue from a top-down perspective 1
- A radio-opaque marker is placed on the skin over any palpable finding to identify its location on the image 1
- The nipple should be positioned pointing toward the edge of the film, with the breast straight rather than rotated medially or laterally 2
Standard Use in Breast Imaging
- The CC view is routinely performed alongside the mediolateral oblique (MLO) view as part of standard two-view mammography for both screening and diagnostic purposes 1
- Together, these two projections detect 94% of breast malignancies, compared to 90% with only one projection 3
- The CC view is essential for evaluating the medial and lateral aspects of the breast, which may not be fully visualized on the MLO view alone 1
Supplemental CC Views
- Magnification CC views are routinely obtained to identify calcified tumor areas that might not be apparent on standard views, increasing imaging resolution for better depiction of calcification shapes, numbers, and extent 1
- Spot compression CC views with or without magnification are used to specifically evaluate clinical findings or clarify features of masses 1
- Exaggerated CC views (craniocaudal exaggerated) help visualize tissue in the far lateral or medial breast that may be excluded from standard positioning 1
- Rolled CC views are performed by rolling the breast medially or laterally while keeping the X-ray beam angle unchanged, which separates overlapping structures and differentiates summation artifacts from real lesions in 97.7% of equivocal cases 4
Clinical Importance
- The CC view is critical for detecting microcalcifications associated with ductal carcinoma in situ (DCIS), as calcifications are the most common mammographic finding of malignancy (62% of cases) 1
- Magnification CC views significantly reduce underestimation of disease extent, as standard two-view mammography alone underestimates the size of low- and intermediate-grade DCIS by 2 cm in up to 50% of cases 1
- The CC view must be compared sequentially with preceding studies to accurately interpret post-surgical and radiation changes, which can overlap with signs of malignancy 1
Common Pitfall
- Never rely on a single CC view alone for diagnosis—orthogonal or supplemental views are essential, as failure to obtain them can miss true pathology 5