Cone Compression View vs. Diagnostic Mammogram
No, a cone compression view is not the same as a diagnostic mammogram—rather, it is one specific type of additional view that may be included as part of a diagnostic mammogram workup. 1
Understanding the Distinction
Screening vs. Diagnostic Mammography:
- Screening mammography consists of 2 standard radiographic views of each breast (typically craniocaudal and mediolateral oblique views) performed on asymptomatic women for routine surveillance 2
- Diagnostic mammography includes these standard views PLUS additional specialized views such as spot compression views (also called cone compression views) or magnification views to investigate a specific finding 1
What is a Cone/Spot Compression View?
A cone compression view (also called spot compression view) is a specialized mammographic technique that:
- Uses a small compression paddle to apply focal pressure to a specific area of concern 3
- Helps evaluate the margins of a nodule or mass by spreading out overlapping tissue 3
- Determines whether an asymmetry persists or represents summation artifact from overlapping normal breast tissue 4
- Can be performed with or without magnification 5
The Complete Diagnostic Mammogram
A diagnostic mammogram is a comprehensive evaluation that may include: 1
- Standard two-view mammography
- Spot/cone compression views
- Magnification views (particularly for microcalcifications) 5
- Additional projections as needed
- Often combined with targeted ultrasound 1
The key distinction: Diagnostic mammography has higher sensitivity but lower specificity compared to screening mammography, precisely because it includes these additional targeted views 1, 2
Clinical Context
Diagnostic mammography is indicated in two situations: 2
- Evaluating symptomatic women (palpable mass, nipple discharge, breast pain)
- Additional workup after an abnormal screening mammogram (BI-RADS 0 requiring further evaluation)
Common pitfall: Insurance carriers may label routine mammograms as "diagnostic" in certain asymptomatic women (e.g., those with prior cancer history), creating billing confusion, but this does not change the technical definition 1, 2
Modern Alternative
Digital breast tomosynthesis (DBT) may replace traditional spot compression views in certain diagnostic situations, showing equivalent or superior diagnostic accuracy compared to conventional supplemental diagnostic mammographic views including cone compression 1, 6