From the Guidelines
When a right breast mammogram comes back abnormal and the left one is normal, a bilateral diagnostic mammogram and an ultrasound evaluation should be obtained for women aged 30 years or older, as recommended by the NCCN clinical practice guidelines in oncology 1. This approach is based on the most recent guidelines, which emphasize the importance of thorough evaluation in women over 30.
- For women under 30, an ultrasound evaluation is often the initial step, followed by consideration of diagnostic mammography if necessary, due to the lower yield of mammography in denser breast tissue and lower risk of breast cancer in this age group 1.
- The decision to perform bilateral diagnostic imaging versus focusing on the abnormal breast alone depends on several factors, including the patient's age, risk factors, family history of breast cancer, and the radiologist's assessment of the abnormality.
- The NCCN guidelines from 2018 provide a detailed approach to diagnostic follow-up, including the use of ultrasound, diagnostic mammogram, and consideration of breast MRI for certain cases 1.
- It's crucial to follow the healthcare provider's specific recommendations, as they will consider individual circumstances and apply the most appropriate diagnostic approach based on the latest guidelines and clinical judgment.
- The goal is to balance the need for thorough evaluation with the potential risks and benefits of additional imaging, prioritizing the patient's safety and well-being.
From the Research
Diagnostic Approach for Abnormal Right Breast Mammogram
When a right breast mammogram comes back abnormal and the left one is normal, the next steps in diagnosis may involve additional imaging techniques to confirm or rule out breast cancer.
- The use of magnetic resonance imaging (MRI), ultrasound, and mammography can be considered for further evaluation 2, 3, 4, 5.
- MRI has been shown to have high sensitivity for detecting breast cancer, especially in dense breast tissue, with a sensitivity of 94.6% and specificity of 74.2% 2.
- Ultrasound can be useful for evaluating mass lesions, particularly those greater than 10mm in size, with a high sensitivity for malignant mass lesions 5.
- Mammography may be less sensitive than MRI or ultrasound, but can still be useful for detecting calcifications and non-mass lesions 2, 5.
- A bilateral diagnostic ultrasound/mammogram may not be necessary if the abnormality is only in one breast, but it can be considered if there are suspicious findings on the initial mammogram or if the patient has a high risk of breast cancer.
- The choice of imaging modality for further evaluation and potential biopsy should be based on the characteristics of the lesion, patient factors, and the availability of imaging modalities 6, 5.
Considerations for Biopsy
- If a lesion is detected on MRI but not on mammography or ultrasound, MRI-guided biopsy may be necessary to obtain a tissue diagnosis 4.
- Ultrasound-guided biopsy can be used for lesions that are visible on ultrasound, and has been shown to be accurate in 87% of cases 6.
- The choice of biopsy method should be based on the location and characteristics of the lesion, as well as the patient's overall health and preferences 6, 5.