II. Categories of Mammographic Abnormalities

  1. Category 1: Normal Mammogram
  2. Category 2: Benign-appearing abnormality
  3. Category 3: Indeterminate, possible risk of malignancy
  4. Category 4: Suspicious for malignancy
  5. Category 5: Malignant until proven otherwise

III. Benign Mammogram Findings

  1. Intramammary lymph node
    1. Smooth walled mass within the Breast tissue
    2. Lucent center
    3. Usually Mammogram repeated in 6 months
  2. Smooth walled mass
    1. Associated with cyst or fibroadenoma
    2. Evaluate with breast Ultrasound
  3. Scattered Microcalcifications
    1. Bilateral shot-gun like appearance
    2. Usually smooth, round with little density variation
    3. Not clustered
    4. Associated with:
      1. Benign fibrocystic change
      2. Sclerosing adenosis

IV. Worrisome Mammogram findings suggesting Breast Cancer

  1. Mass with irregular borders
    1. Highly suggestive of carcinoma
  2. Clustered Microcalcifications
    1. Five calcifications in 1 cm area needs evaluation
  3. Spiculated Density
    1. Highly suggestive of Breast Cancer

V. Initial Work-Up of Mammographic Abnormality

  1. Studies
    1. Diagnostic Mammogram
      1. Cone Compression View
      2. Magnification View
    2. Breast Ultrasound
    3. Stereotactic Breast Biopsy
  2. Algorithm based on Findings
    1. Simple Cyst
      1. Reassure
    2. Solid or atypical
      1. Category 2 (Benign)
        1. Re-image with Mammogram in 6 months
      2. Category 3 (Indeterminate)
        1. Image guided Breast biopsy
          1. Ultrasound guided Breast biopsy
          2. Stereotactic Breast biopsy
        2. Surgical Breast Biopsy
          1. Needle Localization

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