An annual mammogram is a screening mammogram and usually involves taking images (views) of each breast from two different directions. If the radiologist or physician interpreting the screening mammogram images sees something that is questionable, unclear or abnormal on the images, they often ask the patient to come back for additional imaging (on the same day or on a subsequent date).
Additional imaging may consist of:
- Additional orientations or "views" (images taken at different angles)
- Breast ultrasound which is frequently used to evaluate questionable areas such as suspected cysts seen at screening mammogram.
- Special mammography views, which may include magnification views or focal/spot compression views. Both are used to make a small area of breast tissue easier to evaluate.
- Other adjunctive imaging such as MR, Sestamibi or T-scan imaging
Magnification views use a small magnification table (depending on type of mammography system being used by the facility) which brings the breast closer to the x-ray source and further away from the film plate. This allows the acquisition of "zoomed in" images (2 times magnification) of the region of interest. Magnification views provide a clearer assessment of the borders and the tissue structures of a suspicious area or a mass. Magnification views are often used to evaluate micro-calcifications, tiny specks of calcium in the breast that may indicate a small cancer.
Spot compression is also known as compression mammogram, spot view, cone views, or focal compression views. All mammograms involve compression of the breast. Spot views apply the compression to a smaller area of tissue using a small compression plate or cone. By applying compression to only a specific area of the breast, the effective pressure is increased on that spot. This results in better tissue separation and allows better visualization of the small area in question. Spot compression views show the borders of an abnormality or questionable area better than the standard mammography views. Some areas that look unusual on the standard mammography images are often shown to be normal tissue on the spot views. True abnormalities usually appear more prominently and the margins (borders) of the abnormality can be better seen on compression views.
Cleavage view (also called "valley view") is a mammogram view that images the most medial (central) portions of the breasts. This is the portion of breast tissue "in the valley" between the two breasts. When one breast is imaged and the other breast is left out of the compression field, some of the breast being imaged may get pulled or left out too. To get as much medial tissue as possible, the mammogram technologist will place both breasts on the plate at the same time to image the medial half of both breasts.
A cleavage view may be performed when there is a questionable density on the medial edge of the mammogram film and the radiologist needs to see more of this density (if possible). A cleavage view may also be performed if the radiologist sees something suspicious in the mediolateral-oblique (MLO) mammogram view and cannot find the area on the cranial-caudal view (CC) view. Click here to learn more about views taken during mammography.
Please note that women who are recalled for additional or special views should not be alarmed. Eight out of ten patients (80%) that get recalled for additional views are subsequently categorized as "benign" or "probably benign" and receive follow up with mammography in 12 months or 6 months, respectively. Only about one out of ten women who are recalled for special views are determined to have carcinoma.
Updated: May 4, 2008
Click here to learn more about the breast cancer diagnosis process
