Chief Complaint: Breast Mass
a. History: No Co-morbidties
B. Mammography:
| BI-RADS Category | Interpretation | Recommended Action |
|---|---|---|
| 0 | Incomplete | Additional imaging (e.g., ultrasound, spot compression, or MRI) |
Spot compression (also called focal compression or compression views) is a specialized mammographic technique used to evaluate a localized area of concern more clearly—typically when a mass, asymmetry, or distortion has been detected on standard views.
Targeted Area: The radiologist or technologist identifies the area of interest seen on the initial mammogram (usually from a craniocaudal or mediolateral oblique view).
Small Compression Paddle: A smaller compression paddle than usual (often 5–10 cm wide) is used. This paddle applies focused pressure on the area of interest while surrounding tissue is spared.
Patient Positioning:
The breast is carefully repositioned to center the area in question.
Compression is applied directly over the region, flattening it to eliminate overlapping structures and spread out the tissue.
Image Acquisition: A mammogram is taken in the same projection as the one showing the abnormality (e.g., CC or MLO) and possibly in orthogonal views for better characterization.
Reduces tissue overlap, improving visualization
Clarifies margins of a mass (e.g., distinguishes between a true mass and overlapping glandular tissue)
Better characterizes asymmetries or architectural distortions
Helps differentiate benign from suspicious lesions
If a mammogram shows a vague density in the upper outer quadrant, spot compression can determine if it is a true mass or simply overlapping fibroglandular tissue. If the area resolves under compression, it’s likely benign.
Would you like an annotated diagram or example mammographic images to illustrate this?
Higher sensitivity in fatty breasts: As women age, their breasts usually become more fatty and less dense, making mammography more effective at detecting abnormalities.
Detection of microcalcifications: Mammography can detect microcalcifications and architectural distortions, which may not be seen on ultrasound.
Standard of care: According to guidelines (e.g., ACR, NCCN), mammography is the first-line imaging for breast mass evaluation in women over 30, including elderly patients.
To further characterize a palpable mass after mammography.
If the mass is not visible on mammography (e.g., posteriorly located or very small).
To distinguish cystic vs solid lesions.
To guide biopsy, if a lesion needs tissue sampling.
In patients who cannot undergo mammography (e.g., severe kyphosis, painful positioning).
Ultrasound is complementary—used for further characterization or if mammographic findings are inconclusive.
Would you like a comparison table of mammography vs ultrasound in this context?