Mammographic positioning in women with pectus excavatum: An anatomic challenge

To assess mammographic image quality in women with pectus excavatum (PEx) compared to women without PEx.

Fifty-six women with PEx between the ages 36-80 (median, 57 years) with screening mammograms from 2006 to 2020 were identified in an IRB-approved HIPAA-compliant retrospective review. Two fellowship-trained breast radiologists independently evaluated mammographic quality of 109 individual breasts in the 56 women using Enhancing Quality Using the Inspection Program (EQUIP) positioning criteria and visual breast density assessments. The number of images per breast was documented. Comparison was made to 2:1 age-matched controls whose screening mammograms were performed in the same year. A power analysis for the difference in the number of images per breast between study groups was performed before data collection.

Statistically significant differences with worse performance in women with PEx included: the pectoralis muscle extending to the posterior nipple line (p < 0.0001); adequacy of tissue visualized (p < 0.0001); inframammary fold included (p < 0.0001); breast free of skin folds (p = 0.003); presence of fibroglandular tissue at the CC view posterior edge (p < 0.0001); and CC and MLO within 1 cm of each other (p < 0.001). The average number of images per breast in the PEx group was greater than the control group (2.94 vs. 2.24, p < 0.0001).

PEx women more often fail to meet mammographic positioning quality standards and more often require additional views for screening.