[Additional images and subsequent palpation--indispensable conditions for efficient diagnosis using mammography]

As adjuvant to standard two-view mammography with craniocaudad and oblique projection additional mammographic views are required to definitely establish a diagnosis in about 30% of patients. These are further views of the entire breast in other planes, repetition of standard mammographic projections, special views of parts of the breast and of the axillary region and tangential spot films. In case of nonpalpable mammographic abnormalities additional views help to study the constancy of the findings (superimposition effect?), the diagnostic significance (occult carcinoma?, parenchymal asymmetry?, benign or malignant microcalcification?) and to determine the topographical position of the lesion. Not uncommonly palpatory findings can be picked up mammographically only by special views, often they require further views in other planes for better delineation of the lesion. The important correlation of palpatory and mammographic findings is frequently possibly only with tangential spot films. Only personal physical examination by the mammographist will ensure the appropriate use of additional mammographic views. This concomitant palpation should be carried out immediately before mammography and especially after completion of mammography while viewing the mammographic images. Additional mammographic views make it possible to improve the diagnostic accuracy of numerous malignant and benign lesions of the breast and of the axilla. Conclusive proof of the benignity of a lesion and thus prevention of an unnecessary biopsy is mostly only possible by means of additional special views. This includes superimposition effects, tumorlike asymmetry, lipomas, fibroadenolipomas and oil cysts all of which amount to 12% of all patients in our material.