[The correct mammographic exam: the usefulness of additional views]

Till 20 years ago, physical examination of the breast was the fundamental procedure for the diagnosis of breast conditions, but mammography has now become the only examination to diagnose infraclinical carcinoma. High quality mammographic images enhance the radiologist's skill.

We performed 2713 mammograms in a year's work and then selected 456 patients with questionable or poor mammographic findings (craniocaudal or midlateral oblique views) for further studies. The additional examinations were performed either to show the whole gland or to clarify the following findings: hyperdensity/asymmetry, ill defined nodule/pseudonodule, stellate lesions, microcalcifications, superficial or cutaneous lesions, inflexed nipples. As additional studies, we acquired spot compression images with/without magnification, exaggerated craniocaudal and cleavage images, images with a skin marker, rolled and tangential images. Based on radiologic findings, 155 patients were submitted to US, 104 to FNAB (under US or stereotaxic guidance) and 67 to surgery.

The additional views proved useful in 83.2% of patients showing the whole parenchyma in 35.4%, ruling out suspected abnormalities in 28.8%, depicting and characterizing nodules and microcalcifications in 19% of patients.

In our study, additional views played an important role in the correct execution of mammographic studies because they: showed the whole gland; permitted to rule out suspected pathologic conditions; confirmed and defined previous questionable lesions, thus allowing the radiologist to plan the proper diagnostic route.