Mammography is the gold standard tool for the early detection and diagnosis of breast cancer. However, like all medical tests, mammography is not foolproof and there are several pitfalls that can lead to incorrect interpretation:
- Overlapping tissue: The breast is made up of of glandular fat and connective tissue. Although it is a three-dimension structure, the normal tissue of the breast can overlap on mammography (a 2D snapshot), leading to artifactual asymmetries on review of the images. These can lead to false positives, where the radiologist asks for additional workup only to reveal no underlying suspicious finding. The advent of digital breast tomosynthesis (“3D mammography”) has helped decrease this type of false positive recall for images.
- Dense breast tissue: Breast density, or the ratio of glandular tissue to fat in the breast, can also be a challenge in mammography. Women with dense breast tissue are more likely to have false negatives, where the mammogram appears normal but there is actually an underlying cancer hidden behind normal breast tissue. On mammography a suspicious mammographic finding can be masked by dense tissue. Supplemental screening with breast ultrasound or breast MRI, depending on risk factors, may be considered in women with dense breasts.
- Image quality: Poor image quality can also impact the accuracy of mammographic interpretation. Factors such as incorrect positioning, movement during the exam, or technical issues with the equipment can all lead to blurry or malpositioned images that are difficult to interpret.
- Radiologist experience: The experience and expertise of the radiologist also plays a role in the accuracy of mammographic interpretation. Less experienced radiologists have been shown to be more prone to making errors due to their lack of familiarity with certain imaging findings. Expert radiologists have the retinal miles to interpret breast imaging quickly and confidently.
To mitigate these pitfalls and improve the accuracy of mammographic interpretation, it is important for radiologists to receive ongoing training and education. This can include reviewing case studies, participating in continuing medical education courses, and collaborating with experienced colleagues. In addition, advanced imaging technologies such as digital breast tomosynthesis (DBT) and breast MRI can help to improve diagnostic accuracy by providing additional views and information about the breast tissue.
Overall, while mammography is a valuable tool in the early detection and diagnosis of breast cancer, it is important to recognize the limitations and potential pitfalls in interpretation. By staying up-to-date with the latest technology and techniques and receiving ongoing training and education, radiologists can improve their skills and accuracy, ultimately leading to better patient outcomes.