X-ray mammography: Ductography, Pneumocystography, Imaging mammography

Medically reviewed: 11, February 2024

Mammography: X-Ray of the Breast

X-ray studies in mammology are a group of radiation diagnostic techniques that give an idea of ​​the morphological structure of breast tissue, the presence of additional formations (including those not palpable), their nature and prevalence. X-ray studies in mammology include survey mammography (in 2 and 3 projections), aim mammography, ductography, pneumocystography, etc.

Obtained radiographs of mammary glands should be preserved for the possibility of conducting a comparative analysis of images in dynamics. X-ray examinations in mammology are not indicated during pregnancy and lactation.

Review mammography

Survey mammography in two standard projections – X-ray examination of breast tissue and regional lymph nodes (supraclavicular and axillary) in a straight and oblique projections. Survey mammography is performed for healthy women older than 35 years 1 time in 2 years, after 50 years – annually; with the pathology of the breast – in an individual mode.

During the study, the mammary gland is clamped between 2 mammogram plates for better mammogram quality. The survey mammography in two standard projections allows to reveal the cyst, fibrocystic mastopathy, benign and malignant tumors of the mammary gland and other pathological changes.

Today, mammology uses X-ray film mammography and digital mammography. In film research, the image is recorded on an X-ray film; with digital mammography – displayed on the monitor screen, stored in the computer memory, can be processed using various programs.

Digital mammography is the most informative for high density of breast tissue.

Survey mammography serves as a method of screening – that is, examining mass groups to detect pathological changes in the mammary glands (primarily breast cancer) in the early stages.

Mammography is performed for women older than 35-40 years, whereas at a younger age informative and safe is ultrasound of the mammary glands. The accuracy of mammography in the detection of pathology is 70-80%; the study does not exclude the receipt of false negative or false positive results. In case of doubt, ultrasound, ductography, pneumocystography, sight mammography, MRI of the mammary glands may additionally be prescribed. The quality of mammography depends on the class of mammography used, the technology of developing the images, the qualifications of the radiologist. Indications for mammography are determined by a mammologist, oncologist or gynecologist.

Indications for mammography

Mammography is used for prophylactic screening of women older than 35 years with the goal of detecting early non-palpable breast cancer. Healthy women under 45 years of age mammography is held every 2 years, after 45 years – every year. In the presence of dysgormal hyperplasia of the breast, the frequency of mammography is determined individually. Diagnostic mammography is performed with pains in the mammary glands, palpable seals, discharge from the nipple, any changes in the skin of the breast, the nasal region or nipples.

Mammography is indicated for the purpose of distinguishing between breast wall tumors and breast tumors, to monitor the progression of mastopathy, the staging of primary breast cancer, and the dynamic evaluation of the state of the gland tissues after surgery.

By means of mammography, calcinates, cysts, fibroadenomas, malignant neoplasms of the breast are revealed. In case of suspected breast cancer, the diagnosis is verified by performing a puncture biopsy of the mammary gland or trepanobiopsy, followed by a cytological examination of the biopsy specimen. Mammography is performed on the 5-12th day of the menstrual cycle, in women in menopause – at any time. Mammography is not given to pregnant women and breastfeeding women.

Mammography: Method of conducting

When conducting mammography, special mammography equipment is used. For mammograms, a woman is asked to take off her clothes above the waist. Before mammography, avoid applying to the skin of the breast and axillary areas of perfume, deodorants, lotions, powders, because the ingredients of cosmetics can give artifacts on mammograms.

Before the procedure your doctor should be warned if a history of mammary gland surgery, including plastic surgery for breast augmentation and mammary gland endoprosthetics. If breast implants are available for mammography, special device settings are selected to prevent complete compression of the endoprosthesis. The presence of a breast implant makes it difficult to visualize and qualitatively diagnose the condition of the breast.

During the survey mammography, mammograms of both glands are performed in the straight and lateral (oblique) projections. For mammography each breast is alternately clamped between a special stand and a plate and X-ray irradiation is performed.

Breast compression is necessary to improve the quality of mammograms. With a small breast size, experienced pains, expressed fibroadenomatous changes, mammography can be moderately painful. If necessary, targeted mammograms of individual sections of the breast are performed.

To do this, the test areas are marked with lead marks and a narrow tube is taken. In the presence of secretions from the nipples into the milk ducts, an x-ray contrast is introduced and ductography is performed. If you want to determine the most precise place for puncture, use a special grid with holes. The procedure of mammography takes no more than 15 minutes.

Mammography: Interpretation of results

When deciphering the results of mammography, the radiologist takes into account clinical and anamnestic data. When evaluating mammograms, the structure of fat and glandular tissue, ducts, vessels is studied. When identifying pathological foci, their number, size, location, shape, shape, symmetry, homogeneity are established.

The tissues of the breast with different densities on mammograms have shades of white, gray and black. In the process of interpreting the results of mammography, it should be borne in mind that tissue density is higher in young women, as well as in hormone replacement therapy, and decreases after menopause, a previous oophorectomy.

Fibroadenomas and cysts in mammograms are defined as oval or rounded formations that have a clear distinction from healthy tissues. In contrast, with breast cancer, the shadows that are identified may have vague contours, radiant or prickly borders.

Calcifications detected by mammography may be benign or accompany the development of breast cancer, so always require further clarification.

Mammography: Method Restrictions

Early detection of breast cancer during preventive mammography increases the survival statistics of women with this disease by 30%. In a number of cases, with the help of mammography, it is possible to detect tumors less than 5 mm in diameter and conduct organosaving operations.

The radiation load accompanying the mammogram is insignificant (less than with chest X-ray) and can not provoke the development of oncology. In general, the risk of regular mammography is significantly lower than the probability of spontaneous development of breast cancer.

Informative mammography is limited in nulliparous women and women younger than 35 years due to high tissue density, with endoprostheses of the mammary glands, severe mastopathy. With the location of tumor changes in the thickness of the gland, mammography may not reveal them and give a false negative result.

Review mammography in three projections

Mammography in three views is a method of radiation diagnosis of changes in the tissues of the breast with the help of the polycystonic x-ray of each gland in standard (direct, oblique) and additional (usually lateral) projections. Survey mammography in three projections allows to obtain an image of the maximum possible volume of the gland from different angles of view.

It is carried out in case of necessity of specification of the structure of connective and glandular tissue, vessels, ducts, lymph nodes; localization of pathological foci, their number, size, shape, shape; with individual features of the size or structure of the breast.

Imaging mammography

Imaging mammography is an additional radiological examination of the mammary gland, which gives the most complete information about the dubious part of the tissue in the presence of a tumor or suspected of it. Imaging mammography complements the survey images, is performed in doubtful cases in order to clarify the true nature of the nosological process or to monitor the puncture biopsy.

On targeted mammograms due to multiple magnification, the examined area is visualized more clearly, which avoids the diagnostic inaccuracies caused by the effect of the projected shadowing.

Ductography

Ductography – contrast X-ray mammography examination of the ducts of the mammary gland. The ductography is shown in case of pathological (spontaneous, bloody) secretion from the nipple for diagnostics of intra-flow formations.

Before ductography under local anesthesia areoles in the milk ducts, a contrast agent absorbing X-rays is injected, after which images are taken in the upper-lower (direct) and oblique projections. On the images obtained, the contrasted duct is visually visualized together with the branches, in the presence of a tumor, its location and dimensions are determined.

Ductography serves for refining diagnosis of the condition of the milk ducts after their artificial contrasting. In the process of ductography a series of X-ray mammography images is performed, along which the filling of the channels with iodine contrast is monitored. Intraprotrophic growths are mostly benign in nature, but in some cases may be precancerous changes or a malignant tumor.

Therefore, the main purpose of ductography is to confirm or refute the diagnosis of intra-cellular breast cancer.

Ductography is usually preceded by an overview mammography or MRI of the mammary glands, which reveal the formation in the mammary gland, but can not accurately indicate the location of the tumor (lobule, duct, fatty tissue). Currently, mammology uses ductography as the main method that allows you to determine intra-flow changes and their clear localization. Indication for conducting ductography specified mammologist, roentgenologist or oncologist.

Indications for ductography

The method of ductography has narrowly directed indications. The main purpose of ductography is the identification of intra-flow papillomas, cancer, adenomas and cysts of the breast. By means of the ductography , intra-flow formations of 1 mm in size can be detected. A direct reason for carrying out ductography is pathological secretion – allocation of the nipple hemorrhagic (bloody, brown) or serous.

Since the cases of pathological secretion from the mammary gland can be due to various causes (deformation of ducts in mastopathy, inflammation, endocrine pathology, in-flow formations), doktografiya is complemented by a study of the smear from the nipple of the breast, the definition of prolactin and oncomarker of breast cancer CA 15-3.

Suspicion of intraprotective formations usually occurs with unilateral character of bloody or serous-amber precipitates. With the help of ductography the causes of pathological secretion are established in 92-96% of cases. In addition, the exact location and prevalence of intra-flow changes is determined during the process of ductography, which is extremely important for the planning of surgical treatment. In some cases, the ductography has a therapeutic effect: after washing the duct with contrast material, some patients stop the pathological discharge from the nipple.

Contraindications for ductography

ductography is contraindicated in case of allergy to iodine-containing contrast, pregnancy, acute inflammation of the mammary gland (mastitis, abscess), lactation, atypical cells in smears-secretions of the mammary gland and palpable tumors in the excretory ducts to prevent the migration of malignant cells along the ducts. The dentography is performed 5-12 days after the start of the last menstruation; women in menopause have no restrictions on the duration of the procedure.

Ductography  and Method of conducting

The doppler is performed in an x-ray room equipped with a mammography unit. Before the procedure of ductography, a woman must undress to the waist, taking off her body jewelry. Before ductography it is strictly forbidden to try to massage or squeeze the mammary gland on its own to avoid traumatization of the ducts. 2-3 days before ductography recommend to start taking spasmolytic drugs.

After processing the areola, the doctor presses on the nipple, looking for the secretion of the secretion opening of the milk duct. Then a thin dilator is introduced into the opening of the duct to expand it. With the help of a flexible plastic cannula, a contrast (verografine, urotrust, etc.) in the amount of 0.25-0.5 ml is injected into the duct. After that the mammary gland is placed on the mammogram stand, pressed with a plate and X-rays are taken in a straight and oblique projection.

Breast compression ensures uniform distribution of contrast across the ducts, minimizes its number, and the use of a flexible cannula prevents the entry of air emboli into the ducts, which may make it difficult to follow the evaluation of the goggles. After the end of the doktografiya contrast is removed. The study lasts about 30 minutes. Holding a ductography can be accompanied by a slight discomfort.

Ductography: Interpretation of results

On the received duchtogrammy milk ducts with branchings are clearly distinguishable, which allows to detect filling defects, deformation of ducts, their caliber, expansion or constriction, outlines, shape and localization of tumor-like changes. An experienced radiologist or mammologist on the basis of a ductography will distinguish dystrophic or other changes from intra-cellular cancer.

If intradermal papillomas are detected, the implementation of sectoral resection of the mammary gland is indicated, since such changes are regarded as a precancerous disease. In case of confirmation of intra-cellular breast cancer, a further examination is carried out, including lung radiography, thoracic CT, abdominal ultrasound, scintigraphy, and mastectomy.

Complications after ductography

In the course of ductography there is an insignificant danger of traumatizing of the milk duct with the introduction of a catheter or contrast. Usually such damages pass independently without additional interventions. If the catheter hits the unchanged duct, the results of the ductography will be false negative, not revealing the desired changes. Radiation exposure in the implementation of ductography is not dangerous and does not have a carcinogenic effect.

Pneumocystography

Pneumocystography – an additional X-ray study of fluid formations (cysts) of the mammary glands.

Pneumocystography is performed after a targeted puncture biopsy of the formation and aspiration of its contents. Without removing the needle, through it into the cavity air is introduced, then the radiographs in the necessary projections are performed. With the help of pneumocystography, the complete cyst emptying is estimated, the architectonics of cavity education is being clarified, wall extensions are revealed, etc.

Taking into account the data obtained, the question of the possibility of performing local sclerotherapy replacing surgical tactics in 80% of patients with solitary mast cysts is being solved.

Key Points about Mammography