Recent preoperative mammographic evaluation (usually within 3 months) is necessary to determine a patient’s eligibility for breast cancer conservation treatment. It should be performed with high quality, dedicated mammographic equipment in a facility certified by the FDA under the Mammographic evaluation prior to biopsy or definitive surgery plays an important role in establishing the appropriateness of breast cancer conservation treatment by defining the extent of a patient’s disease, the presence or absence of multi centricity, and other factors that might influence the treatment decision. It is important for evaluating the contralateral breast. Bilateral mammography is required for palpable lesions as well as nonpalpable lesions that can be identified only radiographically. Nonpalpable masses and microcalcifications comprise an increasing percentage of carcinomas treated with breast conservation.
The breast tumor should be measured in at least two dimensions on the mammographic views or from ultrasonography if it is performed. The size of the tumor should be included in the mammographic report. If the tumor is an indistinct or spiculated mass, approximate dimensions can be given from either the mammogram or the sonogram. The skin of the breast in the area of a mass should be evaluated for thickening that might signify tumor involvement. If the mass is associated with microcalcifications, an assessment of the extent of the calcifications within and outside of the mass should be made, including the dimensions of the area in which calcifications are located. If one or more clusters of microcalcifications are the only markers of the tumor,their location and distribution should be described. For evaluation of masses and microcalcifications, specialized views with positioning adapted to the location of the abnormality may be helpful. Magnification mammography and spot compression is important for characterizing microcalcifications and defining the margins of masses. Ipsilateral multifocality or multicentricity may be present and influence the treatment selection. In every instance, when one abnormality is seen, all areas of each breast should be fully evaluated for the presence of additional disease.
Using magnification mammography and ultrasound, patients with tumors suitable for breast conservation can be selected with a high degree of accuracy. Some studies have suggested that magnetic resonance imaging (MRI) is a useful adjunct to mammography and ultrasound for identifying multifocal and multicentric disease. The use of intravenous contrast material (gadolinium) with MRI allows for the detection of regions of high vascularity in the breast, which include many, but not all, breast cancers. MRI has been found to be more sensitive than mammography as a screening technique in patients at very high risk for breast cancer development. Unfortunately, many benign lesions also exhibit high contrast uptake and so the number of false positive examinations is high. This and the cost, the lack of standardization of technique, and the difficulty in biopsying lesions seen only on MRI have limited the wide-spread use of MRI in the evaluation of these patients. Currently, there are no data on whether treatment changes that occur in response to the additional lesions seen on MRI will affect local recurrence rates or overall patient survival.
