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Year : 2003  |  Volume : 13  |  Issue : 3  |  Page : 323-325
Writing a mammography report


Tata memorial Hospital, Parel Mumbai 400012, India

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Keywords: Mammography, breast carcinoma

How to cite this article:
Ramani S K. Writing a mammography report. Indian J Radiol Imaging 2003;13:323-5

How to cite this URL:
Ramani S K. Writing a mammography report. Indian J Radiol Imaging [serial online] 2003 [cited 2020 Feb 19];13:323-5. Available from: http://www.ijri.org/text.asp?2003/13/3/323/28708
Mammography report is the only written document upon which clinical management decisions are based. Although many breast lesions do not have diagnostic mammographic appearances, the radiologist must convey to the clinician an assessment of the chance of malignancy for any given finding and should direct the clinician toward an appropriate course of action. The report must be clear, concise, candid, and judicious. Since many lesions are not clearly benign or malignant on mammography, reporting must often deal with possibilities rather than certainties. Biopsy decisions will be based on the mammographic findings alone. Thus, any word or phrase in the mammography report can profoundly affect patient management.

Mammography reports should be succinct and accurate. As important medical documents, reports should be standardised and clear.[1]

For screening studies, the following questions need to be answered:

Is the examination normal?

Is there an area(or areas) of concern requiring further evaluation?

Diagnostic studies:

If based on screening study, is anything confirmed? Are there findings consistent with breast cancer? What is the next step. Following complete work up, assessment categories 1 to 5 are used.

The impression should be a conclusion with specific recommendations, not a repeat of what was said in the body of the report. Do not use the report to make a decision or shift responsibility.

On clinically occult lesions, the radiologist interprets the mammogram and provides guidance and final recommendations (eg it is unnecessary to say "biopsy if clinically indicated" for a cluster of microcalcifications, or a non palpable mass).

Guidelines for writing such reports, based on the Breast Imaging Reporting system, developed by the American College of Radiology should be used. This will standardize mammography reporting so that the reports are clear, understandable and decisive.[2]

BIRADS consists of a lexicon of terminology with definitions to provide standardized language. BIRADS consists of six important headings: [Table 1]

A full diagnostic work up should be completed, which would include additional views, ultrasonography, and comparision with previous studies, before categorizing into category 1 to 5. [Table 2].

Format for mammography report should consists of:[3].

  1. Pertinent Clinical history.
  2. Type of study performed.
  3. Notation about comparision with previous studies.
  4. A succinct description of overall breast composition provides information about the accuracy of mammography for the breast being evaluated.
  5. Significant findings and modifiers are described according to standardized terminology, that has relevance in terms of potential for malignancy.
  6. The report concludes with an overall assessment into category 1 to 5, based on the possibility of malignancy, and recommendations for future action, where appropriate.


Findings that are of significance in patient management should be reported. Overall density is significant in that small cancers can be missed. Speculation concerning true histology that is based on the mammogram contributes little to overall management. The terms fibrocystic disease,fibrocystic changes,fibrocystic tissues,dysplasia,and hyperplasia are inappropriate and should be eliminated from image interpretation. Histopathologic terms should be reserved for the pathologist.[4].

It is important to add a disclaimer at the end of the report. In mammography the disclaimer protects the radiologist from the ignorant clinician who is not knowledgeable about the limitations of mammography and the meaning of a normal report.[5].


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Not all breast abnormalities show up on mammography. The false negative rate of mammography is approximately 10%.

The management of a palpable abnormality must be based on clinical grounds.

If you detect a lump or any other change in your breast before your next screening mammogram, consult your doctor immediately.

Many a times, the clinician do not like radiologist to be directive in their report, and instead, they describe the finding, and recommend clinical correlation. Recommending clinical correlation for a non- palpable mass on mammography is insufficient.

To give an example - an asymptomatic woman undergoes screening mammogram, which shows an irregular/ spiculated mass that has a high probability of malignancy. You recommend clinical correlation in the report, sign it, & telephone the clinician about it being a cancer. Assume that for some reason biopsy is not performed, and on palpation the lump could not be felt.

The matter goes to court. The clinician says he performed clinical correlation and could not palpate the lump, based on the radiology report recommendation. In this kind of situation a must biopsy report is what is required.

It is important that the radiologist carefully read the mammography report before signing it. Right and left breast locations for a mammographic abnormality must be correct and, consistent throughout the report. The report should always be explicit in guiding the clinician on the future course of action.

The phrase " malignancy cannot be excluded " should not be used. The report should assess possibilities rather than express uninformative warnings. The report must reconcile our desire to do no harm to the patient, with concern for her as well as ourselves.

 
   References Top

1.Breast Imaging Companion. Gilda Gardenosa. 2nd ed.Lippincott Williams & Wilkins, Philadelphia. 2001.Ch 17, 466-472.   Back to cited text no. 1    
2.Kopans DB, D'Orsi CJ, Adler DD, et al: Breast Imaging Reporting and Data System. Reston VA, American college of Radiology, 1998.   Back to cited text no. 2    
3.D'orsi CJ, Debor DD: Communications Issues in Breast Imaging. R.C.N.A 33: 1231 - 1245, 1995.   Back to cited text no. 3    
4.Breast Imaging. 2nd Ed. Daniel B Kopans. Lippincott Raven. 1998.Ch 24, 761-796.   Back to cited text no. 4    
5.Mammographic Interpretation. A Practical approach. Marc J.Homer. McGraw - Hill,Inc.1991. Ch 5,23-29.  Back to cited text no. 5    

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Correspondence Address:
S K Ramani
Tata memorial Hospital, Parel Mumbai 400012
India
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Source of Support: None, Conflict of Interest: None


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