First written in August 6, 2017; updated – May 27, 2018
Mammographies or x-ray of the breasts are being done frequently. Patients have copies of the reports and try to look or even “interpret” what are written or stated there. One output or scenario of patients’ “interpretation” is that they are not bothered by what are stated or written because they claim they do not understand them and would rather wait for a breast specialist’s explanation or interpretation. This is a good and best stance – let a breast specialist explain and interpret the reports or the statements in the reports. The breast specialists correlate (they should) whatever statements or phrases seen in the reports with the physical examination findings (they should do physical examination of the breast and not just rely on the radiologist’s findings) and decide which are significant and which are not significant findings and whether to follow or not to follow the recommendations made by the radiologists. There may be reports of something like presence of more than one-centimeter nodules or masses on mammography but which are not seen on physical examination (usually breast nodules or masses 1-cm or more should be palpable by a breast specialist). In such situation, the breast specialists have to decide what to do, with the options of repeating the mammography; request for a different diagnostic tests on the breasts such as ultrasound or magnetic resonance imaging; or just wait and watch with repeat physical examination of the breast at another time, such as one month or at planned intervals. There may be reports of something like presence of microcalcifications that are suspicious of malignancy. The breast specialists have to take a look at the mammographic plates and scrutinize the microcalcifications reported by the radiologists and decide whether they are significant or not; whether they are highly suspicious for malignancy or not; or whether they should do needle-localization biopsy or not as recommended by the radiologists. A lot of times, mammography reports contain such a phrase: BIRADS 0 – needs additional examination even though there are no architectural distortion, discrete mass lesion, and suspicious microcalcifications seen. Most of the time, ultrasound of the breast is the additional examination recommended. The breast specialists have to decide on this. If the mammogram report there are no architectural distortion, discrete mass lesion, and suspicious microcalcifications seen and the physical examination done by the breast specialists show no abnormal findings, particularly no dominant mass, there is usually no need to have additional examination.
Another output or scenario of patients’ “interpretation” is that they are bothered by what are stated or written because they look alarming such as presence of nodules; presence of multiple nodules; presence of calcifications, both macrocalcifications and microcalcifications; BIRADS reporting, such as BIRADS 0 – needs additional examination and BIRADS 4 – suspicious for malignancy; and presence of a recommendation to do a biopsy. In such a scenario, the advice is to see a breast specialist right away for proper interpretation and recommendations, one to allay undue fear and anxiety which may not be necessary because it may turn out there is no problem afterall. Second, to be helped in deciding whether the radiologists reports (findings and recommendations) are valid or not.
Important take home tips:
Whatever be the report of the mammograms, consult a breast specialist right away for proper interpretation, explanation and recommendations.
Since mammograms in the Philippines and probably in other countries frequently contain BIRADS 0 – needs additional examination even though there are no architectural distortion, discrete mass lesion, and suspicious microcalcifications seen, consult a breast specialist right away proper interpretation, explanation and recommendations. He / she will make the necessary recommendations whether an additional examination is needed or not.
For all mammogram results, there must be a clinical correlation, meaning comparison of the mammogram results with the clinical findings and other available data This phrase is usually seen in all mammogram reports.