RSNA: Avoiding pitfalls in breast radiology

CHICAGO—Despite concerns from radiologists about reading breast imaging exams due to medicolegal notoriety, most breast imaging exams in the country are still being read by radiologists who lack dedicated breast imaging training.

Looking to educate attendees about potential mammographic blind spots in radiology, a group of researchers led by Jade De Guzman, MD, a faculty member at University of California, San Diego, presented “Blind Spots and Pitfalls in Breast Imaging” today as part of the Radiological Society of North America (RSNA) Poster Presentation series.

The presentation’s teaching points include differentiating perceptual versus cognitive errors in breast imaging and providing an algorithmic approach for reading screening and diagnostic mammograms, breast US and breast MRI.

“I would say the majority of radiologists who read breast are not fellowship trained in breast imaging,” De Guzman said. “It is impossible to have specialized training in everything. Our presentation covers common pitfalls radiologists encounter when interpreting mammograms, breast ultrasound and breast MRI.”

De Guzman said the purpose of the presentation is to allow the radiologist to improve their approach to interpreting these exams, helping them to be more thorough.

Blind spots De Guzman mentioned include the subareolar region.“It’s just under the nipple and it’s hard to get enough compression on the mammogram to get a clear image of this area with many overlapping normal structures, primarily ducts,” she said. “It is also important to pay attention to the inframmary fold and axillary tail, commonly not imaged on a standard craniocaudal mammographic view.”

The presentation included a few pointers for attendees.“I’d say the most important thing to do when reading breast in to evaluate every corner of every image.”

De Guzman added age and risk stratification also are important.

“Whenever possible, always have prior exams even further than just the standard two years,” De Guzman said. “If you look farther back, you can see slow change over time."