Teach you how to easily understand X-ray reports, don’t be intimidated by professional terms!

Author: Qin Naishan, Chief Physician, Peking University First Hospital

Reviewer: Song Guohong, Chief Physician, Peking University Cancer Hospital

Mammography is one of the important tools for breast cancer screening and plays a vital role in clinical practice. However, for many women, facing the professional terms on the examination report may be confusing or even anxious. Let's learn about the common terms and their meanings in the mammography report, and share some guidance information on preparation before the examination so that patients can understand their examination results more clearly.

First, let's talk about the preparation before the examination. To ensure the accuracy and image quality of the mammography examination, patients should clean their breast skin the day before the examination and avoid using any oil, powder or other skin care products. This is because some skin care products may produce artifacts similar to calcification in X-ray imaging, which will interfere with the doctor's judgment of the examination results. Other than that, no special precautions are required, just keep the breasts in their natural state.

Figure 1 Original copyright image, no permission to reprint

When it comes to calcification, many patients will immediately think of breast cancer. However, this is not the case. Calcification is very common in women, especially women over 45 years old. About 60%-80% of their mammography films can be seen with calcification. Of these calcifications, 80% are benign, and only a very small number are malignant. Therefore, when the description of "calcification" appears on the examination report, patients do not need to panic too much. Doctors will judge whether the calcification is benign or malignant based on its morphology, and most calcifications are benign. It is worth noting that benign calcifications usually do not turn into malignant ones. Common benign calcifications include vascular calcification, skin calcification, etc., which gradually appear with age.

In addition to calcification, mass is also a common term on mammography reports. Similarly, mass is not equivalent to breast cancer. There are many benign diseases, such as fibroadenomas, complex cysts, etc., which will appear as "masses" on X-rays. Therefore, when seeing a "mass", patients do not need to be too nervous. Doctors will distinguish between benign and malignant based on the shape, margins and other characteristics of the mass.

Architectural distortion is another more complex sign in mammography. It refers to the changes in the surrounding normal structures caused by small lesions on the breast, making these structures look different from normal structures. Architectural distortion can be either benign or malignant. Benign architectural distortion may be caused by scars after surgery or trauma, and can also be seen in proliferative diseases such as radiation scars; malignant architectural distortion is caused by breast cancer. Benign and malignant architectural distortions are very similar in X-ray images, making it more difficult for doctors to judge whether they are benign or malignant. If the patient has a history of breast-conserving surgery, breast trauma or puncture biopsy, the patient should actively provide this medical history information to the doctor to help the doctor more accurately determine the cause of the architectural distortion. In the absence of a clear history of the above, the doctor may recommend a puncture biopsy to clarify its nature.

Patients do not need to worry too much when "asymmetric breast tissue" appears on the mammography report. Asymmetric breast tissue is also a common sign in X-ray examinations. It may be caused by a variety of reasons, such as asymmetry during development, asymmetry caused by breastfeeding, and asymmetry during menopausal breast regression. Bilateral breast asymmetry caused by these reasons is usually a benign change. When patients have focal asymmetry, that is, the density is higher than the opposite side only in a smaller area, the doctor may recommend short-term follow-up.

The "BI-RADS" classification system on the mammography report is also important for patients to understand. BI-RADS stands for the Breast Imaging Reporting and Data System, which divides the possibility of malignancy of breast lesions into 0-6 categories. Among them, BI-RADS 0 means that the examination is uncertain and further examination is required; BI-RADS 1 means that the breast is completely normal; BI-RADS 2 means benign breast lesions; BI-RADS 3 means that there are suspicious lesions in the breast, but the possibility of benignity is high and short-term follow-up is required (usually 6 months of follow-up); BI-RADS 4 means that the possibility of malignancy of the lesion increases and a puncture biopsy is required to confirm the diagnosis; BI-RADS 5 means that it is almost certain to be breast cancer; BI-RADS 6 means that the patient has been diagnosed with breast cancer and is undergoing efficacy evaluation. It should be emphasized that the BI-RADS classification only indicates the possibility of breast cancer, and does not directly represent the malignancy of breast cancer.

Figure 2 Original copyright image, no permission to reprint