Reasoning for 3D mammo vs regular mammogram?

Hi there. In my case, the reason for the "upgrade" was simply that 1) they bought new equipment and 2) my insurance started paying for it. But I understand 3D is better for dense breasts, and it is possible to compare back to 2D. Hope that helps and thinking good thoughts for you.

Not trying to be Negative Nelly here. Glad you are getting US as well! I had dense fibrocystic breasts and always did 3D mammograms, including the day I had my US and biopsy. 3D mammograms that day were All Clear! 1.9 cm tumor was picked up only on US.

Fingers crossed for you that all is benign!

Sara536

MRI is the most sensitive exam for breast cancer, some say too sensitive so its always important to have them done where they read many of them per day. Cancers are identified on MRI because they are vascular and enhance with a characteristic pattern. I don't believe it would miss something that was later identified on US unless it was completely avascular.

Many times when an MRI is done it is followed by an US in order to further characterize a finding and to facilitate biopsy. There have been times when an US is "normal", the MRI shows an abnormality, then the "second look US" finds a very very subtle abnormality that corresponds to the MRI finding. In my experience this happens when a whole-breast US is done for screening purposes in patients without a lump. If there is something really subtle it could be overlooked on US machine settings used for screening vs dianostic US where you know where you are looking and have an idea of what it might be ahead of time. Its a matter of perception for both the tech and the radiologist.

oxygen18

MRI takes the most training and experience. There are so many variables involved in their acquisition of images, and the degree of sensitivity is such that one needs to know what can be safely ignored when interpreting them otherwise there are lots of false positives. The ACR even offers a special certification in breast MRI interpretation.

Mammograms are X-rays and all radiologists understand how to read regular X-rays. Many do not like to read mammograms and read them reluctantly which results in a less than optimal interpretation. Its not enough to merely identify the presence of a mass or calcifications one must be able to tell if they are suspicious or not so to avoid unnecessary biopsies.

US is my favorite modality for examining the breast. It supplies so much more information about masses. The characterization of a mass with US is superior to a mammogram (which basically tells us that there is a mass and where you should look with US). All radiologists learn to read US including breast US. That being said if one immerses themselves in breast US long enough one begins to pick up many more subtle changes in the breast tissue, other than masses, that are not always appreciated.

After 30 years of reading breast imaging, and only breast imaging since 2003, I am a bit biased about who should read what. At first I assumed all rads read mammograms at the same level until I decided to make it my career. I learned far more about breast imaging that way than any general radiologist could. Medicare rules state you must interpret close to an average of near 500 mammograms a month to be qualified to read mammograms and be reimbursed by medicare. I routinely read thousands of mammograms a month depending on where I was practicing. There is no way to get those numbers if you are also reading chest X-rays, abdomen cat scans etc. I did 100's of biopsies each year as well. I personally would only go to breast centers where the rads do nothing but breast imaging and breast biopsy procedures but I do admit that is not always possible.

I am also of the (probably unpopular) opinion that only fellowship trained breast surgeons should be operating on breasts. The more recently trained ones that I know also have training in plastic surgery techniques so that there is a much better cosmetic outcome after lumpectomy and other breast surgeries.

djmammo,

Thanks so much for these answers. Glad to hear you are partial to my favorite test, ultrasound. Also glad that breast surgery fellows are finally learning basic cosmetics skills.

I had not even been aware that there exist breast radiology specialists until around the time of dx. Had to find out on my own, as I was questioning the need for biopsy.

Referring drs had never seemed to care where I got mammos done, and some even wrote the mammo rx on letterhead of general radiology companies.

I like to think that in smaller communities the general radiologists get much experience at interpreting breast images, as by default they see more of those than do the general rads in large cities where specialists are available.