GAMUT I-19-S
MAMMOGRAPHY MISTAKES AND PITFALLS FOR RADIOLOGISTS AND OTHER PHYSICIANS


1. Reading mammograms under poor viewing conditions:
a. With any room light reflected off films (overhead lights, lamps, hallway, other viewboxes)
b. Without large, good quality magnifier
c. With regular viewbox or dim light source (strong light source needed for mammogram reading)
2. Assuming a lesion is benign (especially a nodule) based on screening films only without proper workup (eg, magnification views or ultrasound).
3. Recommendation for biopsy of benign milk of calcium crystals due to failure to perform true lateral views or magnification views.
4. Mistaking a hypoechoic mass for an anechoic cyst on ultrasound. Many solid lesions including carcinomas can appear as hypoechoic masses with acoustic enhancement.
5. Failure to recommend biopsy for a carcinoma because it was thought to be a benign radial scar.
6. Incomplete or inaccurate assessment of a palpable lesion due to failure to correlate the palpable area with the imaging findings (esp. during ultrasound).
7. Failure to recognize microcalcification pattern of DCIS when there is no associated mass density.
8. Calling a patient back or recommending biopsy for the muscle shadow sometimes seen medially on the CC view (sternalis muscle or medial extension of the pectoralis muscle).
9. Correct assessment of the margins of a nodule or mass as poorly circumscribed, circumscribed, or well circumscribed. Also halo versus moat distinction.
10. Failure to do an axillary view for abnormal lymph nodes during diagnostic workup of a probable carcinoma in the breast.
11. Recommend unnecessary workup or biopsy due to failure to recognize benign axillary or intramammary lymph node characteristics.
12. Failure to make diagnosis of lymphadenopathy due to not looking in axillary region or not recognizing signs of lymph node abnormalities.
13. Failure to spot an early breast cancer developing when multiple bilateral lesions are present (nodules, calcification clusters, or both).
14. Recommending unnecessary biopsy of posttraumatic or postbiopsy fat necrosis.
15. Attempting to biopsy dermal calcifications due to failure to obtain tangential views.
16. Leaving the tip of the localization wire short or proximal to the lesion due to bad positioning or use of a needle that is insufficiently long.
17. Calling a patient back or recommending biopsy of a lesion which appears to be an interval change on comparison to one prior mammogram when review of older mammograms show the lesion is actually unchanged for years.
18. Recommending biopsy of a complicated cyst because the gauge of the needle used for aspiration was too small and no fluid was drained. Some complicated cysts require an 18 gauge needle and a 10 cc syringe to aspirate thick or inspissated fluid, mucin, or grummous contents.
19. False ultrasound diagnosis of a hypoechoic lesion in the retroareolar region due to shadowing caused by the skin of the nipple and areola.
20. Absent, vague, or indecisive recommendation in written report leading to failure or delay of patient or physician to proceed to the next appropriate procedure. One common example is the ultrasound report which ends with just the impression "complicated cyst" without giving a specific recommendation such as biopsy or aspiration.
21. Failure to call a patient back or recommend biopsy of a lesion which appears to be stable on comparison to prior mammograms over a less than 3 year interval when it is actually an indolent carcinoma (esp. DCIS).
22. Calling a patient back or recommending biopsy for a false microcalcification cluster due to a fingerprint or scratch artifact.
23. Failure to notice unilateral diffuse increase in breast density due to widespread malignancy such as inflammatory carcinoma.
24. Interventional biopsy of the wrong lesion due to the presence of multiple lesions. This most often occurs when a partial field preliminary view is done which happens to make a second area look like the area of concern when actually the area of concern is outside the field of view.





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