Case 31 continued

Spot compression magnification mammography should be performed to better evaluate the mass seen on initial CC and MLO views. Mammographic margins should always be assessed on spot views, not on the full-breast views!

An aside on Spot Mags: I always recommend SPOT MAGs whenever possible. I am not a big fan of SPOT-NON-MAGS and MAG-NON-SPOTS! As for SPOT-NON-MAGS: once you are a mammo pro, magnification should not be confusing, and it will often reveal calcifications not appreciated without it. As for MAG-NON-SPOTS: these films are usually produced by a technologist frustrated by the size of the patient's breasts. They try a bigger paddle to have a better chance of imaging their target. Unfortunately, without good spot compression, magnification views are usually under compressed and underexposed and blurry. Calcifications are very difficult to analyze without high-quality spot mags. Demand good images!

Ultrasound and MRI may be helpful in this patient, but the diagnostic mammographic work-up should be completed first.

What is your assessment of this mass?

• Circumscribed, round, high density
• Circumscribed, lobular, equal density
• Indistinct, lobular, low density
• Obscured, oval, high density