An Effective Way to Solve Equivocal Mammography Findings: The Rolled Views

Abstract

SUMMARY: BACKGROUND: The aim of this study was to investigate the efficacy of the rolled views taken in craniocaudal (CC) and mediolateral oblique (MLO) projections in solving equivocal mammography findings. PATIENTS AND METHODS: The rolled views were taken by changing the positioning of the breast but not the obliquity of the X-ray beams. The breast was rolled medially or laterally in the rolled CC view, and inferiorly or superiorly in the rolled MLO view to separate overlapping structures from each other. RESULTS: We evaluated equivocal findings in 87 asymptomatic women undergoing either CC (n = 48, 55%) or MLO (n = 39, 45%) rolled views between 2001 and 2008. The rolled views were helpful in solving equivocal mammographic findings and making proper decisions on management in 85 of the 87 (97.7%) women. This technique was used for breast asymmetries in 55 of the 87 (63.2%) women, and was sufficient to directly show summation artifacts in 59 of 79 (74.6%) women. The rolled views revealed 4 intramammary lymph nodes, 2 circumscribed masses out of 6 obscured masses, 7 summation artifacts, and 2 circumscribed masses out of 9 questionable masses. CONCLUSIONS: The rolled view is an effective method of differentiating summation artifacts from real lesions on mammography in both the CC and the MLO view.

Fig. 1

a Rolled CC view of the left breast. In LCCRM+, while the upper part of the breast is rolled medially, the lower part is changing position from medial to lateral. In the same way, the upper part can be rolled laterally in LCCRL+ (L: left breast, CC: craniocaudal, R: roll, L: laterally, M: medially, +: upper tissue). b Rolled MLO view of the right breast. In RMLRS+, the outer or lateral part of the breast is rolled from inferior to superior. In the same way, the outer part can be rolled from superior to inferior in RMLRI+ (R: right breast, ML: MLO, R: roll, I: inferiorly, S: superiorly, +: lateral or outer tissue).

Fig. 3

a In the left CC view, a questionable mass is seen in the outer quadrant (arrow) b The upper-outer part of the breast is slightly rolled medially (from lateral to medial) in the LCCRM+ view. Because the equivocal mammographic finding lost its previously suspicious characteristics, it was considered a focal deposit of benign fibroglandular tissue, and this patient was categorized as BI-RADS 2 and invited to annual screenings. c Mammographic finding on left CC remained the same, even in the third year of follow-up, without any malignant progress.

Fig. 4

Distribution of cases regarding BI-RADS assessment categories after rolled views. ^aBoth underwent spot compression and sonography as an additional method. ^bSix were lost to routine screenings; remaining 65 patients were stable on (1 or more) routine mammographic screenings. ^cThirteen were stable on 2-year follow-up or even later (some). ^dBiopsy revealed sclerosing adenosis.