Mammography Reports: Understanding the Diagnostic Process of Breast Cancer

This article discusses the importance of mammography reports in the diagnostic process of breast cancer. It explains the role of radiologists in analyzing mammographic findings and the use of the Breast Imaging Reporting and Data System (BI-RADS) to standardize mammography reporting. The article also explores the use of process maps and flowcharts in the documentation process.

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Mammography Reports
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Mammography Reports
Mammography reports are instrumental tools in the diagnostic process of breast cancer.
The radiologist has the task of analyzing mammographic findings for chances of malignancy and
for provision of guidance to clinicians for the necessary course of management. For better
comprehension, the reports need to be clear, standard and concise. Screening studies determine
whether the examination is normal or where there might be need for further evaluation (Schapira
et al, 2018).
Mammography is basically medical imaging which utilizes the x-ray system to view the
inside of breasts. The mammogram enables early detection and the diagnosis of breast conditions
in women. The x-ray helps medical personnel diagnose and treat conditions. Small part of the
body is exposed to an insignificant dose of ionizing radiation that produces the pictures of body’s
inside.
Digital mammography (full field digital mammography) is a system where the x-ray film
has been replaced with electronics meant to convert the x-ray into mammographic details of the
breast. The breast images are moved to a computer where they are assessed by a radiologist and
stored. Computer-aided detection (CAD) systems are built to search mammographic images that
are digitized, checking for abnormality in density, mass or calcification which are indications of
cancer. This system brings to attention the specific areas observed and the radiologist evaluates
the areas (Schapira et al, 2018).

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Diagnostic Studies
Based on the screening study, the findings can be confirmed and determined whether they
are consistent with breast cancer. There are assessment categories that are used to establish the
steps forward. The mammographic findings should help put together conclusions and
recommendations. The reports are written using guidelines based on Breast Imaging Reporting
and Data Systems (BI-RAIDS). This system was developed by American College of Radiology
and standardizes the mammography reporting for clarity and decisiveness (Schapira et al, 2018).
Breast Imaging Reporting and Data System
BI-RADS is a system of reporting and assessments which radiologists use to describe the
findings in breast imaging reports. The system enables organization of analyses and interprets the
findings. The levels range from 0 to 6 and the assessments help in determination of the following
steps (Shikhman & Keppke, 2017).
Incomplete Assessment (BI-RADS 0): there is need for additional imaging evaluation
and/or comparison to prior mammograms. This indicates that the potential abnormality is not
clearly seen or defined ad more tests are required. These tests could involve use of spot
compression, magnified views, ultrasound or special mammogram views. There is the point of
comparison with older mammograms to observe any changes that may have occurred.
Complete Assessment (BI-RADS 1): Negative. This essentially means that there is no
substantial abnormality to report. The breasts appear the same with no indication of masses,
lumps, structures or calcifications. Negative means there is a positive outcome (Schapira et al,
2018).

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BI-RADS 2: Benign finding. This means the findings are non-cancerous but the
descriptions by the radiologist follow the order of benign calcifications, calcified fibroadenomas,
lymph nodes in breasts, implants or fat containing lesions. These may be related to previous
surgery and the findings are stored for future comparisons.
BI-RADS 3: Probably benign finding. This entails a follow up after short duration. There
is a follow up with repeat imaging done after 6 months and more regular follow ups till stability
in the findings is achieved. The findings in this level indicate a very high probability of being
benign (98%). The findings do not change over the course of time.
BI-RADS 4: Suspicious abnormality. In this case biopsy is considered. The findings are
not definitively cancer but they could be it. There is wide range of suspicion in this category. It
can be further divided into findings of low suspiciousness to be cancer. Intermediate suspicion of
malignancy and moderate suspicion (Shikhman & Keppke, 2017).
B-RADS 5: Highly suggestive of malignancy. This requires that necessary action take
place. Findings are cancer-like with 95% chance of being cancer. Biopsy is highly
recommended. High density masses and calcification may be observed.
BI-RADS 6: Known biopsy-proven malignancy. The findings are applicable on a
mammogram with previous determination of cancer by prior biopsy. This I used to assess the
response of cancer to treatment (Shikhman & Keppke, 2017).
Sections in a Mammogram Report
Mammography consists of pertinent information which appears at the top. This displays
the details of the patient and reason for the mammogram. The clinical history of the patient
follows. This includes history of breast conditions and any medication the patient is using. The

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procedure entails explanation of types of mammograms taken and the various views for
screening. Other sections are notations done on the previous studies, description of breast
composition and the descriptions of findings and modifiers (Schapira et al, 2018).
Process Maps
Process in general are tools that give the workflow processes visual perspective. This
shows all the steps in the process and the existing relationships between them. The tools help in
gauging the relationship between inputs and outputs in a system. Process maps are used in
starting initiatives as a way of understanding the process (Fossland & Krogstie, 2016).

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Flowcharts are visual representation of the various steps or sequences and the decisions
involved in a particular process. This is a very vital tool in business and institutions. The steps in
the process are indicated by use of diagram shapes. The steps are usually linked with
interconnecting lines and arrows that display the direction of flow. This presentation enables the
logical viewing and following of the process from its point of initiation to the very end. Much
efficiency is attained with proper design and construction of the flowchart (Fossland & Krogstie,
2016).
There are different symbols or shapes used in flowcharts. The varying shapes present
different meanings in their application. There are symbols for start and end points, indications of
process or decisions that are made, input or output connector, preparation, storage or
documentation. It is imperative that the meanings of the symbols be well understood in order to
appropriately perceive the process.
Flowcharts can be used in a range of disciplines. They are used in technology, business,
engineering, science, government, medicine, education and manufacturing. Flowcharts are
utilized in designing programs or systems, documentation of processes, workflow
documentation, project planning and auditing of processes. They are also used in mapping
algorithms, management of data and in various engineering processes (Fossland & Krogstie,
2016).
Top Down Process Map
This is a tool that is used in mapping the high levels and then progressing to the deeper
levels in the process. The initial step is listing the first process at the highest level. The high level
step is input at the top of the process map. The processes that fall under the high level step are

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listed below so as to gain insight in the details involved in each high level step. The processes for
all the high-level steps are subsequently listed in the top down approach (Boutros & Cardella,
2016).
Top down process maps are constructed suing squares in place of the modules or
activities in an organization. Lines connect the activities representing ownership between
activities and successive sub activities as is the case in the process flow of an organization.
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This top down process map is important when starting projects. Ii is used many situations
when investigating process triggers. It also shows what the establishment provides to customers,
both internally and externally while fully comprehending the context (Boutros & Cardella,
2016).
Important factors to observe possible confusion between inputs and outputs or customers
and suppliers when these aspects are available in the process flow. There are critical connections
that can be made with the rest of the organization. An important aspect is how well the
requirements for each category, in put or output is understood. Disagreement may arise in some
cases about how the area fits in the entity.
Swim Lane Diagram
Swimlane diagrams can also be referred to as cross-functional diagrams. This diagram
shows the steps in a workflow or process flow. The activities involved in the process flow are
grouped into ‘swimlanes.’ The swimlanes are vertical or horizontal representation of activities
that fit within the category that they are illustrated under. The lanes may be based on actors in
charge of performing certain roles, the stage of the process where the activity occurs or the areas
that require emphasis in communication through the diagram. Swimlane diagrams communicate
more information on who performs certain actions or when they take place (Boutros & Cardella,
2016).
Institutions or entities have internal and external requirements in the documentation
process. The diagrams are important in precisely enabling this. They are crucial for reporting of
standards or compliance among other functions. Some reasons for using swimlane diagrams can
be the documentation of enterprise resource planning implementation. The documenting process

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is part of the implementation planning. This is a way of maintaining standards and certification
which are important factors that customers, especially patients consider. This tool is utilized in
ensuring compliance with the regulation that have been established. It is also a means of a means
of preparing for eventual transfer of leadership or ownership.
Some internal reasons for using process flow documentation is to ensure quality work
majorly due to consistency and provision of visibility. This helps in observation of the process of
job performance by the management. The workflow diagrams help in initiating process
improvement in organizations. Additionally, the tool provides flexibility to all employees who
are able to learn how to perform different jobs (Boutros & Cardella, 2016).
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References
Schapira, M. M., Barlow, W. E., Conant, E. F., Sprague, B. L., Tosteson, A. N., Haas, J. S., ... &
Herschorn, S. D. (2018). Communication Practices of Mammography Facilities and
Timely Follow-up of a Screening Mammogram with a BI-RADS 0
Assessment. Academic radiology.
Fossland, S., & Krogstie, J. (2016). Enterprise Process Modeling in Practice–Experiences from a
Case Study in the Healthcare Sector. In Enterprise, Business-Process and Information
Systems Modeling (pp. 365-380). Springer, Cham.
Boutros, T., & Cardella, J. (2016). The basics of process improvement. CRC Press.
Shikhman, R., & Keppke, A. L. (2017). Breast, Imaging, Reporting and Data System (BI
RADS).