Ultrasound tends to under-measure invasive lobular and multifocal breast cancers, while mammography alone under-calls extent in dense breasts. Contrast-enhanced techniques track invasive extent more closely, but DCIS without enhancement can still be missed or under-sized, and calcification on mammography remains the better guide there.
When modalities disagree on size, state each measurement in the report, say which you consider most reliable and why, and recommend targeted sampling of any additional lesion before it changes the operation.
- Report the size from each modality when they disagree, and say which you trust
- Use calcification extent on mammography to size DCIS
- Be cautious with ultrasound measurements in lobular and multifocal disease
- Recommend biopsy of additional enhancing lesions before they change surgery
Why it matters
Surgical planning rests on the size the radiologist commits to.
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