•Diagnostic Ultrasound and Ultrasound-guided Breast Cyst Aspiration
•Breast MRI & MRI-guided Breast Biopsy
•Stereotactic & Ultrasound-guided Core Biopsy
•DEXA and other diagnostic services relating to women’s health.
Each digital screening mammogram is checked by our Women’s Diagnostics physicians then a second time using a sophisticated CAD computer algorithm for the assurance and peace of mind.
All of our Women’s Diagnostics physicians are specially trained and experienced in women’s imaging. All patients with a breast health concern are evaluated by a breast care specialist. These experts are able to navigate a patient through the diagnostic process if follow-up is required – from ultrasound or MRI through to biopsy if that is necessary, all in one of our outpatient offices.
Enhanced protection of breast health can be accomplished using several radiological procedures, but usually begins with the patient having a digital mammography study. A Breast Ultrasound is used for further evaluation of women with a palpable lump or to clarify the nature of a mass seen with digital mammography. MRI of the Breast is used when further study is necessary. Overviews of these procedures follow.
Digital Mammography With Computer-Aided Detection
All of our offices are equipped with the latest digital mammography equipment. Digital mammography is an x-ray study of the breasts, which uses a low level of radiation. Digital mammography can detect lesions in breast tissue that may go unnoticed because they are too small to be felt. This makes digital mammography particularly valuable as a screening tool in detecting early breast cancer.
There may be some discomfort associated with a digital mammogram due to the compression that is necessary to obtain a clear picture of the internal structures. The compression is not dangerous and does not damage breast tissue. It improves the accuracy of the digital mammogram and also reduces the amount of radiation needed for the test. The discomfort is temporary and can be relieved by oral analgesics. Routine screening digital mammograms should be scheduled within the first 14 days after the patient’s period to reduce the amount of potential discomfort from the compression.
Routine screening digital mammograms are interpreted by a Digital Mammography Specialist at Sitron-Hammel Radiology. Two views of each breast are taken at the time of the office visit. If additional views are needed to make the diagnosis, the patient is contacted to return for specialized spot or magnification views as requested by the Radiologist. If no additional views are needed, a report is sent to the patient and to the referring physician.
There is no special preparation for the digital mammography exam, however, patients should not use any powders, creams or deodorant under the arms or around the breast area in preparation for the exam.
As part of the complete exam, current films are always compared with prior studies. Patients should bring any prior mammogram studies with them for their appointment. Please note that it is very important that all mammograms are returned to us so that the patient has a complete history file. Please note that digital mammograms are only scheduled for patients under the age of 30 if there is an abnormality or severe family history.
MRI of the Breast (MR Mammography)
What is the role of Breast MRI for detection of possible breast cancer?
Breast MRI is a new and rapidly developing imaging modality. The techniques and interpretation of MRI are still evolving. The exact role of Breast MRI in evaluation of possible breast cancer remains controversial and a subject of active research and refinement. In certain patients and in certain situations Breast MRI is valuable in augmenting other tests (digital mammography, ultrasound and physical examination).
How is Breast MRI for cancer detection performed?
Breast MRI for cancer detection can be performed of one or both breasts. These studies always require intravenous contrast (dye). The dye will be given through an intravenous line toward the end of the test. The cancers are well visualized because they take up the dye (enhance). The study is performed between the 6th and 16th day of the menstrual cycle, which is the time in the cycle when normal breast tissue takes up relatively less of the MRI dye and, therefore, we are better able to differentiate breast cancer from normal glandular tissue.
The patient will lie on her stomach during the examination which will take approximately 45 minutes. It is very important to remain still. Our staff will be available throughout the exam to monitor and speak with the patient.
Why a Breast MRI?
The most common reasons physicians order a Breast MRI include:
•Screening for cancer in high risk patients
•strong family history
•history of breast carcinoma
•history of Atypia demonstrated on biopsy
•Resolve an indeterminate (unclear) mammogram finding
•Define the extent of the carcinoma prior to therapy
•Evaluate breast implant integrity
Are there breast cancers that are not detectable by Breast MRI?
Yes, at least 12% of cancers will not be detected with MRI. The most common types, which do not show up on the MRI, are ductal carcinoma in situ or invasive lobular carcinoma.
Are there abnormalities, which show up on MRI that are not cancer?
Yes. Unfortunately, it is often not possible to differentiate these benign abnormalities from cancer on MRI. There are many benign (non-cancerous) findings that will show up on MRI and these include lymph nodes, fibroadenoma, lobular carcinoma in situ, ductal hyperplasia, fibrocystic disease, papilloma and sclerosing adenosis.
Is Breast MRI screening recommended in normal risk patients?
MRI screening is NOT recommended in the general population due to inadequate specificity (accuracy) at this time. Many of the abnormalities detected on MRI turn out to be false positives. In other words, many benign lesions will show up in the MRI and the MRI cannot differentiate these lesions from cancer. Even in patients who are at very high risk for breast cancer, the false positive rate is most commonly between 20-40%. Even in high-risk patients, up to 80% of the time when the MRI leads to a biopsy, the biopsy is benign.
In normal risk patients, the number of false positives would be even higher. Furthermore, the added sensitivity of MRI over combined physical examination and mammography is only about 2-7% in high-risk patients. In other words, only 2-7% of high-risk patients would have cancer seen on MRI, which was not visible with other means. In normal risk patients this number would be expected to be much lower. Therefore, MRI is NOT considered an appropriate screening test at this time.
When is MRI of the breast performed for evaluation of breast implants?
Breast implants occasionally rupture or leak. Often leakage or rupture can be determined with mammogram, physical examination and/or ultrasound. When necessary MRI can provide a more detailed assessment. Breast MRI examinations performed to assess the integrity of breast implants are performed without contrast (dye). These non-contrast MRI exams evaluate both implants but do not assess the breast for the presence of cancer.
Are there other considerations with MRI?
•Certain patients may not be able to undergo the examination (e.g., claustrophobia, pacemaker).
•The MRI findings may not be conclusive.
•If a lesion is seen only on MRI, the only way to biopsy the lesion is after an MRI localization procedure.
•There may be a need for intravenous injection (dye).
•The appearance of the breast can change during menstrual cycle and normal glandular tissue can obscure or mimic breast cancer.
•The test is expensive.
Interpretation of Breast MRI
The MRIs are complementary to the other imaging tests and physical examination. MRI does not replace digital mammography, physical examination or ultrasound. It is important to correlate the MRI findings to the other tests (digital mammograms, ultrasounds) as well as with an individual’s clinical history. The MRIs require a greater amount of time for image reconstruction and interpretation than digital mammograms. University Radiology has specific board certified radiologists who specialize in the interpretation of MRI and/or mammography. The radiologist will fax a reading and, if necessary, call the referring physician directly at the time of interpretation.
Is the MRI as good as a surgical biopsy?
No. A biopsy is more accurate than the MRI. An MRI often cannot replace a biopsy and having a negative MRI does not exclude the possibility of cancer.
What are the possible recommendations after Breast MRI?
If the MRI study is interpreted as normal or showing benign disease, further evaluation will usually revert back to physical examination and digital mammography. It is still possible that based on findings on the digital mammogram or physical examination that the patient will still need a biopsy.
If the MRI is inconclusive, a short-term follow up MRI may be recommended. This is often the case since breast MRI is so sensitive and often detects small questionable abnormalities, which ultimately turn out to be benign.
If the MRI is worrisome for cancer the patient will need a biopsy. If the region of concern is not visible on digital mammography or ultrasound and not palpable, the patient may need an MRI guided biopsy.