Get answers to your Breast Imaging questions.
The American College of Radiology recommends annual screening beginning at age 40 and this is what we recommend at the Breast Center. Women who are considered higher risk may need to begin mammography earlier; such as in these instances:
For screening mammogram patients, our goal is that their exams will be perfomed and completed in 15 minutes. These exams will be interpreted by the radiologist within 1-2 working days, and letters will be mailed to the patient's home address upon interpretation.
Diagnostic mammography often is a longer exam, because additional images and possibly ultrasound are performed. These patients are given their results at the time of their exam, both verbally and in writing.
Screening mammography is performed in asymptomatic patients -- patients who have no clinical signs or symptoms of breast cancer. Two views of each breast are obtained and are checked for technical adequacy by the technologist. These are interpreted later by the radiologist with results sent to the patient by mail.
Diagnostic mammography is performed in symptomatic patients -- patients who have signs or symptoms of breast cancer such as a palpable lump, nipple discharge, skin changes, etc. We also perform diagnostic mammography in patients with a past history of breast cancer, for follow-up of an abnormal screening mammogram, or for short-term follow-up of probably benign findings. These studies begin with the typical mammography views, with additional views and ultrasound obtained as deemed necessary by the radiologist. The studies are interpreted on line, with results given to the patient immediately.
A digital mammogram takes less time to perform and typically involves a lower radiation dose to the patient. It also give us the ability to optimize the image, very similar to the way you optimize a digital photograph. Images are stored electronically so the is less chance of images being lost. In addition, images can be interpreted remotely, so second opinion interpretations may become easier.
Recent studies indicate a higher cancer detection rate of digital mammography in certain patients, including those with dense breasts, those under 50 years old, and those who are pre- or peri-menopausal.
High risk factors for breast cancer include:
We will keep the prior film mammograms in the patient's X-ray jacket. Some of these prior studies will be converted to digital images in order to make it easier for the radiologist to compare them to the new study.
At the UMMC Breast Center, all breast imaging studies (mammograms, breast ultrasounds and breast MRI) are interpreted by board-certified radiologists who are subspecialized in breast imaging. Our specialists have more than 20 years of combined experience in interpreting these studies, and this is all that they do. Some studies have suggested that the use of subspecialized radiologists, and the greater experience of radiologists who interpret higher numbers of these exams, improves diagnostic accuracy.
Approximately 10% of screening mammograms are called back for additional imaging evaluation, which involves diagnostic mammography views and/or ultrasound. Of those that are called back, only about 10% of those require biopsy (90% are either explained as benign findings or simply require short-term follow-up). Of those that are biopsied, only about 30% actually are cancer. Another way to put this is that out of 1,000 screening mammograms performed, approximately 5 patients will be found to have cancer.
If there is a suspicious finding on your mammogram, you will typically need to have additional views and/or ultrasound performed. The radiologist will consult with you in person and will recommend additional evaluation to make a diagnosis. This might be ultrasound-guided core biopsy, stereotactic breast biopsy, cyst aspiration, needle localization and surgical consultation, or MRI-guided biopsy. We will make every attempt to schedule and perform these procedures as soon as possible, so that our patients do not have to endure a long wait to find out whether or not they have breast cancer.
Ultrasound is used:
Ultrasound forms images of the breast utilizing sound waves, not X-rays. No compression is required; a warm gel is placed on the skin and an ultrasound probe is rubbed over the skin to obtain the image.
Ultrasound can often show abnormalities which might go undetected on mammography due to extremely dense breast tissue. Ultrasound is used most commonly in conjunction with mammography, not as a replacement for mammography.
Elastography is a very new ultrasound technique which helps to measure the 'hardness' of breast lesions by placing gentle compression on the lesion with the ultrasound probe and comparing ultrasound information before and after the compression. Preliminary studies have indicated that this technology may be useful in differentiating benign and malignant lesions in the breast.
These are the recommendations for screening breast MRI, according to the new American Cancer Society guidelines:
MRI is the most highly sensitive imaging study for the detection of invasive breast cancer and recent studies indicate it may also be highly sensitive for the detection of intraductal breast cancer. Although it is highly sensitive, it is not highly specific. This means that it also finds lesions which are not cancerous and leads to false positive results and subsequent biopsies. Because of its high false positive rate, high cost and the fact that it benefits from specialized expertise for interpretation, general screening of the population with breast MRI is not ready for prime time. It should be used only for specific indications, as an adjunct to mammography and breast ultrasound.
At this point, MRI should be used in screening only for high risk patients.
Other indications for the use of breast MRI are:
There are many exciting technologies being investigated in the field of breast imaging. All of this work is in the hopes of detecting breast cancer at the earliest stage possible to allow patients the best chance for a cure.
One new technology being developed is Tomosynthesis, an adjunct to digital mammography. In conventional mammography, a 3-D structure (the breast) is evaluated with a 2-D image. A major drawback of mammography is that structures can be superimposed on a single image. This can result in cancers being hidden on the image or can cause the false appearance of cancer, leading to unnecessary biopsies, etc. Tomosynthesis is a 3-D digital technique that removes the effect of superimposed structures by taking multiple low dose exposures of the breast and processing the information into 1 mm thick slices. This shows promise in improving detection of breast cancers by mammography and decreasing the rate of false positive studies.
Breast-specific gamma imaging (BSGI) and Positron emission mammography (PEM) are developing nuclear medicine techniques which also show promise in detecting breast cancer at early stages. Rather than depending on the shape or appearance of cancer, these techniques depend on the metabolism or biology of the lesion for detection.