Mammography and other Diagnostic Breast Imaging Procedures
What is Mammography?
Mammography, also known as a mammogram, is the examination of the breasts using x-rays. Mammography is considered the most effective tool for early breast tumor detection. Most medical experts agree that successful treatment of breast cancer often is linked to early diagnosis.
There are two types of mammography, screening and diagnostic. Screening mammography is used for patients with no symptons or concerns. Two standard images are taken of each breast. Diagnostic mammography is a specialized mammogram designed to solve a particular problem. The radiologist designs each exam in order to answer the particular problem at hand.
Our practice uses digital mammography. Also known as a full-field digital mammography, digital mammography produces images that are shown on a high resolution monitor. Because the images are digital, they allow the radiologist to alter the magnification, brightness and contrast of the images to produce detailed images . Computer-aided detection, or CAD, uses complex algorithms to aid the radiologist in noting abnormal areas of density, mass, or calcification that may alert the radiologist to the presence of cancer. The CAD system highlights these areas on the images, alerting the need for further analysis.
What are the advantages of digital mammography and computer-aided detection?
- Compared to conventional mammography, digital mammography images are processed more quickly.
- The superior contrast resolution of digital mammography and its ability to manipulate images make for more accurate detection of breast cancer.
- Computer-aided detection, or CAD, obtains a second, computerized reading in the hope of finding more cancers and more accurately gauging signs of malignancy.
- Digital mammograms can be archived in various ways and easily retrieved, and copied.
How often should I have a mammogram?
Current guidelines from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40.
The National Cancer Institute (NCI) recommends that women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.
When should I schedule my mammogram?
Generally, the best time to schedule a mammogram is one week following your period. Do not schedule your mammogram for the week before your period if your breasts are usually tender during this time. Always inform your x-ray technologist if there is any possibility that you are pregnant.
How should I prepare for a mammogram?
On the day of the exam:
- Do not wear lotion, deodorant, or powder under your arms or on your breasts.
- Remove all jewelry and clothing from the waist up. You will be given a gown that opens in the front.
What should I expect during this exam?
Our technologist will ask you detailed questions about your personal and family history of breast cancer, history of breast surgery, and whether there has been any change in your breasts.
To image your breast, an x-ray technologist will position you near the machine and your breast will be placed on a platform and compressed with a paddle. Breast compression is necessary in order to:
- Even out the breast thickness - so that all of the tissue can be visualized.
- Spread out the tissue - so that small abnormalities won't be obscured.
- Allow use of a lower x-ray dose.
- Hold the breast still - to eliminate blurring of the image caused by motion.
- Reduce x-ray scatter - to increase picture sharpness.
The technologist will go behind a glass shield while making the x-ray exposure. You will be asked to change positions between views. The process is repeated for the other breast. Routine views are a top-to-bottom and side view. The exam takes about 15 minutes.
The technologist will apply compression on your breast and, as a result, you will feel pressure on the breast as it is squeezed by the compressor. Some women with sensitive breasts may experience some minor discomfort. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
A result letter, in lay terms, will be mailed to you within 30 days as required by MQSA (Mammography Quality Standards Act )
Diagnostic mammograms are specialized mammograms designed to solve a particular problem.
Reasons to have a diagnostic mammogram:
- Question arising from a screening mammogram
- Breast symptom such as a lump, focal breast pain or nipple discharge
- Follow-up exams
- Personal history of breast cancer in the past three years
In addition to the four views obtained in a screening mammogram, there are many specialized views that are possible to further investigate a finding. The radiologist then requests specialized additional views in order to further evaluate clinical problems. The most common view is called a "spot compression magnification" view. This is a magnified view of a particular area of the breast. The radiologist may also want to do an ultrasound.
Ultrasound uses sound waves to generate a picture of the breast tissue. There is no radiation exposure with ultrasound. No compression is necessary. Ultrasound is particularly useful in telling cysts from solid masses in the breast. Cysts are very common and totally benign; about half of all women have some cysts in their breasts at some point. Ultrasound is also a useful aid in evaluating patients with dense breasts on mammography.
Sometimes we do find a lesion that requires a biopsy. Fortunately, the vast majority of breast biopsies can be accurately performed with a needle and do not require surgery. Depending on the finding, a needle biopsy is performed, using either stereotactic (mammogram), ultrasound, or MRI guidance.
Ultrasound-Guided Breast Biopsy. The radiologist uses ultrasound to locate the area for biopsy and to direct the needle used in collecting breast tissue samples. The area to be biopsied will be numbed with local anesthesia. You can resume normal, non-strenuous activities immediately after the procedure is done. The samples are sent to the pathology lab for analysis. Results are usually available within 48 hours.
Stereotactic-Guided Breast Biopsy. If we recommend a stereotactic biopsy, which biopsies abnormalities seen with mammography but not ultrasound, we will refer you to a local hospital where these biopsies are performed. They are performed as an outpatient.
Magnetic Resonance Imaging of the Breast
MRI is a technique using a very strong magnet and radio waves to pick up signals from the breast tissue. We use state-of-the-art equipment including a dedicated bilateral breast surface coil. The patient lies face-down within the scanning field for approximately 45 minutes. The primary way that abnormal tissue stands out on MRI is because it gets more blood flow than the remaining tissue. We can detect blood flow by taking images before and after the infusion of an intravenous substance (gadolinium). Breast MRI is most useful in detecting breast cancer and evaluating the integrity of implants. Breast MRI is also employed in patients with a known breast cancer in whom there is a question about how extensive the disease is. Medical indications (reasons) for breast MRI are evolving, and are the subject of many studies around the country.
For more information on this topic, please visit www.Radiologyinfo.org.