Mammography

Mammography is an excellent tool in the fight against breast cancer, which is the most common cancer among women, other than skin cancer, and the second-leading cause of cancer deaths in women. Annual screening mammography remains the only scientifically proven lifesaving imaging modality for the detection of breast cancer, with reduction in breast cancer mortality up to 40%.

The American Cancer Society, American College of Radiology, and Society of Breast Imaging recommend annual screening mammography beginning at age 40. However,, specific breast complaints could warrant a mammography procedure, and family history or other risk factors may indicate the need for mammography with greater frequency and initial screening at a younger age. Mammography allows our radiologists to detect breast cancer or other abnormalities in their earliest stages, often long before they can be felt through clinical or self-breast exams. Early detection of breast cancer means early treatment that is less invasive and more effective.

Digital mammography

We offered digital mammography first to the Omaha metropolitan area at Jennie Edmundson Hospital and have extensive experience with this modality. Digital mammography is similar to standard (film-based) mammography in that x-rays are used to produce detailed images of the breast. For both techniques, it is necessary for the breast to be compressed and from the patients point of view, the exam is very much the same. With digital mammography, the image is recorded by and stored on a computer instead of film which improves ease of exam acquisition, storage, access and transmission. In addition, the magnification, brightness and contrast can be altered after the exam is completed to optimize visualization of certain areas. Digital mammography has lower average radiation dose without a compromise in accuracy. Many studies have shown that the accuracy of digital mammography is comparable to that of standard mammography. One large research study by the National Cancer Institute showed that both digital and film mammography had sensitivities (the ability to tell if a cancer is present) for breast cancer of 70 percent in the overall study population. However, digital mammography was more accurate in finding cancers than film mammography in women under age 50 or women of any age who had very dense breasts. The rates of inconclusive results were similar between digital and film.

How should women determine which type of mammogram to have?

Women under age 50 or with a “heterogeneously dense or extremely dense” rating on their prior mammogram should consider digital mammography. Women who are uncertain about their density status should inquire about it at the time of their next visit with their health care provider. However, other factors are important and one should keep in mind that film mammography has been successfully used as a screening tool for breast cancer for over 35 years.

Computer-aided detection (CAD) for mammography

CAD is an exciting advance in the field of breast imaging that provides the radiologist with a computerized second review of mammograms. Computer-aided detection is a computer-generated algorithm that identifies areas of increased density, tissue asymmetry, and suspicious micro-calcifications. CAD effectively functions as a “second pair of eyes” and has been shown in studies to improve cancer detection by up to 20%.

Breast ultrasound

High-resolution breast ultrasound is applied as a problem-solving tool used in conjunction with mammography. Sonography is directed to areas of mammographic abnormality or symptomatic areas of the breast. Ultrasound is also used to differentiate cysts from solid masses and can be used to guide breast biopsies.

Breast Specific Gamma Imaging (BSGI)

It is a noninvasive nuclear medicine examination that uses a radiotracer agent and a high resolution small gamma camera to obtain images of the breast. It is an adjunct to mammography. BSGI has the same indications as MRI with the addition of patients who need an MRI of the breast, however, have contraindications to MRI. No special or unusual patient preparation, exam should be performed day 7-10 of your cycle. Not recommended if pregnant or breastfeeding. For the procedure, you will get an IV and be injected with a special nuclear medicine agent call sestamibi. Wait 10 minutes with subsequent imaging similar to a mammogram but with gentle compression. You will be sitting during the exam and a total of four images are obtained, each one takes about 10 minutes. All the images will be compared to prior mammograms or ultrasounds if available. According to the National Institutes of Health (NIH), the risks from the radiation dose associated with BSGI are considered to be “minimal”.

Breast MRI

High-resolution breast MRI is a powerful imaging modality to be used in conjunction with mammography. Breast MRI is predominantly reserved for staging breast carcinoma, evaluating implant integrity and as a screening exam in high-risk patients. This includes patients with a known genetic risk of breast cancer (BRCA1, BRCA2, Li-Fraumeni syndrome, Cowden syndrome, bannayan-Riley-Ruvalcaba syndrome), women with a >20-25% lifetime risk of breast cancer, and women who received chest radiation between the ages of 10-30 years. Identification of cancer hinges on the fact that malignant tissue shows greater blood flow than surrounding normal breast tissue. Therefore, cancer obscured by dense breast tissue on a mammogram may appear more obvious on MRI.

Breast biopsy procedures

It may not be possible to tell from imaging studies alone whether a lesion is benign or malignant, so it may be necessary to obtain a tissue sample. As an alternative to open surgical biopsy, we perform several minimally invasive breast biopsy procedures utilizing ultrasound, stereotactic, and MRI guidance.

Ultrasound-guided core biopsy or aspiration

Ultrasound is used to guide core needle biopsy of a solid lesion or aspiration of a cyst. Breast imaging specialists watch in real time during the procedure, which requires only local anesthesia and no radiation.

Vacuum-assisted stereotactic breast biopsy

Mammographic digital images are obtained to guide core needle biopsy. This technique is most often applied for biopsy of calcifications or lesions seen mammographically and not seen by ultrasound. The procedure requires local anesthesia and only low-dose radiation.

MRI-guided vacuum-assisted breast biopsy

Contrast-enhanced MRI images are used to guide core needle biopsy directed to sites of MRI abnormality not seen on mammography or sonography. The procedure requires only local anesthesia and no radiation.

Bone densitometry (DEXA scan)

A DEXA scan quickly, painlessly, and accurately measures bone strength, density, and mineral content. This is highly effective in diagnosing osteoporosis and monitoring the effectiveness of treatment.