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Mammography

Mammography

Advanced Medical Imaging Consultants, P.C. provides state-of-the-art mammography services at the Poudre Valley Hospital Breast Diagnostic Center at the Harmony Campus (in Fort Collins) and at the Banner Health System Breast Diagnostic Center at McKee Medical Center (in Loveland). Services include screening mammography, diagnostic mammography, and breast ultrasound, as well as minimally invasive breast biopsy procedures. Mammography uses low dose x-rays to look at the interior of the breast and can detect cancers that are too small for you or your doctor to feel.

Computer Assisted Diagnosis (CAD)
Breast MR
Stereotactic Breast Biopsies

Frequently Asked Questions About Mammography:

When should I get a mammogram?

Every woman should have a mammogram beginning at age 40 and every year after that. Some women with a strong family history of breast cancer should have their first mammogram before they reach their 40th birthday. If you have such a history, check with your doctor to see when you should start.

What happens during my mammogram?

At the exam you will remove your clothes from the waist up and change into a gown. You will talk to a specially trained nurse about breast self examination and any questions you may have. Then a technologist will have you stand in front of the mammogram machine, which is an x-ray machine with a special plate that compresses your breast. Breast compression is very important to get the best and most accurate pictures possible, and helps prevent overlapping breast tissue from obscuring small cancers. Also with good compression, less radiation is needed to make accurate images. Good compression sometimes is uncomfortable, but the breast is compressed for only a few moments. For your annual screening mammogram, two images of each breast in different positions are taken.

How do I prepare for a mammogram?

On the day you have the exam, do not use any powder, deodorant, or cream on your breasts or underarms. Wear clothing that is easy to remove from the top, so you only have to remove clothing from above the waist. If your breasts become tender at a specific time during your menstrual cycle, try to schedule your mammogram at the time of the month when they are least tender.

Who interprets the mammogram, and how do I get the results?

A radiologist experienced in mammography will evaluate the mammogram images and prepare a written report of the findings and possible diagnosis. The report will be sent to your doctor and to you. This report is usually mailed out a few days after your exam.

What does it mean if I’m asked to go back for more mammogram images or a breast ultrasound?

Sometimes the radiologist sees something on the screening mammogram about which he or she needs more information to make a diagnosis. Extra mammogram views may be needed if the initial exam shows breast tissue “shadows” that overlap in a way that complicates diagnosis. Other times the mammogram may show a mass that looks like a probable cyst, and ultrasound is the best test to prove that such a mass really is a benign cyst.

How much radiation do I get from a mammogram?

By Federal guidelines, each mammogram image exposes your breast to no more that 0.3 rad, which is a measurement of radiation dose. The amount of radiation each breast gets from a screening mammogram is about the same as the amount of natural background radiation you get in six months of normal daily life. (Most of that background radiation comes from the sun.)

Where can I learn more?

You may learn more by calling the Poudre Valley Hospital Breast Diagnostic Center at the Harmony Campus (Fort Collins, CO), (970) 207-4700, or the Banner Health System Breast Diagnostic Center at McKee Medical Center (Loveland, CO), (970) 203-6518. The receptionist will direct you to someone who can answer your questions.

Also, visit our Links page for more information about mammography and breast cancer.

 

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Computer Assisted Diagnosis (CAD)

Computer-aided detection (CAD) technology is a recent advance in the field of breast imaging. The CAD technology essentially works as a second pair of eyes, reviewing a patient's mammogram film after the radiologist has already made an initial interpretation. If the computer software detects any breast abnormalities or "areas of interest" on the mammogram film, it marks them. The radiologist can then go back and review the mammogram film again to determine whether the marked areas are suspicious and require further examination (with additional imaging tests or biopsy). With the CAD technology, the radiologist still makes the final interpretation of the mammogram.

Technology Used:
The ImageChecker® System, the first FDA approved Computer Aided Detection (CAD) System for breast imaging, assists radiologists during their review of screening mammograms by identifying areas on the mammogram that contain features associated with cancer that may warrant a second review.

A study presented at the 2000 Radiological Society of North America (RSNA) meeting found that using R2 Technology's CAD software increased the detection of breast cancer by approximately 20%. Among the 12,860 women in the study, 49 cancers were detected:

  • 32 cancers were detected by both CAD technology and by the radiologist, who interpreted the women's regular mammogram films
  • 9 cancers were detected by the radiologist alone
  • 8 cancers were detected by the CAD technology alone (the radiologist then reviewed the mammogram films again to find the suspicious areas)

Computer-aided detection has the potential to help detect breast cancer in earlier stages, when the chances of surviving the disease are the highest.

Lesion Identification:
CAD places a tiny asterisk or other markers on sites of increased breast density or potential microcalcifications. These represent areas that are important for the radiologist to carefully scrutinize. The radiologist will then determine if further investigation is needed.

Additional Resources and References
To learn about the R2 Technology ImageChecker CAD system, please visit www.r2tech.com

 

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Breast MR

A breast MR is a non-invasive procedure that uses magnets and radio waves to produce a picture of the inside of the body. This test is not painful, and there is no radiation involved. It is usually done for breast cancer staging or for evaluating implants. MR is also useful in imaging dense breast tissue, which is often found in younger women, and in viewing breast abnormalities that can be felt but are not visible with conventional mammography or ultrasound. In general, MR is a compliment to a diagnostic mammogram and does not replace screening mammography.

During an MR of the breast, the patient lies on her stomach on the scanning table. The breast protrudes into a depression in the table, which contains coils that detect the magnetic signal. The table is moved into a tube-like machine that contains the magnet. After an initial series of images has been taken, the patient may be given a contrast agent intravenously (by injection into a vein). The contrast agent is not radioactive; it is sometimes used to improve the visibility of a tumor. Additional images are then taken. The entire imaging session takes about 1 hour.

Although not a replacement for traditional mammography, magnetic resonance (MR) imaging of the breast is an evolving and growing imaging technique. Breast MR is extremely helpful in evaluating mammogram abnormalities and identifying early breast cancer, especially in women at high risk. High-risk women include those who have had breast cancer or have a mother or sister who has been diagnosed with breast cancer. Breast MR is used most commonly in high-risk women when the findings of a mammogram or ultrasound are inconclusive because of dense breast tissue or there is a suspected abnormality that requires further evaluation.

If a suspicious area is detected, your doctor may recommend an MR-guided needle localization. Using MR images, a localizing wire is positioned in the abnormal area. The wire and abnormal tissue are then surgically removed.

 

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Stereotactic Breast Biopsies

What is X-Ray Guided Breast Biopsy?

Mammography is an excellent way to detect breast abnormalities, but in many cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. To make this determination it is necessary to obtain a tissue sample for microscopic examination. As an alternative to open surgical biopsy, which removes an entire breast lump for microscopic analysis, a hollow needle may be passed through the skin into the suspicious lesion with the help of special breast x-rays . The small sample of breast tissue obtained in this way can show whether the lesion is malignant or benign, and the procedure is much less invasive than the surgical approach. A special computerized mammography machine uses intersecting coordinates to pinpoint the area of tissue change. This method is called stereotactic biopsy or x-ray-guided biopsy. A pathologist examines the obtained specimen and makes a final diagnosis so that treatment planning can begin.

What are some common uses of the procedure?

A stereotactic breast biopsy is most helpful when mammography shows a mass, a cluster of microcalcifications (tiny calcium deposits that are closely grouped together), or an area of abnormal tissue change, but no lump can be felt on careful breast examination. There are a number of biopsy instruments and methods that are utilized with x-ray guidance. They include core biopsy, which uses a large-bore needle to remove a generous sample of breast tissue, and a vacuum assisted needle biopsy device (VAD), based on an instrument called the Mammotome®, which uses vacuum suction to obtain a tissue sample.

X-ray images also are used to place a guide wire into the suspicious area in order to help locate the lesion during open surgical biopsy, which is performed in an operating room.

An x-ray-guided biopsy often is done when:

  • A woman has a mammogram showing a suspicious solid mass that cannot be felt on breast examination.
  • A woman has a mammogram showing a suspicious cluster of small calcium deposits.
  • The structure of the breast tissue is distorted.
  • A new mass or area of calcium deposits is present at a previous surgery site.
  • The patient or physician strongly prefers a non-surgical method of assessment.

How should I prepare for the procedure?

Even though most women who have a breast biopsy are found not to have cancer, despite an abnormality on the mammogram, you may want to have a relative or friend join you to lend support and to drive you home. If you are taking aspirin or a blood thinner, your physician may want you to stop three days in advance of the biopsy.

What does the equipment look like?

Sometimes a specially designed table is used for stereotactic biopsy. In this case, the patient is lying face-down with her breast projecting through a hole in the table. The actual biopsy is done below the table after raising it to gain access to her breast. The procedure also may be done with the patient upright in a chair, but she must not move during the procedure. An upright study may be best for those women who might have difficulty climbing onto the table, or who are unable to lie prone for any reason.

A paddle-shaped instrument compresses the breast during biopsy. A tray is nearby, containing all of the equipment necessary for the biopsy.

How is the procedure performed?

The first step is to clean the skin and inject a local anesthetic. A small nick is made in the skin and the tip of the biopsy needle is advanced to the calculated site of the lesion. At this point stereo images are again obtained to confirm that the needle tip actually is within the lesion. Usually 5 to 10 samples are collected when doing a core biopsy, and at least 12 when using the VAD. Then a final set of images is obtained. If they show that the lesion has been mostly or completely removed, a small clip is left at the biopsy site so that it can be easily located if the lesion proves to be cancer. Afterwards the skin opening is covered with a dressing; it need not be sutured. You will be told to avoid strenuous activity for 24 hours after returning home, but then will usually be able to resume normal activities.

What will I experience during the procedure?

X-ray-guided breast biopsy can take from 30 to 60 minutes or more. Most women report little or no pain, and no scar is left from the tiny skin incision. Many women find the major discomfort of the procedure is from lying on their stomach for the length of the procedure. Strategically placed cushions may reduce this discomfort.

 

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