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We are winning the fight against breast cancer.  Increased public awareness has lead to earlier diagnoses and higher cure rates.  Early diagnoses are being made in more women due to annual breast cancer screening with mammography.

Screening Guidelines:

Women without significant family history (breast cancer in a first-degree relative, i.e. mother or sister) Baseline Exam at age 35, then annual screening beginning at age 40
Women with significant family history of breast cancer Baseline exam at age 30, then annual after age 35

When a radiologist interprets a mammogram, he or she will look for several signs of cancer such as asymmetric areas, certain kinds of calcifications, tissue distortion, a nodule, a focal star-shaped pattern, or a change from a previous mammogram.  Normal or other noncancerous tissues can resemble cancerous ones.  That is what makes interpretation of mammograms difficult and why it requires professional radiologists with mammographic training.

If a questionable area is found on a screening mammogram, it will need further assessment.  This may involve additional special mammographic views or breast ultrasound.  A determination is then made whether the area in question is benign, probably benign, or suspicious for cancer.  If benign, the patient should resume routine annual screening mammograms.  If “probably benign” the area in question is considered to have a very low likelihood of malignancy and a short interval follow-up mammogram in 6 months is indicated to confirm that the area in question is stable and benign.  If the finding has an appearance that is suspicious for cancer, a biopsy is indicated. 

Depending on the type of finding, there are different biopsy options available including open biopsy, or imaging-guided percutaneous needle core biopsy using stereotactic mammography or ultrasound for guidance.  The breast surgeon is typically the physician that discusses with the patient which type of biopsy is best for her specific situation.  If a patient does not have a breast surgeon, a primary care doctor can obtain a referral.

Breast Imaging Glossary:

Screening Mammogram  – A screening mammogram is an x-ray of the breasts performed in women without any symptoms or signs of breast cancer on exam.  The study includes two x-rays of each breast.  The American Cancer Society recommends a baseline study at age 35, then annual exams from the age of forty onward.  In patients with a family history of breast cancer in a mother or sister, baseline study and annual screening would be started earlier.

Diagnostic Mammogram – A diagnostic mammogram is an x-ray of the breasts performed in women with a new lump or other abnormality on physical exam.  This involves the routine two views of each breast, plus additional special views to evaluate the area of abnormality.

Additional Mammographic Views –  If a questionable area is identified on a screening mammogram, the patient is asked to return for further assessment with targeted supplementary views to better evaluate the area in question.  Breast sonogram may also be performed at the same return visit.  The radiologist then decides whether the area is benign, probably benign, or suspicious for cancer.  If benign, the recommendation is to return at the time of the next routine screening exam.  If probably benign, a short follow-up period of 6 months may be recommended to confirm the site in question is stable.  If a finding remains suspicious for possible cancer, biopsy will be recommended. 

Breast Sonogram – A breast sonogram is a targeted ultrasound exam performed to a assess a palpable breast lump or a suspicious area found on a mammogram 

Breast Biopsy – When a suspicious area is identified by mammography or ultrasound, biopsy may be indicated to determine whether or not it represents cancer.  Approximately 20% of biopsies turn out to be cancer.  Depending on the type and location of abnormality, this may be performed in one of several ways including open surgical biopsy under general anesthesia or percutaneous (through the skin) needle core biopsy under local anesthesia using ultrasound or stereotactic mammography to guide the biopsy.

Open Biopsy – This is the surgical removal of the suspicious appearing area in the breast by a surgeon through a skin incision under general anesthesia.  The suspicious area will typically be targeted by placement of a thin guide wire by a radiologist under stereotactic mammography or ultrasound guidance techniques immediately prior to the surgery.  Wire localization is sometimes not necessary if the breast abnormality can be palpated (felt) by the surgeon.  One advantage of open biopsy is that typically the entire suspicious area will be removed from the breast for microscopic examination by a pathologist.

Needle Core Biopsy – This technique utilizes a needle like biopsy probe that is placed in the breast through a small skin nick under local anesthesia and obtains multiple small core like tissue samples from the suspicious area.  Imaging guidance is used by a radiologist to accurately place the probe in the suspicious area.  Imaging guidance may be stereotactic X-ray or ultrasound, depending on which imaging technique best demonstrates the suspicious area.  Advantages of needle core biopsy are that it does not require general anesthesia or stitches.  The patient may return home immediately following the procedure, which typically lasts about 1 hour.

Stereotactically Guided Breast Biopsy – This is a technique used for accurate placement of a needle core biopsy probe for biopsy of a suspicious area found on a mammogram.  The suspicious mammogram finding may be a density, calcifications, or a nodule.  The patient lies comfortably on her stomach on a special table that allows the breast to be suspended through a hole in the table where it is held in place for the procedure by gentle compression.

Ultrasound Guided Breast Biopsy – This technique is used for accurate targeting for biopsy of a suspicious abnormality visible by ultrasound. 

Fine Needle Aspiration (FNA) – FNA is used for sampling of fluid from breast cysts that appear suspicious (“complex” appearance on ultrasound).  Most breast cysts are benign (“simple” appearance on ultrasound) and do not require aspiration.  Aspiration is performed using a fine needle placed in the breast by a radiologist under ultrasound guidance and local anesthesia.

Needle Core Biopsies and FNA are performed by SDI Radiologists at The Breast Center located at St. Joseph's Women's Hospital

To schedule an appointment, call 813-348-6988.

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