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Breast Imaging

Breast imageWhen should I have a screening mammogram?

We at the Seattle Breast Center, along with the American Cancer Society and the American College of Radiology , recommend annual screening mammography starting at age 40. If you are high risk for breast cancer (if your mother or sister had breast cancer before the age of 50), then we recommend beginning screening 10 years before the age at which your mother or sister was diagnosed. For instance, if mom found out she had breast cancer at age 45, we would recommend starting screening at age 35.

How is mammography performed?

A screening mammogram consists of two views of each breast. In order to see through the breast tissues, it must be compressed. Our technologists are very experienced in positioning the breast as gently as possible, and the compression lasts only seconds while the mammogram is obtained, and the compression is released. It takes an average of about 10 minutes to take the four views. The technologist will then check the films to make sure they are of good quality. After that you are free to leave.

How is my mammogram read and who reads it?

When the technologist has finished your exam, the mammograms are placed through a computer-assisted detection system or CAD. The images are digitized and run through the CAD system and displayed for the radiologist to interpret.

All our radiologists are specialists in Breast Imaging who read a large volume of mammograms, perform all breast interventional procedures and participate in the Northwest Hospital Breast Multidisciplinary Team. We do not read your screening mammogram right when you are there. Why? Because we know that the best way to detect breast cancer is to read screening mammograms at a quiet time, with no interruptions when we are fresh and maximally alert. We read these studies in batches with the aid of the CAD software. Because of this, we have the best chance of finding a cancer if there is one there.

How much radiation is involved?

Mammography uses radiation to form images of the breast. The dose is extremely low, much lower than any other X-ray exam or CT scan. The amount of radiation from a mammogram is comparable to the amount you would receive on a cross-country flight.

What should I wear?

You will be asked to undress from the waist up for the exam. We provide robes to cover up. Any comfortable clothing is appropriate.

Mammogram

What preparation is needed?

We ask that you do not apply deodorant the morning of your mammogram, or that you wash this off thoroughly prior to your appointment. The flecks of deodorant can show up on the films and be confused for abnormalities.

How long will it take?

The exam should take less than 15 minutes.

What is a Call-Back?

In about 10% of cases, a question arises as a result of the screening mammogram. This does not mean that you have breast cancer. Most of these turn out to be entirely normal. But whenever there is a question, we will “Call Back” the patient for more views, and possibly an ultrasound. If this happens we will call you to arrange an appointment. We also send a letter to your home so that we will be sure to contact you.

When will I get results?

We read screening mammograms within 24 hours of your appointment. We send a letter to your home and to your doctor as soon as possible, always within three days of your appointment. If there is any finding on the films, we will call you immediately in addition to sending you a letter.

What if I have had mammograms at another facility in the past?

We would very much like to see your old films to compare with your current mammogram at the Seattle Breast Center. This is very helpful in showing the pattern of breast tissue has not changed over time. It would be best if this can be arranged before your appointment so that you can bring the old films in yourself, but we would be happy to facilitate the process at the time of your exam.

Diagnostic Mammogram

How is a Diagnostic Mammogram different from Screening?

Diagnostic mammograms are specialized mammograms designed to solve a particular problem. The radiologist designs each exam in order to answer the particular question at hand.

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 addition to the four views obtained in a screening mammogram, there are many specialized views that are possible to further investigate a finding. 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.

Breast Ultrasound

Ultrasound uses sound waves to generate a picture of the breast tissue. 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 very helpful in characterizing masses and lumps.

What happens if they find something in my breast?

Sometimes we do find a lesion that requires a biopsy to find out what it is. 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.

Breast Biopsy

How is a Breast Biopsy done?

Stereotactic-Guided Breast Biopsy The stereotactic table is specially designed so that you can lie face-down with one breast positioned through a hole in the table. Two digital x-ray images are taken from different angles, allowing the radiologist to precisely localize the area to biopsied. Once the area has been located, the radiologist numbs the area with a local anesthetic, then uses computer guidance for precise needle placement and collection of small tissue samples.

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.

Both methods are as accurate as a surgical biopsy and are performed on an outpatient basis, taking less than 40 minutes to perform and requiring no stitches. Furthermore, the patient 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.

MRI-Guided Breast Biopsy Our breast radiologists were some of the first to perform this procedure in the country. We can perform a standard needle biopsy in the MRI suite if a lesion is detected only on a Breast MRI exam, and this can be performed in under an hour.

Magnetic Resonance Imaging of the Breast

What is Breast MRI and how is it useful?

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 25 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 infusion of an intravenous substance (gadolinium) that is easily seen on MRI. Breast MRI is most useful in detecting breast cancer and evaluating the integrity of implants. Breast MRI is often 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.

Who reads the Breast MRI exams?

Our Seattle Breast Center radiologists, specifically trained in MRI of breast related diseases, perform and interpret the study. We utilize a special computer-assisted detection (CAD) program designed for the processing and interpretation of Breast MR Images. Because we are Breast Imaging specialists, we can achieve maximal integration of breast imaging studies so that the patient achieves the best possible care.

Ductography

What is a Ductogram?

A ductogram, also called a galactogram, is a test done if you are having persistent nipple discharge from a single duct, and your mammogram is normal. A tiny tube is inserted into the duct and a tiny amount of iodine contrast dye is injected into the duct. Several mammogram pictures are then obtained, with the ducts outlined by the iodine contrast dye. This shows whether there is anything inside the duct which could be producing the discharge. Most women report that this is not painful. When the duct is filled with fluid, it may feel a cramping sensation similar to what many women experience with their menstrual cycle.

Please Note: Via Radiology offers breast imaging and bone density exams at the Seattle Breast Center on the Northwest Hospital campus.

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