Mammography and Breast Imaging Page:

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When to have a mammogram

It is recommended by various health organizations that women over the age of 50 should have annual mammography to screen for early breast cancer. Many doctors also recommend the same for women in the 40 to 50 age group as well. Under the age of 40, breast tissue tends to be very dense, and difficult to image with the mammogram. After 40, the breast tissue involutes, becomes less dense on the xray and imaging then becomes useful.

What to expect on your first mammogram:

The first thing you will notice is the compressor. This is a paddle-like device that compresses or squeezes your breast into something that resembles a pancake or a flat object.

When the breast is in the compressor, the technologist will activates the xray machine and take the mammogram picture. After this, she then releases the compression. Usually, two views are taken of each breast.

(photograph at right shows a mammogram machine)

The mammogram can show tiny microcalcifications, which indicate early breast cancer. We see many benign types of calcifications also, so the radiologist should be well trained and a skilled interpreter to avoid sending all the benign calcifications to the surgeon for a biopsy.

In the event the mammogram shows a suspicious finding, the patient may be recalled for additional views with magnification, or for a breast ultrasound. See example of breast ultrasound below. If the suspicious finding can be seen on the ultrasound machine, then ultrasound percutaneous needle biopsy can be done right there on the spot. This is very quick, causes only minor momentary discomfort, and the patient goes home right away. The biopsy usually gives the answer whether the suspicious finding is benign or malignant. If it is malignant, the patient then will proceed to a more complete excisional biopsy of the breast lesion by a breast surgeon usually with preoperative needle localization done by the radiologist.

Mammogram shows a suspicious mass (red arrow)

Ultrasound shows cancer ( Right - red arrow and circle )

Ultrasound guided percutaneous biopsy was positive for infiltrating ductal breast cancer.

If the suspicious finding on the mammogram can not be visualized with the ultrasound machine, then the patient may proceed to Stereotactic Biopsy which is done in a special mammogram machine by the radiologist.

Stereotactic Breast Biopsy Information 
This procedure is usually done on an outpatient basis. It is performed by the radiologist who sends the biopsy sample to the pathologist for interpretation.

Indication for procedure: Mammogram shows a suspicious mass or calcification in the breast.

Preparation: Nothing by mouth after midnight. Do not take any aspirin or anticoagulants. The patient remains awake during the entire procedure.

Prone Table Method Only:

Conscious Sedation is usually given during the procedure in the form of a Valium type and a Narcotic drug. Note: if biopsy is done with patient sitting upright in chair, no sedation can be given because it interferes with patient being able to sit up.

Local anesthesia with xylocaine injected into the skin and subcutaneous tissues causes some initial pain and burning in the skin, which lasts about 4 seconds then, becomes numb. Additional xylocaine mixed with epinephrine is injected through the hollow cannula of the biopsy needle prior to biopsy.

Make sure you inform your doctor of any allergies to these drugs.

Possible risks and complications:

Bleeding, hematoma: inform your doctor if you are taking aspirin or coumadin or anticoagulation which will cause bleeding.

Infection: Sterile technique is used so that antibiotics are not usually given to the patient unless special conditions such as Mitral Valve prolapse or Endocarditis.

Description of procedure:

There are two different devices, 1) patient sitting in chair upright. 2) Patient lying on table prone as breast hangs down through aperture in the biopsy area. Both methods use: xray imaging of breast in two planes 15 degrees apart and Computer calculation of depth and x,y coordinates of the breast lesion for the biopsy needle. Using sterile technique, Betadine preparation and local skin anesthesia with xylocaine, a Biopsy needle is advanced to the lesion and samples obtained for microscopic analysis by the pathologist. After procedure: Pressure is placed over biopsy site to stop bleeding.

If sedation was used, patient may be observed for 4 to 6 hours in the hospital before going home.

Types of Biopsy Needles:

The Best Biopsy device is the BIOPSYS developed by Dr. Parker in Colorado. This uses a cutting cannula and suction to obtain directional samples with good core cylinder shape. If the Biopsys is not available, then a good heavy spring loaded biopsy gun is also acceptable.

Sample xrays: The samples are always x-rayed to confirm presence of calcification in the specimen.

Benign Mass: Mammogram showing biopsy proven benign fibroadenoma (red arrow):

Typical Mammogram Findings in Breast Cancer

small white particles are cancer-calcifications

Spiculated Mass-with radiating lines-Cancer

 
 
 
ACR Certified and R2 Checker

All mammography equipment in the Memorial Healthcare System is state of the art, ACR(American College of Radiology) Certified. All screening mammmograms are read by a dedicated Breast Imaging radiologist and overread using R2 Image Checker computer technology.

We will be enrolling patients in an FDA trial (approximately 12/02 ) to compare the sensitivity of film screen mammography and digital full field mammography.

Please contact the Breast Center at (954) 985-5916 for your mammogram. Starting December 2002 you may wish to be considered for the above clicical trial.

Thank you for your interest!