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Any patient with a breast symptom such as a palpable lump, nipple retraction, nipple discharge or a lump in the axilla (armpit), should have a consultation with a breast surgeon, to complete the Triple Assessment Process ( clinical examination, imaging and biopsy if required). Professor Paul Redmond provides a consultation service on Tuesday and Wednesday afternoons for private patients at the Consultants' Private Clinic:
Radiologists use an array of imaging technologies (such as ultrasound, mammography, magnetic resonance imaging (MRI) to image the breast. Other technologies available include computed tomography and PET imaging, access to these tests will also be facilitated if required.
The aim of this information is explain the process of assessment that clients attending the breast imaging typically may experience.
The client is referred to the Breast Imaging Unit and will have imaging performed as well as a clinical assessment. The clinical consultantion includes a discussion of the relevant symptoms and a clinical breast examination. The exact imaging tests performed will depend upon each patient’s unique situation.
A diagnostic mammogram is an x-ray exam of the breast in a woman who either has a new breast problem (for example, a breast lump, nipple discharge, etc.). During a diagnostic mammogram four standard pictures are taken, two of each breast. Occasionally extra views are performed to carefully study an area of concern. In most cases, special views enlarge a small area of suspicious breast tissue to make it larger and easier to evaluate. This is termed a spot compression/magnification view. Screening mammograms (i.e. taken at BreastCheck) are the four standard views, the patient is recalled if any extra views are required.
A mammogram is perfored following an injection of contrast (iodine-based) x-ray dye. This test is an extra dimension to provide detail regarding the blood supply of small masses. Biopsy of positive lesions can be performed by ultrasound or mammogram guidance.
The modern mammography machine uses low radiation doses to produce breast x-rays that are high in image quality (usually about 0.1 to 0.2 rads per picture). Strict guidelines ensure that mammography equipment is safe and uses the lowest dose of radiation possible. Many people are concerned about the exposure to x-rays, but the level of radiation from mammography today does not significantly increase the breast cancer risk for a woman who gets regular mammograms.
To put dose into perspective, if a woman with breast cancer is treated with radiation, she will likely get a total of around 5,000 rads (a rad is a measure of radiation dose). If she has yearly mammograms beginning at age 40 and continues until she is 90, she will get a total of 20 to 40 rads. To put it another way, the dose of radiation that she gets during a screening mammogram is about the same amount of radiation from her natural surroundings (background radiation) she would average over about 3 months.
Ultrasound, also known as sonography, uses high-frequency sound waves to look inside a part of the body. A handheld instrument placed on the skin transmits the sound waves through the breast. Echoes from the sound waves are picked up and translated by a computer into a black and white picture that is shown on a computer screen. This test is painless and does not expose you to radiation.
Breast ultrasound is sometimes used to evaluate breast problems that are found during a screening or diagnostic mammogram or on physical exam. Biopsies are also carried out under ultrasound guidance.
For certain women at high risk for breast cancer, screening MRI is recommended along with a yearly mammogram. High risk generally refers to women who have at least two close relatives with breast cancer. MRI is not recommended as a screening tool by itself, as it might miss some cancers that a mammogram would detect. MRi is also used to assess some breast cancers in more detail. Breast MRI is performed as a problem solving tool and as specialist screening in genetic conditions. MRI scans use magnets and radio waves instead of x-rays to produce very detailed, cross-sectional pictures of the body. The most useful MRI exams for breast imaging use a contrast material (called gadolinium) that is injected into a vein in the arm before or during the exam. This improves the ability of the MRI to clearly show breast tissue details.
These tests may lead to the need to take a tissue sample (biopsy).
Breast Biopsies can be ultrasound guided, stereotactically (x-ray) guided or MRI guided.A suspicious area in the breast may be found by physical exam, mammogram or another imaging method, or by some combination of these. But no matter of how it was found, cancer can only be confirmed by a biopsy. This means a sample of cells or tissue is removed and looked at under the microscope. For suspicious areas that cannot be felt (and even for some that can), imaging tests may be done to be sure the right area is biopsied.
There are two main types of biopsies.
Fine needle aspiration (FNA) biopsy uses a very thin, hollow needle to remove fluid and tiny bits of tissue.
Core needle biopsy (CNB) uses a slightly larger needle to remove a piece of tissue about 1/16-inch in diameter and ½ inch long.
All biopsies are performed using image guidance, either ultrasound, mammography or MRI.
Usually several samples are taken form the area to ensure enough material is obtained to allow accurate diagnosis. All biopsies are taken with local anaesthetic (drugs are used to make the area numb). Patients may feel a pushing sensation but they are not painful.
The results of imaging studies will be discussed with patients at the time of first consultation. All results will also be sent to your general practitioner in 48 hours.
All results of biopsies are discussed in a team setting enabling full multidisciplinary review and easing access to ongoing referral and treatment as required. Biopsy results are available in 7-10 days. This is to allow not only the process of pathological analysis but full team review. Biopsy results will be supplied to you by our Breast Care Coordinator as soon as they become available.