Mammography Screening and Diagnostic
- Women age 40 and older should have a mammogram each year.
- A screening mammography exam detects masses and calcifications before a physician or patient can feel them.
- Diagnostic mammography is performed on patients who have a current problem, such as pain, lump, nipple discharge or skin changes.
- Three-dimensional (3-D) mammography, also known as tomosynthesis, is the latest technology for breast cancer screening. It can better differentiate a cancer from overlying glandular tissue. This increases cancer detection and decreases chances of a “false positive.”
Ultrasound
Ultrasound evaluates breast tissue by using sound waves instead of radiation to produce an image of the breast. Ultrasound is particularly valuable in determining the difference between a cyst (fluid-filled mass) and a tumor (solid mass).
Breast MRI
Women who have an increased risk for breast cancer can get a breast MRI. This provides detailed images that can detect small tumors. The MRI can also examine lymph nodes in the underarm, an area often difficult to assess. MRI also provides guidance for MRI biopsies of the breast. For premenopausal women, the best timing for breast MRI is day 7-15 of the menstrual cycle (day 1 is defined as the first day of bleeding).
Breast Biopsy
Your doctor has recommended that you have a breast biopsy because a suspicious area was seen on your mammogram. This is a simple procedure performed at the Breast Health Center by our team of breast imaging specialists.
During the biopsy, a small sample of tissue will be collected from the suspicious area. The tissue samples will be sent to a pathologist, a physician specializing in the analysis of tissue samples under a microscope. The pathologist will provide the biopsy results to your physician, who will review them with you. This outpatient procedure requires minimal preparation and recovery time.
It is likely that your procedure will be performed using one of the three primary imaging systems common in breast biopsy: ultrasound, X-ray or magnetic resonance imaging (MRI).
Before Your Procedure
In advance of your biopsy procedure, you should inform your doctor of any medications and vitamins you are currently taking – either prescription or over-the-counter. Your doctor may advise you to stop taking certain medications before your scheduled biopsy.
You may also be advised to wear loose clothing for comfort and not to wear deodorant or perfume. Most patients can eat and drink normally and perform their typical daily activities before arriving for their breast biopsy.
During Your Procedure
On the day of the procedure, you will be asked to undress and will be given a gown to wear. Depending on the imaging system used to help guide your biopsy, you may have your breast compressed similar to a mammogram, or a gel may be applied if your physician is using ultrasound imaging. If you are having an MRI-guided biopsy, you will have an IV inserted into your arm so that a contrast agent can be used to see small details in the breast. After you have been properly positioned for your biopsy, your breast will be imaged and the area to be biopsied located. Your skin will be cleansed with sterilizing solution and numbed with anesthetic. A very small skin nick will then be made to make it easier for the biopsy needle to enter the breast.
Typically, multiple tissue samples will be collected through the single skin nick. A final set of images may then be taken to verify that the appropriate tissue was collected. Your physician may place a small marker (smaller than a piece of rice) at the biopsy site to make it easy to find the exact location of the biopsy in the future. The marker is made of a metallic alloy, such as titanium or stainless steel, and you will not be able to feel or notice the marker after it has been placed.
After Your Procedure
Pressure will be applied to your breast for a few minutes. A small bandage will be placed over the skin nick and you may be provided with an ice pack to apply over the biopsy site. In some instances, a compression wrap bandage may be placed around your chest to minimize chances of swelling or bruising.
Your doctor may prescribe a non-aspirin pain reliever to help alleviate any possible discomfort. Detailed instructions will also be provided on how to care for the biopsied area. Most women can resume normal daily activities immediately following their procedure.
Frequently Asked Questions
Q: How much of the breast tissue or lump will be removed?
A: Only a small sampling of tissue will be taken from the suspicious area
Q: How long will the biopsy take?
A: Biopsy times vary depending on each patient’s situation. Typically, the total time for a biopsy is 45 – 60 minutes from the time you enter the exam room until the time you leave. This includes the time it takes for the doctor to remove tissue samples, which is usually less than one minute.
Q: Will I experience any pain during the procedure?
A: Each patient is different, but you might feel a slight sting or pinch when the anesthetic is first being administered to your breast. Numbing the breast before the biopsy should make the rest of the procedure as pain-free as possible.
Q: How will I feel after the procedure?
A: Your breast may be slightly tender, and you may experience some bruising at the biopsy site. Typically, most women can resume many of their normal activities the same day as the procedure. Your doctor will advise you of post-biopsy procedure care.
Stereotactic, Ultrasound and MRI guided biopsies
- Stereotactic breast biopsies: The patient will lie on a padded table on their stomach. Their breast will be placed through an opening in the top of the table. The technologist will position the breast to localize the area of concern. Some compression will be required to maintain proper positioning during the procedure. Our radiologist will utilize a specialized computer to guide the biopsy device/needle to the lesion and remove small tissue samples from the area of concern.
- Ultrasound-guided biopsies:The patient will lie on a padded table on their back. This procedure utilizes sound waves to assist the radiologist with placing a special biopsy needle into the breast lesion. Our radiologist will remove small tissue samples from the area of concern.
- MRI-guided biopsies: The patient will lie on a padded table on their stomach. Their breast will be placed through an opening in the top of the table. The technologist will position the breast to localize the area of concern. Some compression will be required to maintain proper positioning during the procedure. A needle is placed into the breast lesion under MRI guidance. Our radiologist will remove small tissue samples from the area of concern.
After your biopsy we will place a small titanium clip or marker in your breast at the biopsy site to easily identify the area that was biopsied. You will not feel or notice the clip, and the clips are not associated with any health risks.
The technologist will hold pressure for a few minutes to stop any bleeding. We will apply a steri strip and sterile dressing to your biopsy site. You may feel some tenderness at the biopsy site or experience bruising after your biopsy for several days. Patients can take Tylenol for discomfort. You can resume normal actives after your biopsy unless you get additional instructions.
We send all biopsy specimens to the pathologist for final diagnosis. These results are typically available within 48 to 72 hours. We perform the above biopsy procedures at our diagnostic centers at the Outpatient Center at Surfside and the Outpatient Center at the Sanctuary and at Lee Health – Coconut Point
Cyst Aspirations
The patient will lie on a padded table on their back. This procedure utilizes ultrasound guidance. Sound waves will assist the radiologist with placing a small needle into the mass in your breast and extract fluid from it. We send the fluid to pathology to be examined under a microscope to assess for any abnormalities.
Savi Scout
An alternative to needle localization is the FDA-cleared device called a Savi Scout. The radiologist will place a reflector Savi Scout next to the breast lesion using imaging guidance. This can be placed at any time before surgical removal. On the day of surgery the surgeon will scan the breast using a hand piece that emits infrared light and a micro-impulse signal to detect the location of the reflector. Real-time audible and visual indicates assist the surgeon in accurately locating the reflector, along with the target lesion. Use of this device allows for more flexibility in scheduling surgery and can improve the patient’s experience.
Needle Localization/Open Biopsy
Using mammographic, ultrasound or MRI guidance, the radiologist will place a tiny needle and wire into the suspicious lesion in your breast. The radiologist will confirm the needle is in the correct place and then remove it — but the wire will remain in place. We will then transport the patient to an outpatient surgical suite to have a surgeon perform the open biopsy.
Bone Densitometry / Osteoporosis Screening
Bone density testing is one of the best ways to identify whether you are at risk for developing osteoporosis, an ailment that leads to brittle bones and fractures. The Breast Health Centers offer DEXA osteoporosis scanning, which can give your physician an accurate picture of your bone density early enough to help make a real difference.