Digital mammography can often detect breast cancer before you ever feel a lump.
This completely noninvasive exam uses low-dose radiation to quickly produce high-quality detailed images of the breast that can be magnified and adjusted for improved contrast to possibly reduce the need to return for additional imaging.
At Long Island Community Hospital Women’s Imaging, we provide the latest in state-of-the art mammography and related services in a warm, caring and compassionate environment. These services include:
- Screening and Diagnostic Mammography
- Stereotactic Breast Biopsy
- Needle Localization
- Excisional (Open) Biopsy
- Galactography (Ductography)
- Breast MRI
- 3D Breast Tomosynthesis
Screening and Diagnostic Mammography
Mammography is considered the “Gold Standard” in breast cancer detection. It is the best method to screen for the presence of small undetectable lumps or groups of microcalcifications, which may be the only sign of breast cancer.
Early detection of breast cancer through Full-Field Digital Mammography affords greater opportunity for successful treatment of breast cancer.
LI Community Hospital Women’s Imaging Services uses full-field digital mammography with computer-aided detection (CAD), a completely noninvasive mammography that utilizes low-dose radiation to produce high-quality detailed images of the breast. CAD technology scans the images and marks any suspicious areas, basically working as a “second pair of eyes.”
- Screening mammography is used to help find breast cancer early in women who have no symptoms. It’s also used for patients with breast implants (breast augmentation).
- Diagnostic mammography is used to identify abnormal physical findings or abnormalities on screening mammograms.
The radiologist may recommend a follow up mammography exam such as spot compression views, which uses a smaller compression paddle at the site of the abnormalities, or magnification views, which uses a smaller compression paddle and a special magnification tray. This assists the radiologist to enlarge the area of interest allowing the radiologist to view additional detailed information.
Digital Full-Field Mammography is significantly better for screening women:
- Under age 50 (no matter what level of breast tissue density).
- Of any age with very dense or extremely dense breast tissue.
- Of any age who are pre- or peri-menopausal women (defined as women who had a final menstrual period within 12 months of their mammography).
Stereotactic Breast Biopsy
Stereotactic technology uses a computer to enable the radiologist to locate and obtain a sample of the questionable area. It uses “stereo” X-rays (X-rays taken from two angles) and a special biopsy needle
A stereotactic breast biopsy is most useful when mammography shows a mass, cluster of microcalcifications (tiny grouped calcium deposits) or an area of abnormality but no lump can be felt.
Women can take comfort in knowing that stereotactic breast biopsy procedures are safe, simple and only mildly uncomfortable. There is:
- No external scarring and no internal scarring to interfere with future mammograms.
- No lengthy wait for test results.
- No exposure to general anesthesia.
- No prolonged recovery period.
Preparation: On the day of your procedure, it is best to wear a comfortable, two-piece outfit since you will need to wear a gown. Also, avoid deodorants, perfumes, creams, powders or lotions, which can interfere with the images. Patients should ask their healthcare provider about discontinuing blood thinners or aspirin prior to the procedure.
What to Expect: You will be lying face down on your abdomen on a specially designed table. Your breast will be placed through an opening in the table. The table will be raised, and the procedure will be performed beneath you by the radiologist and technologist. Just like a mammogram, the breasts will be compressed. Several computerized images will be taken and reviewed by the radiologist. The skin of the breast is cleansed, and a local anesthetic (lidocaine) is injected with a small needle much like a dentist would use. You will feel a tiny pinch similar to a pinprick. Once the anesthetic has numbed the area, the radiologist will insert a biopsy needle and take additional images to ensure proper placement. Several samples of the tissue will be extracted for analysis. A tiny clip may or may not be placed inside the breast to mark the area biopsied.
Your Results: Samples of your biopsy are taken to the pathologist for analysis and examined under a microscope. The findings of your biopsy will be reported to your healthcare provider who will forward the results to you.
A needle localization procedure is the way the radiologist helps your breast surgeon find the area of abnormal tissue. This also reduces the length of surgery and minimizes the removal of healthy tissue.
After the exam the specimen will be sent to the pathologist and examined under the microscope. The findings will be sent to your healthcare provider who will, in turn, forward the results to you.
Preparation: On the day of your procedure it is best to wear a comfortable, two-piece outfit since you will need to wear a gown. Also, avoid deodorants, perfumes, creams, powders or lotions, which can interfere with the images. Patients should ask their healthcare provider about discontinuing blood thinners or aspirin prior to surgery.
What to Expect: The procedure is similar to that of a mammogram. The technologist will seat you in a special chair. The radiologist will numb the breast tissue with a local anesthetic (lidocaine). You will feel a pinch or a tiny pinprick. The radiologist then inserts the localization needle to the exact position of the abnormality. Several images will be taken to confirm the location. When the abnormality is targeted, a very thin small guide wire is inserted down through the inside of the needle to mark the position of the abnormality. A small hook at the end of the wire keeps it in place, and the needle is then removed. A dressing is placed over the wire, and you will then proceed to surgery.
Excisional (Open) Biopsy
Excisional biopsy yields the largest breast tissue sample out of all the breast biopsies with diagnosis accuracy of close to 100%.
Preparation: On the day of your procedure, it is best to wear a comfortable, two-piece outfit since you will need to wear a gown. Also, avoid deodorants, perfumes, creams, powders or lotions. Patients should ask their healthcare provider about discontinuing blood thinners or aspirin prior to surgery.
What to Expect: The surgeon may have the radiologist “mark” the area to be biopsied by placing a thin wire into your breast and into the tumor. This is called needle localization. At the time of your procedure, you will be taken to the operating room and most likely placed under general anesthesia. The surgeon will make a 1- to 2-inch incision in your breast and remove the localization wire (if placed) and a margin of tissue around it. Once the procedure is completed, the incision will be closed with stitches and a bandage will be placed over the area.
Your Results: The entire specimen will be sent to the pathologist for analysis, and the results will be sent to your referring healthcare provider.
Galactography, or ductography, is a special mammographic procedure that involves injection of contrast agent (dye) in a milk (mammary) duct to determine the source of nipple discharge.
Since mammography cannot show the inside of a mammary duct clearly, galactography is used. Nipple discharge is fairly common and usually benign (noncancerous), but many times it causes anxiety and discomfort in women. It can be caused by infection, cysts, noncancerous tumors (such as papillomas), ductal ectasia (widening or hardening of the duct) or cancer. Cancer most associated with nipple discharge is called ductal carcinoma in situ (DCIS). DCIS is cancer cells that start in the milk ducts, but have not gone outside the duct walls into the surrounding tissue. It is considered “contained” within the duct. This is a highly curable form of breast cancer that may also be called “intraductal carcinoma.”
Nipple discharge should be reported to your healthcare provider if it is:
- Bloody or watery with a red, pink or brown color.
- Sticky and clear in color or brown in color.
- Spontaneously appearing without squeezing the nipple.
- On one side only.
How to Prepare: On the day of your procedure, it is best to wear a comfortable, two-piece outfit since you will need to wear a gown. It is very important that you do not manipulate the breast or express secretions from the duct for 24 hours prior to the procedure. If the duct is “dry” at the time of your procedure, it cannot be performed.
What to Expect: The procedure will be performed if nipple discharge is present on the day of the procedure. Initially, you will lie down, and the nipple will be cleansed with an antiseptic. The radiologist will attempt to elicit nipple discharge. Once the discharge is visible, a tiny catheter is placed into the opening in the nipple where the discharge is coming from. A small amount of contrast dye is then injected into the duct using a very small syringe. Then, you will move to the mammography unit, and a mammogram is performed. The contrast dye enhances the anatomy of the duct to show whether there is a mass inside the duct.
Galactography can be mildly uncomfortable, but usually is not associated with pain. More commonly, it is referred to as a “fullness” as in lactation (breastfeeding). You may experience slight tenderness from the manipulation and compression. If so, acetaminophen or ibuprofen should relieve any discomfort.
After the procedure is completed, a small bandage is placed over the nipple to prevent the contrast dye from leaking onto your clothes.
Your Results: Your healthcare provider will be informed of the results, who will, in turn, forward the results to you.
Breast MRI (Magnetic Resonance Imaging)
An MRI is a painless procedure in which radio waves and powerful magnets linked to a computer are used to create detailed images of areas inside the body without using radiation. MRI is a supplemental tool to help diagnose breast cancer and has been approved by the FDA for about a decade.
MRI is the most reliable method to evaluate for rupture or leakage for women who have breast implants.
MRI is useful for patients with dense breast tissue, scar tissue from a prior lumpectomy site or abnormalities that can be felt but are not visible with mammography or ultrasound. It is useful to determine whether breast cancer has spread to the chest wall, which may affect treatment. It is also helpful to distinguish if a cancer is limited to one area or is “multifocal,” involving more than one area.
MRI is many times used for women at high risk, such as:
- Women with a prior history for breast cancer.
- Women who have a first-degree relative with breast cancer such as mother, sister or daughter.
- Damage to one of the BRCA genes (found in specialized blood testing).
How to Prepare: Personal items such as watches, rings, necklaces, credit cards with magnetic strips or any items that contain metal should be left at home or removed prior to the MRI scan.
What to Expect: You will be asked to wear a hospital gown for the procedure. You will lie on your stomach on a table during the scan. The breasts will be placed through an opening on the table, which contains coils that detect the magnetic signal. The table is moved into a tubelike machine that contains the magnet. You will hear the equipment making a muffled thumping sound for several minutes. There is no pain involved with an MRI. After several images have been taken, you may be given a contrast agent (dye) intravenously. The contrast is not radioactive. Contrast is used to improve the ability to view any tumors. Additional images are then taken. The entire procedure takes approximately one hour.
Your Results: After the exam, the radiologist will interpret the images and send a report to your healthcare provider.
3D Tomosynthesis: Using high-powered computers, breast images are converted into a stack of very thin “slices” – building what is essentially a 3-D mammogram. The X-ray arm sweeps in a slight arc over the breast, taking multiple images in just seconds. Fine details are more clearly visible, no longer hidden by the tissue above and/or below.