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Breast Imaging
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Mammography
Breast Ultrasound
Needle Core Breast Biopsy
Pre-Operative Needle Localization
Breast Cyst Aspiration
MAMMOGRAPHY
Description:
Breasts are examined in cephalo-caudad and medio-lateral oblique projections using low dose film screen technique. Patient must be able to sit up, maintain position, and tolerate pressure on the chest wall and firm compression of the breast.
Indications:
- Any breast mass. This includes patients scheduled for biopsy and evaluates breast tissue other than the dominant mass.
- Breast complaints or findings including possible breast mass, skin changes, nipple discharge, breast pain, includes breasts that are difficult to palpate and lumpy breasts with history of multiple previous biopsies.
- Metastasis from unknown primary. (In cases of axillary node biopsy, request the mammogram BEFORE the biopsy).
- High risk patients: i.e. previous diagnosis of breast cancer and/or strong family history especially pre menopausal breast cancer in a close relative.
- Baseline screening examination between 35 and 40 recommended by ACS and ACR, and subsequent routine follow-ups.
Low Yield Indications:
Examination of women under the age of 35. Request on any patient under 30 must be approved by radiologist.
BREAST ULTRASOUND
Description:
High resolution ultrasonic breast scanning.
Indications:
To characterize lesions found on physical examination, mammography or another imaging modality.
Alternative:
Biopsy or Aspiration.
Diagnostic Accuracy:
Using strict criteria, 98% of lesions called cysts on ultrasound are cysts. If criteria are met, nothing further is required. If not a typical cystic lesion, or lesion is a solid mass,, aspiration or biopsy may be necessary.
NEEDLE CORE BREAST BIOPSY
Description:
Needle core biopsy (11G or 14G) of mammographic, sonographic or palpable abnormalities. Can be done with radiographic (stereotactic) or sonographic guidance, depending on the lesion. Radiologist should be consulted regarding preferred method for the lesion under consideration.
Indications:
Suspicious abnormalities that are able to be imaged for biopsy guidance. There are some limitations in terms of lesion type and location. Radiologist should be consulted in each case to determine the preferred method of image guidance.
Alternative:
Excisional biopsy.
Preparation:
No anticoagulation medications for 72 hours prior to procedure. (Low dose aspirin is not a contraindication).
Complications:
Infection or Hematoma at biopsy site are potential but uncommon complications.
Diagnostic Accuracy:
Specificity 95-99% in published series.
PRE-OPERATIVE NEEDLE LOCALIZATION
When a suspicious lesion on mammogram or ultrasound cannot be palpated, localization is needed to guide surgical biopsy.
Description:
A 21 gauge needle containing an internal hook-wire is inserted into the lesion area under ultrasound or mammographic guidance (occasionally MRI). Films are taken in two projections to demonstrate relationships between the lesion and the needle tip. The hook-wire is engaged, the needle removed and the patient goes to the operating room with the films and radiology note. Procedure takes 30 to 45 minutes.
Indications:
Non-palpable lesions suspicious for malignancy discovered on mammography, ultrasound, or MRI.
Preparation:
Withhold pre-operative medication. Patient must be alert and cooperative for upright positioning. IV lines impede the procedure.
Complications:
Syncope. Displacement or transection of wire during surgical procedure.
BREAST CYST ASPIRATION
Description:
Aspiration of a lesion which fails to meet strict criteria for a cyst, or is a cyst but is symptomatic. At the discretion of the Radiologist, this may be carried out under mammography or ultrasound guidance.
Preparation:
None.
The University of Pennsylvania Health System, Philadelphia, PA © 2006,
The Trustees of the University of Pennsylvania
