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Breast Tomosynthesis or 3D Mammography (now with low dose C-View technology) is a form of digital mammography where the images are obtained in thin slices when the machine acquires projections in an arc around your breast. You will not notice any difference when having the mammogram. The computer algorithm allows the radiologist to see the breast in a set of images that gets rid of the overlapping changes from adjacent tissue, a common cause for call back examinations, or false positive examinations. This unique acquisition allows subtle details of distortion to show up even in fatty tissue increasing sensitivity and specificity in all types of breast tissue, not just dense tissue.
Digital Mammography is obtained the same manner as film screen mammography - with compression. However, the images obtained at our soft mammogram facility using digital technology and a MammoPad cushion for comfort allows the radiologist to manipulate the image and density to better see through dense tissue. In a study done in 2005, the ACRIN Digital Mammographic Imaging Screening Trial (DMIST), Digital mammography detected significantly (up to 28%) more cancers than screen film mammography in women 50 and younger, premenopausal and perimenopausal women and women with dense breasts. The ability to digitally manipulate the images also cuts down on repeat images for dense tissue and overall delivers a smaller dose of radiation in certain types and thickness of breast tissue.
Computer Aided Detection is a computer algorithm that acts as a second pair of eyes for the radiologist much like using spell check for documents. The computer algorithm detects various differences in the tissue and marks an area of concern. This allows the radiologist to take a second look to ensure potential findings are not overlooked. Various studies have shown up to 24% increase in breast cancer detection with this method.
Bone mineral density measures the amount of loss of bone density and allows prediction of a bone fracture risk. This test allows you to be treated before a bone is broken, or determines the level of density when a bone is broken. It is also used to measure response to treatment for decreased bone density. New software now allows measurement of body mass index (BMI) and allows for assessment of the change in fat and muscle content when a patient is on a weight loss regimen or workout regimen. Some insurances cover body scans in conjunction with physician weight management protocols.
Screening ultrasound in dense tissue helps to find incidental tumors. In some studies in Asia, where dense breast tissue is more prevalent, whole breast ultrasound has picked up as many breast cancers as screening mammography, however, each study missed 33% of cancers picked up by the other modality (meaning both studies done together get the best results). Many of these cancers found incidentally are in addition to lesions detected on mammography. The cancers found on ultrasound tend to be invasive cancers. The gold standard of mammography however, picks up different types of cancers, many of which are missed on ultrasound alone, especially in it's early stages. Screening ultrasound in our facility is performed by a physician with expertise in breast ultrasound.
Although we do not offer MRI examinations, we are happy to offer review of outside MRI examinations in order to correlate other clinical issues which may not be addressed by the radiologist reviewing MRI alone. Some radiologists who read MRI do not read mammograms and breast ultrasound to correlate the findings with the clinical questions. Our radiologist will coordinate the care of the entire patient with review of all breast imaging procedures. If a second look ultrasound is needed to correlate a lesion seen on MRI, our physicians are experts in breast ultrasound and perform lesion correlation to avoid intricate MRI guided biopsies when possible.
Breast Ultrasound is used as part of a diagnostic study to further evaluate an area of abnormality picked up on mammography or to evaluate a symptom such as a lump or breast pain. Many causes of breast pain are found by ultrasound such as cysts, fibroadenomas, and abscess which may be missed on mammography alone. Rarely, breast cancers can also cause breast pain depending on the location of the cancer. In our practice, a physician with expertise in breast ultrasound performs ultrasound of the entire breast, not just the area of concern.
Stereotactic core biopsy is performed for lesions seen on mammography. Core biopsies are minimally invasive procedures that allow sampling of the breast tissue and therefore avoid a surgical excisional biopsy. Stereotactic core biopsies are performed with the patient lying on their stomach on a raised bed. The breast falls through a hole in the table and the technologist manipulates the breast for the biopsy. Local anesthesia is then given and a small paper cut size incision is made to perform the biopsy. The patient leaves the procedure with a band aid over the incision and often returns to their routine activity the following day. Studies have been performed to show the results of core biopsy are as accurate as surgical biopsy.
Elastography is an ultrasound measurement that allows a mass to be further evaluated on it's tissue properties of compressibility. More rigid masses tend to be malignant and softer tissue tends to be benign. Ultrasound is a very sensitive test for masses but is not very specific (meaning it will pick up many masses but it cannot tell if a mass is benign or malignant in most cases). Elastography allows us to follow benign appearing lesions which are less concerning therefore avoiding core biopsy. Elastography also allows measurement of infiltrative processes within the tissue before it is identified as a focal mass as the rigidity of the surrounding tissue can be picked up as a "hard" area. This is often helpful for evaluation of palpable lesions when a discrete mass is not yet seen on ultrasound in otherwise normal appearing tissue.
Ductography is a procedure that looks at the inside of the milk ducts to further evaluate the causes for concerning nipple discharge. A small ductographic cannula is placed within the discharging milk duct and X-ray dye is injected through a syringe. Only a few drops are needed to entirely visualize the ductal system. The technologist then takes two images of the breast to show the number of lesions and location of lesions to help guide the surgeon or radiologist to perform a biopsy.
J-wires are placed to assist the surgeon for surgical biopsy to sample lesions which cannot be felt or seen. In many cases, where patients have lumpy breasts, the surgeon wants an exact localization of the lesion to be removed so there is no question at the time of surgery as to what is being removed. Our facility is the only facility in Los Gatos that has a surgical center in the same building as the outpatient imaging facility.
Contrast enhancement information is used in breast MRI and Contrast Enhanced Mammography (CEM). An IV injection of non ionic contrast material is used to detect abnormal blood flow to tumors making detection of cancers even easier when they are difficult to detect with other imaging. This procedure is used specifically when breast MRI cannot be done in patients with metallic devices severe claustrophobia or gadolinium allergy.
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