BREAST IMAGING
We would like to provide you with information about the imaging and biopsy procedures available in the Breast Imaging Center at Chesapeake Medical Imaging. We feel that it is important that you understand your breast imaging procedures and results, so that you are confident in the care you are receiving. We realize that mammography is potentially an uncomfortable or stressful experience for many women. Our goal is to help make each woman’s experience with breast imaging a positive one while also providing you with the most advanced technology and professional expertise.
One in eight women will develop breast cancer over the course of her lifetime. Because of recent advances in breast cancer screening and treatment, the five-year survival rated has for breast cancer has risen to 96% if the cancer is found before it has spread beyond the breast. Early detection of breast cancer is crucial for treatment and survival. Mammography is the best method for detecting breast cancer before it becomes palpable and is the only proven cancer detection modality that reduces cancer mortality. Although women with a personal or family history of breast cancer, women who have had radiation treatment to the chest and women with BRCA genetic mutations are at increased risk for breast cancer, it is important to know that most cases of breast cancer are found in women who are not in a high risk category.
The Breast Imaging Team at Chesapeake Medical Imaging is dedicated to providing the highest quality care and service. Our equipment is state-of-the-art, the center is accredited by the American College of Radiology and is in compliance with the Mammography Quality Standards Act. The technologists who perform the mammograms are specially trained and fully certified. This allows the highest level of expertise and experience. All of the imaging studies are interpreted or performed by board certified radiologists who have additional expertise in Breast Imaging.Digital Mammogram (full field digital mammogram)
CMI is the region’s first entirely digital mammography center. A digital mammogram is a computer acquired xray of the breasts. Digital mammography equipment looks and feels similar to the old technology, and compression is still important. However, digital equipment allows for a quicker and therefore often more comfortable study. Digital mammography allows us to use up to 50% lower radiation exposure, and to perform fewer repeat films. Digital images can be manipulated to allow improved visualization of breast structures. A recent large study of over 40,000 women sponsored by the National Cancer Institute has shown that digital mammography is significantly superior to traditional mammography mammography in women with heterogeneous or dense breasts and in women who are premenopausal or perimenopausal. We perform mammography differently depending on whether the study is screening or diagnostic (see below).
Screening Mammography
The American College of Radiology recommends annual screening for women beginning at age 40. The goal of screening mammography is to detect breast cancer at an early stage, while it is still so small that it cannot be felt. Screening is for women without breast symptoms. If you have a breast symptom (such as a lump, new spontaneous nipple discharge, skin changes or persistent focal breast pain), it is essential that you tell the technologist so that the proper imaging will be done. Some breast masses, for instance, will not be shown on the routine screening views. Screening mammography should not be done on women with a new breast symptom, women with a history of breast cancer, women who have had surgery since their last mammogram, women with implants or women whose last mammogram was abnormal.
Screening is not diagnosis; screening is done to detect possible abnormalities. If a screening study appears abnormal, you will be called back for additional imaging (5-10% of women are called back at this facility). Of those called back for additional imaging, over 95% do not have cancer. Please note: call-backs can be dramatically reduced if old mammograms are available for comparison.
At the time of your screening mammogram, the technologist will check the images for quality. Screening mammography studies are the read by the radiologist(s) and also further evaluated by our Computer Aided Detection (CAD) system. A final report is usually available within 24 to 48 hours. The report may be delayed if we do not have previous mammograms for comparison. Both you and your doctor will receive a written report of the results. If you do not receive a report, please call (410) 571-0350 so that we may provide you with the results of your mammogram.
Diagnostic Mammography
Diagnostic mammography is performed for women with a breast symptom (such as a lump, new spontaneous nipple discharge, skin changes or persistent focal breast pain), a history of breast cancer, a history of breast surgery since the last mammogram, breast implants, or if her last mammogram was interpreted as abnormal and recommended follow-up. This examination is checked and read by the radiologist before you leave the imaging department. Diagnostic mammography usually begins with the same routine views used for screening, but will often entail supplemental images and/or ultrasound.
It is important to prepare for your mammogram. Please bring your previous mammograms with you! This can avoid repeat films and suboptimal images. Also, the radiologist needs to see the previous films in order to read the current examination accurately. Your prior mammogram can be readily obtained by calling the place where you had your last mammogram and notifying them that you plan on picking up your films. Alternatively, you can arrange to have them sent to either your address or to CMI. Please do not wear deodorant, powder or cream, as this can cause artifacts on the mammogram. Try and schedule the study for the week after your menstrual period (your breasts will be less sensitive and tender). If breast compression is painful for you, you may take Tylenol, Motrin or another anti-inflammatory medication. Also, be sure to bring your insurance card and any referral forms that your insurance company may require.
Mammography is not 100% sensitive for detecting breast cancer. Approximately 10% of cancers are not visible on a mammogram. This is why monthly breast self exam by the woman herself and yearly exam by a trained health professional breast physical examination is essential.
Breast Ultrasound
Breast ultrasound (sonography) is an invaluable technique that utilizes sound to image tissue. We use breast ultrasound to evaluate lumps that are palpable or found by mammography or MRI. Breast Ultrasound can distinguish fluid filled cysts from solid growths. With ultrasound, we are able to “see” into the tissue in a different way; There is no radiation exposure with ultrasound. In women under the age of 30 with a palpable lump, ultrasound is the first imaging test of choice. All new lumps should be evaluated with ultrasound, since some growths may hide in glandular tissue and not be visible on mammography. If you have a lump, it is extremely important that you alert the imaging staff so that the radiologist can perform the necessary additional ultrasound examination.
Breast MRI
MRI is a sophisticated technology that uses a powerful magnet and radio waves to image tissue. As with ultrasound, there is no radiation exposure. MRI maybe twice as sensitive as mammography in detecting some subtle breast cancers. However, not all cancers that are shown by mammography are demonstrated on MRI. Studies have shown that MRI is helpful in the setting of a newly diagnosed breast cancer, since it can help guide pre-operative planning. MRI is also the optimal method for evaluating breast implant integrity. We also use breast MRI to screen women at high risk for developing breast cancer. The American Cancer Society recommends annual breast MRI screening in conjunction with mammography for women with a 20% or greater lifetime risk of breast cancer. This include some women with a personal or family history of breast or ovarian cancer, women who have had radiation treatment to the chest and women with BRCA1 or BRCA2 genes. Breast MRI may also be useful as a screening tool for women at moderately who have a lifetime risk of breast cancer of 15% to 20%. This would also include women with a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH), as well as women who have dense or heterogeneous breasts when viewed by mammograms. Computer Aided Detection (CAD).
Advances in computer technology have helped improve the accuracy and sensitivity of mammography and breast MRI. CMI uses the latest in CAD technology to evaluate breast images and possibly locate abnormalities that may be missed by traditional techniques.
Minimally Invasive Core Needle Breast Biopsy
Core biopsy has largely replaced open surgical biopsy for breast lesions requiring tissue diagnosis. Core biopsy is easily and comfortably performed at Chesapeake Medical Imaging using local anesthesia; it usually requires no more than 30-45 minutes. With this technique, small samples of tissue are removed with a needle device, using either ultrasound, mammography or MRI to guide the needle. This amount of tissue is sufficient to allow definitive pathologic diagnosis, yet the procedure causes minimal discomfort and no significant breast scarring. When the diagnosis is “benign”, the patient does not need surgical follow-up. If the diagnosis is cancer or precancer, then the surgeon can plan a single step surgical approach, based on the imaging and biopsy results.
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