Breast imaging is divided into two primary categories: screening and diagnostic. Screenings are most often conducted with mammography. However, women in certain high risk groups may have their screening conducted using ultrasound or MRI. The technology used to accomplish a diagnostic exam will depend on what information your physician needs to aid in his or her diagnosis. It is not uncommon in comprehensive breast imaging to undergo multiple exams using different technologies. Each yields unique and valuable information that together provide the most complete diagnostic picture.
If you are asked to undergo additional procedures following a screening mammogram, please try not to worry. Follow-up procedures are common and the vast majority of all breast abnormalities are NOT cancerous.
Mammography can show changes in the breast up to two years before a patient or physician can feel them. For this reason, the American Medical Association and the American College of Radiology recommend women have annual mammograms beginning at age 40.
The mammography services at EPIC Imaging are performed with digital mammography machines, the most advanced technology available. Like standard mammography, digital mammography uses x-rays to produce images of the breast.
However, instead of capturing an image on film, within seconds digital mammography sends the image directly to a computer. Once there, we can put the power of the computer to work. If we have a concern, we can zoom in, enhance the area and examine it more closely without having to take additional pictures. Exams are twice as fast with significantly less radiation exposure.
At Epic Imaging, we have used digital mammography since September 2000, making us the most experienced center in Oregon in this remarkable technology. Because images are immediate, call-backs have been greatly reduced. By adjusting contrast levels we have been able to reveal early calcifications and very small cancers that might have been missed in the single contrast world of film. The technology is ideal for seeing through dense breast tissue and offers better visibility of the breast near the skin line and chest wall.
In 2002 the technology was improved yet again when EPIC added a computer software program known as CAD to our digitally acquired images. CAD is short for Computer Aided Diagnosis. Using advanced mathematical measurements called algorithms, CAD allows the radiologist to conduct a computerized review of digital breast images. This review enables the radiologist to confirm an interpretation or highlight a potential area of concern that may not have been initially apparent to the eye. Research confirms CAD is helping find cancers at very early stages when treatment is most effective.
Breast ultrasound is a frequently used follow-up procedure for evaluating abnormalities found during mammograms or breast exams performed by your doctor. It can quickly and painlessly determine if a suspicious area is in fact a fluid filled cyst (almost always non-cancerous) or a mass of solid tissue, which may require further tests to confirm or rule out cancer.
Ultrasound uses the same echo-locating principles as sonar technology employed for decades by ships at sea. As very high frequency sound waves are directed through the breast, echoes are captured and reconstructed by a computer into live images on the computer monitor. The exam is completely non-invasive and uses no radiation.
Breast MRI provides a different kind of image than either ultrasound or mammography. Like ultrasound, MRI uses no x-rays or radiation. It combines the naturally occurring force ofa magnetic field with radiowaves to produce signals that are reconstructed on a sophisticated computer. With MRI, we are able to enhance the breast tissue using a contrast agent called gadolinium. By studying the properties and appearance of the gadolinium-enhanced breast tissue and vasculatures the radiologist is able to gain insight that would not be available with other technologies.
MRI is particularly important for screening women with a family history of breast cancer or a genetic predisposition for the disease. Women with a genetic predisposition may have inherited a mutation of the BRCA1 or BRCA2 gene. Screening mammography is less effective in detecting cancer among these women, perhaps because they often contract the disease at a young age when their breast tissue is dense and not easily penetrated with mammography.
Breast MRI has proven its ability to diagnose cancers that mammography can sometimes miss, particularly DCIS (ductal carcinoma in situ). It is also being used increasingly as a screening tool for high risk women. If you know you have a genetic predisposition, you should ask your doctor if MRI is appropriate for you and consider regular screenings as early as age 25.
MRI is routinely used to evaluate women who have symptoms, like a lump, that are not explained with either mammography or ultrasound. It is also very effective for determining the extent or spread of breast cancer. For this reason, it is a valuable tool to assist with the difficult decision between a lumpectomy and a mastectomy after a cancer has been diagnosed. Finally, breast MRI is very effective in evaluating breast implants for leakage or rupture.
PET/CT Breast Imaging
PET imaging, short for Positron Emission Tomography, is a powerful tool in the fight for improved breast cancer survival rates. Unlike conventional imaging which measures the structure of a tumor, PET measures the metabolic changes that occur in cells when cancer is present. These changes occur very early on in the course of the disease, long before a tumor is formed. In addition, unlike many procedures that focus on a single area of concern, PET scans provide a picture of the metabolic activity of the entire body. Because of this, PET imaging is frequently used to help determine the extent or spread of cancer as well as how it is responding to treatment.
At EPIC, we utilize the advanced combination PET/CT scanner. This remarkable advance combines two important technologies into a single scanner. PET shows metabolic activity. CT shows the precise form and location of an abnormality. Used in combination, PET/CT provides a full body view revealing the presence or absence of disease, how active it is, whether or not it has spread and precisely where and how large an abnormality is.
Since breast cancer typically responds quickly to chemotherapy, if it is going to respond at all, PET/CT scans provide breast cancer patients with quick confirmation of the effectiveness of treatment. This, in turn, allows the oncologist to make frequent changes in chemotherapy early in the course of treatment to achieve the most successful outcome for the patient.
Molecular Breast Imaging
Molecular Breast Imaging (MBI) is a relatively new technique to detect or evaluate breast cancers. It is particularly useful in women with dense breast tissue and when the results of other technologies are equivocal. EPIC has two MBI technologies: PEM, short for Positron Emission Mammography and BSGI, short for Breast Specific Gamma Imaging. Like PET (see previous page), PEM and BSGI measure the metabolic changes that occur in cells when cancer is present. Unlike PET, these technologies have been optimized for imaging the breast. Both produce extremely high resolution and very detailed images of breast abnormalities.
For breast cancer patients, MBI provides a valuable tool for difficult diagnostic cases and pre-surgical planning for confirmed breast cancers. It is one of our best measures to date to evaluate if a patient is a candidate for breast conserving surgery (lumpectomy) versus mastectomy. In many cases, PEM also provides the earliest possible view of the effectiveness of treatment.
A breast biopsy is a tissue sampling technique used to confirm or rule out the presence of breast cancer. The primary benefit of biopsy is to avoid invasive, unnecessary surgeries. Various methods of obtaining the sample are currently employed at EPIC: ultrasound-guided biopsy, MRI-guided biopsy and stereotactic breast biopsy. The method employed depends upon many factors such as breast size, tissue density and the nature of the abnormality. All methods are minimally invasive alternatives to surgery. Regardless of the method used, local anesthetic is always administered to minimize any possible discomfort.