Follow-up Imagery and Biopsy

If there is an abnormality detected your Doctor may schedule you for a follow-up imaging test. There are several options that your Doctor can choose from:

• Additional images taken at different angles on a conventional mammography machine
• Breast ultrasound, to evaluate questionable areas such as suspected cysts identified during screening mammogram
• Special mammography views, which may include magnification views or focal/spot compression views to evaluate a small area of breast tissue
• Magnetic resonance imaging (MRI) – Magnification views use a small magnification table that brings the breast closer to the x-ray source to capture zoomed in images of the site of interest. This enables doctors in clearer assessment of the borders and the tissue structures of a suspicious site or a mass to evaluate micro-calcifications, tiny spot of calcium in the breast that may be a sign of a small cancer.
• Spot Compression Mammogram – Don’t be alarmed by the name, it is not as bad as it sounds. It is simply a test that focuses in on the small area that was suspicious in the first mammogram. During the test, the physician applies compression to a smaller area of tissue using a small compression plate or cone. This is done to increase the effective pressure on that spot. This results in better tissue separation thereby allowing better visualization of the small site in question. Spot compression mammogram allows doctors to capture better images as compared to standard mammography techniques. Any abnormality in the breast can be seen more prominently on compression views
• Ultrasound – Just like the more familiar prenatal ultrasound a breast ultrasound works with the same technology. Ultrasound testing works by transmitting high-frequency sound waves, inaudible to the human ear, through the breast. The sound waves bounce off surfaces in the breast (tissue, air, fluid) and these “echoes” are recorded and transformed into video or photographic images. This procedure may be used to determine whether a lump is a cyst (sac containing fluid) or a solid mass which could be cancer. If it is found to be a cyst, fluid is typically withdrawn from it using a needle and syringe (a process called aspiration). If clear fluid is removed and the mass completely disappears, no further treatment or evaluation is needed. Ultrasound can also be used to precisely locate the position of a known tumor in order to guide the doctor during a biopsy or aspiration procedure. Ultrasound helps confirm correct needle placement.

Types Of Biopsies:

If the follow up imaging still does eliminate the abnormality you will be scheduled for a biopsy. There are several different types of biopsies that are designed to look at specific types of abnormalities. A fine needle aspiration is used to diagnose a breast lump while stereotactic biopsies zone in areas of micro-calcifications.

Types of breast biopsies include:

• Fine needle aspiration (FNA): Fine needle aspiration is a non-surgical form of breast biopsy in which a small needle is used to withdraw a sample of cells from the breast lump. If the lump is a cyst (fluid-filled sac), removal of the fluid will cause the cyst to collapse. If the lump is solid, cells can be smeared onto slides for examination.
• Core biopsy: Similar to FNA, but a core biopsy uses a larger needle because actual breast tissue is removed, rather than a tiny sampling of cells. A sample of the lump is removed, but not the entire lump. The types of core biopsies include ultrasound-guided core biopsy and stereotactic biopsy.
• Ultrasound-guided core biopsy: This technique obtains breast tissue without surgery. A biopsy needle is placed into the breast tissue. Ultrasound helps confirm correct needle placement — using sound waves reflected off breast tissue — so the exact location of the abnormality is biopsied. Ultrasound can distinguish many benign lesions, such as fluid-filled cysts, from solid lesions. Tissue samples are then taken through the needle.
• Stereotactic biopsy: Stereotactic biopsy involves centering the area to be tested in the window of a specially designed instrument. Mammogram films called SCOUT films are taken so the radiologist can examine the breast tissue. Using a local anesthetic, the radiologist makes a small opening in the skin. A sterile biopsy needle is placed into the breast tissue area to be biopsied. Computerized pictures help confirm the exact needle placement. Tissue samples are taken through the needle. It is common to take multiple tissue samples (about three to five).This type of biopsy is used to remove a sample from an area that shows micro-calcifications. These tiny calcium deposits can be evidence of a rapidly changing cell.