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Follow Up-Studies & Exams
10% of screening mammograms, a question arises about a finding on the images.
These images are interpreted as “Incomplete.” This means that more mammogram
views and/or an ultrasound exam may need to be performed in order to finish
the exam. Most of these follow-up studies are normal. However, sometimes a biopsy
is necessary to further evaluate a finding. Fortunately, most breast biopsies
can be accurately performed with a needle and do not require surgery. Depending
on the finding, a needle biopsy is performed - using either stereotactic, ultrasound,
or MRI guidance.
A mammogram may reveal an abnormal lump or lesion in the breast which cannot
be felt. The American Cancer Society recommends that even when the mammogram
is normal, a lump that can be felt should always be biopsied. A biopsy will
clarify whether a lump is a benign or malignant (cancerous) lesion. A biopsy
is the only method of determining whether a breast abnormality is cancer. This
removal (tissue sampling) of the tissue can be done through surgery or by needle.
The type of procedure used is determined by the appearance, feel (palpability)
and location of the lump or abnormality. When the tissue is sampled, it is sent
to a pathology lab for analysis.
Stereotactic-Guided Breast Biopsy –
The Seattle Breast Center was one of the first facilities in the region to put
this technology into practice over a decade ago. With the use of a specially
designed table, two digital x-ray images are taken from different angles, allowing
the radiologist to precisely localize the area to biopsied. Once the area has
been located, the radiologist numbs the area with a local anesthetic, then uses
computer guidance for precise needle placement and collection of small tissue
Ultrasound-Guided Needle Biopsy – Ultrasound
uses sound waves to produce a picture of the breast tissue. This picture helps
identify lumps or other changes in the breast. The radiologist uses ultrasound
to locate the area for biopsy and to direct the needle used in collecting
breast tissue samples. If the lesion is a cyst, a cyst aspiration (removing
the fluid from a cyst can also be performed using ultrasound guidance This
procedure takes less than 20 minutes to perform.
Ultrasound-Guided Excisional Breast Biopsy (Mammotome) -
The Mammotome biopsy is used for the removal of small, benign masses
when indicated and involves a single insertion of a small probe through a
3mm incision. A vacuum is then used to gently draw, cut, and collect tissue
into the probe’s hollow chamber.
MRI-guided needle biopsy - The Seattle Breast Center
offers state-of-the-art breast MRI for the diagnosis and evaluation of breast
cancer. If a lesion is found which is detectable only by MRI, we may perform
a MRI-guided biopsy to sample the tissue.
These methods are as accurate as a surgical biopsy and are performed on an
outpatient basis, taking approximately an hour to perform. Furthermore, the
patient can resume normal, non-strenuous activities shortly after the procedure
Magnetic Resonance Imaging (MRI)
Northwest Hospital performs high quality magnetic resonance imaging (MRI) of the breast.
We use state-of-the-art equipment including a dedicated bilateral
breast surface coil. Magnetic resonance imaging is a technique that is used
to evaluate the integrity of breast implants and to better define the presence,
or state, of breast cancer. Medical indications (reasons) for breast MRI are
evolving, and are the subject of many studies around the country.
The patient lies on her stomach within the scanning field for approximately
25 minutes. Images are obtained without and with intravenous contrast material.
If the examination is simply for implant evaluation, no contrast material may
be needed. Our Seattle Breast Center radiologists, specifically trained in MRI
and breast related diseases, perform and interpret the study. This allows for
maximal integration of breast imaging studies so that the patient achieves the
best possible care.
Specialized Testing for Women with a Family History of Breast Cancer
BRCA 1 and BRCA 2 genetic mutations account for 5 to 10% of breast cancers and 10 to 15% of ovarian cancers among white women. A woman who has a BRCA mutation has approximately a 60% lifetime risk of developing breast cancer. Seattle Breast Center is now offering genetic testing for the BRCA mutation to qualified candidates. Patients are offered an optional pre-test consultation. This test may or may not be covered by insurance plans, so please know the risk of out-of-pocket expenses.
We will discuss the results of the test with you and provide follow-up recommendations depending on each patients unique test results. If the patient is BRCA negative, but is still considered at high risk, she will be counseled and about routine screening with breast MRI in addition to mammography. If a woman tests positive for the mutation, she will be counseled about other family members who should be considered for testing and recommendations for future surveillance and consultation with appropriate specialists will be made.