BREAST DIAGNOSIS UNIT
Technical advances in recent years, as well as the experience acquired in the interpretation of mammography and other imaging methods such as ultrasound, have considerably improved the detection and characterization of breast lesions, both benign and malignant. Currently it is possible detect small, subtle lesions, accurately predict your probability for malignancy, and even confirm its histological nature percutaneously through biopsy.
The breast nodule is the symptom most frequently associated with breast cancer.. It is estimated that one in ten women with a palpable abnormality or abnormality on a screening mammogram will have a carcinoma, and this probability increases with age, therefore it is of vital importance consult with a specialist in breast pathology before any abnormality detected in self-examination.
It is advisable undergo mammography studies, whether they are de screening (Periodic check-up for early detection of possible breast cancer) o diagnoses (after the detection of any symptom suspicious of breast cancer) in reference units, with radiologists present, as is the case of our clinic, that in view of the findings in conventional mammography, they may consider it advisable to perform projections and complementary tests to reach a definitive diagnosis of the patient in the same act.
We want to tell you a little about the mammography…
Mammography is currently the imaging method most used both in the study of patients with breast symptoms and in asymptomatic patients, in order to diagnose the breast cancer in early stages.
It is indicated in patients older than 35 years without family history and in older 30 years with a family history of breast or ovarian cancer.
It is an imaging method that involves ionizing radiation and requires compression of the breast to achieve quality studies., which can cause some discomfort in some women, especially if it is done the days before menstruation.
The conventional study consists of two projections of each breast, a cranial-caudal (CC) and another mediolateral oblique (OML). Performing two projections in each breast is essential to avoid overlooking lesions visualized in a single projection., as well as to make a correct location of them. Once it has been done, The radiologist evaluates the mammography and whether additional mammographic projections should be performed and/or complete the mammographic study with breast ultrasound that will be performed at that same moment..
The sensitivity of mammography in diagnosing breast cancer ranges from 61 and the 95%, being inferior in patients with dense breasts, where it is estimated that approximately 10% of tumors are not visible on mammography, even if they are palpable, hence It is recommended to complete your study with ultrasound mammary. Its specificity ranges between 80- 90%. Both sensitivity and specificity increase with age, being higher in patients above 50 years.
DIGITAL MAMMOGRAPHY
Why is it important to have a mammogram checked??
Because mammography is single technique diagnosis that has so far proven effective in decreased mortality for breast cancer. The breast ultrasound complements mammography, but it cannot replace mammography in early detection, since there are premalignant and malignant lesions that are only visible on mammography.
Will we use digital or conventional mammography?
Digital. Digital mammography uses the same x-ray technology as conventional mammography, but instead of using film, X-rays are converted into electronic signals that are sent to a computer. The computer converts these electronic signals into images that can be displayed on a monitor and also stored for later use and reference..
Digital mammography presents a series of advantages about conventional mammography: better resolution contrast, easy storage and availability of previous images, possibility of sending images to other centers to consult the report remotely, possibility of manipulation to improve the image, removal of possible plate artifacts, speed of the procedure and lower radiation dose ( issue a 25% less radiation for the patient). Digital mammography is also, superior to conventional mammography in detecting breast cancer in young women, premenopausal or perimenopausal and in women with dense breasts.
Recommendations for attending a mammogram appointment
- take away comfortable clothing to put on and take off (it will be more comfortable for you to wear 2 pieces instead of dress, since we will ask you to undress from the waist up) and avoid using creams, talcum powder and deodorant that day.
- Tell the technician if you are pregnant, if you are giving lactation or if you have prosthesis mammary.
- In the case of having previous studies mammography performed in our clinic or in another center, It is very important that you bring them with you, since radiologists need to check if there are significant changes in your breasts.
- Tell the technician any anomalies you have noticed (bulk, toughness, secretion, nipple inversion…).
- It is also advisable to inform about the use of hormonal treatments, history of breast surgery, or if you have a personal or family history of breast cancer.
- The best time to perform the test is week after period This is when the breasts are least sensitive.. Although if you have an appointment at any other time of the cycle, Don't worry, This will not hinder you from correctly assessing your breasts..
When will I have the results?
After performing the test, The radiologist will analyze the mammogram and issue a report on the same day of the test, what you will take away printed.
If you decide to read your results before going to your appointment with the doctor who requested the test (gynecologist, surgeon, family doctor…) You will find at the end of the report a conclusion about it, where the acronyms will appear BIRADS. In imaging diagnosis of breast pathology, this system is used to describe the radiological findings. (Breast Imaging Reporting and Data System) which classifies the results from 0 a 6.
- Category 0. It is necessary to complete the study with other additional examinations, such as additional mammographic screenings, breast ultrasound or MRI.
- Category 1 y 2. The findings are normal (1) or benign (2). Regular monitoring is recommended.
- Category 3. Findings are probably benign (more than 95% probability of benignity). Short-term follow-up indicated (normally each 6 months) during a period of 2 years.
- Category 4 y 5. An anomaly has been detected. Study of the lesion with diagnostic puncture is recommended.
- Category 6. It has been confirmed that she has breast cancer. It is used to carry out treatment.
Why do I have a breast ultrasound after a mammogram?? Should I be worried?
Breast ultrasound is another type of technique to study the breast that will often be used complementary to mammography, especially in patients with breasts dense or presenting findings mammograms. That is to say, They are different techniques and each one has its usefulness in the study of different breast problems..
Given the complementary nature of both techniques, In most cases it is advisable to do a breast ultrasound immediately after doing the mammogram., according to the criteria of the radiologist who studies the mammograms. For this reason, You should not worry if after the mammogram, The radiologist performs a breast ultrasound.
BREAST ULTRASOUND
What is a breast ultrasound?
Breast ultrasound is the most used imaging method in the study of breast pathology., after mammogram. It is the ptest of choice in those patients younger than 35 years without family history who have noticed any abnormalities or who want to undergo a breast examination. Depending on your age and your family history we will perform the election test.
Their main indications son:
- Nodule characterization or palpable and non-palpable “lumps”.
- Assessment of clinical symptoms and mammographic findings, like breast nodules, helping differentiate benign lesions from malignant lesions.
- Guide to interventional procedures, such as punctures and biopsies.
- Study of breast implants.
- It is the technique of choice to study palpable lesions in women. minors 30 years, in pregnant and lactating women.
It is free of risks for women's health, since there is no exposure to ionizing radiation. Allows you to obtain images in real time through ultrasound, to check the breast structure, characterize the findings and the blood flow circulating through the vessels.
Recommendations when going to your appointment for a breast and axillary ultrasound
- No special preparation is necessary, salvo do not apply creams, lotions or any type of products on the chest and armpit on the day of the test.
- Just like what happens when you have a mammogram, we will ask you to undress from the waist up, so it will be more comfortable for you if you wear two separate pieces and easy to put on and take off clothes.
- If you have previously had a mammogram or breast ultrasound performed at another center, Provide them so that the radiologist can compare whether there are significant changes.
As will be? Will it hurt me?
Once the woman is lying on her back, The radiologist applies a gel on the breast, over which a handheld device will be passed (transducer) to examine the inside of the chest, examining both breasts and armpits.
Indicate any anomalies or changes you have noticed. (bulk, toughness, secretion…etc.).
You may feel some pressure or discomfort during the ultrasound, but overall It is not a painful examination. The days before menstruation, the breasts will be more sensitive, so if the test coincides with those days, can bother more.
When will I have the results?
The radiologist will inform you of the findings at the time of the test and will indicate if it is necessary to monitor the injury or puncture it or if, on the contrary, you should continue with the usual check-ups.. It will issue a report on the same day of the test that you will take printed.
If you decide to read your results before going to your appointment with the doctor who requested the test (gynecologist, surgeon, family doctor…) You will find at the end of the report a conclusion about it, where the acronyms will appear BIRADS. In imaging diagnosis of breast pathology, this system is used to describe the radiological findings. (Breast Imaging Reporting and Data System) which classifies the results from 0 a 6.
- Category 0. It is necessary to complete the study with other additional examinations, such as additional mammographic screenings, breast ultrasound or MRI.
- Category 1 y 2. The findings are normal (1) or benign (2). Regular monitoring is recommended.
- Category 3. Findings are probably benign (more than 95% probability of benignity). Short-term follow-up indicated (normally each 6 months) during a period of 2 years.
- Category 4 y 5. An anomaly has been detected. Study of the lesion with diagnostic puncture is recommended.
- Category 6. It has been confirmed that she has breast cancer. It is used to carry out treatment.
INTERVENTIONAL PROCEDURES
Galactography
Galactography is a technique that allows the assessment of the ductal system after the introduction of a radiopaque contrast.
It is indicated in patients with discharge spontaneous, unilateral and through a single nipple hole, situation in which injury to the ductal system is suspected. The most frequently detected lesions associated with secretion are intraductal papilloma or breast carcinoma.. It can also be due to ductal ectasia. (dilation of the ducts that are located behind the nipple and areola) or fibrocystic changes.
It is important to previously perform a mammogram and ultrasound, since it can detect findings that justify secretion, such as nodules or microcalcifications, being able to do without galactography in some of these cases.
How is this technique performed??
First we administer a spray with lidocaine to the nipple to anesthetize locally the area and dilate the ducts enough to later help us introduce a small catheter with blunt tip introducer needle (no pincha) through the hole through which we visualize the secretion. Once channeled, we will inject the contrast very slowly radiologic, to later perform a mammogram and assess whether there is any alteration in the ductal system.
It is a technique painless, you may notice some discomfort as we introduce the contrast.
Subsequently it does not require special care. You can put a piece of gauze in your bra in case there is any remaining liquid and thus avoid wetting your clothes..
When will I have the results?
The radiologist will inform you of the findings at the same time the test is performed and will indicate whether it is necessary to monitor the injury or puncture it or if, on the contrary, you should continue with the usual check-ups.. It will issue a report on the same day of the test that you will take printed.
Fine needle aspiration puncture (PAAF)
How is a FNAB performed??
In which cases is it recommended to perform a FNA??
The main indication will be in the case of painful cysts for the patient or that generate a situation of anxiety and worry for women due to the sensation of “lump”. In these cases, analysis of the liquid obtained is not necessary., since this type of cysts are completely benign.
Other indications, less frequent, will be the emptying of complicated cysts (inflamed) or abscesses (infection), to differentiate between cystic or solid lesions in doubtful cases, hematoma drainage, seromas… and for puncture of axillary lymphadenopathy.
Do I need any special preparation to attend my appointment??
- As in the case of breast ultrasound and mammography, we recommend you wear comfortable clothes, easy to put on and take off, and preferably two pieces, since we will ask you to undress from the waist up.
- Let us know if you take antiplatelet drugs or is anticoagulated, preferably when you make the appointment.
- You don't have to come fasting, In fact, it is recommended that you come with breakfast, since it helps avoid possible dizziness due to fasting. Take your usual medication.
If the mammography or ultrasound report indicating FNAC performance was performed at another center, aportallo.
Are there complications?
Complications of breast FNA are almost nonexistent, You may notice some discomfort at the puncture point that same day., for which you can take any analgesic that you usually take for pain, like paracetamol or ibuprofen (not aspirin).
Ultrasound-guided percutaneous biopsies. BAG (Core needle biopsy)
A BAG is a type of biopsy that we perform with a needle, usually of 14 to obtain between 2 y 5 cylinders of tissue from the indicated breast lesion for subsequent microscopic analysis in order to evaluate whether or not breast cancer exists.
It is done before local anesthesia and ultrasound guidance.
In recent years, Ultrasound-assisted percutaneous biopsy has spread as an alternative to surgical biopsy, allowing a histological diagnosis of breast lesions without surgical intervention for this. With experience and practice acquired in the technique, correlation rates with surgical biopsy close to the 100%, avoiding the need for surgery in benign lesions, and reducing the number of surgical interventions necessary for the definitive treatment of breast cancer.
Do I need any special preparation to attend my appointment??
- As in the case of breast ultrasound and mammography, we recommend you bring comfortable clothes, easy to put on and take off, and preferably two pieces, since we will ask you to undress from the waist up.
- Bring with you a sports bra, May you have enough left tight, What you will wear at the end of the procedure and will help the area to swell less.
- Let us know if you take antiplatelet drugs or is anticoagulated, preferably when you make the appointment.
- We will ask you to contribute a analysis with basic coagulation performed in the month prior to the biopsy.
- You don't have to come fasting, In fact, it is recommended that you come with breakfast, since it helps avoid possible dizziness due to fasting. Take your usual medication.
If the mammography or ultrasound report indicating the performance of BAG has been performed in another center, aportallo.
What will the procedure be like?? It will hurt me?
It is not a painful procedure, since after cleaning the biopsy area with betadine or chlorhexidine, the radiologist will infiltrate you Local anesthesia
The radiologist will put a gel on the skin of the patient's breast, will locate the lesion to be punctured and decide the shortest and safest access. Once the area has been cleaned and disinfected with betadine or chlorhexidine, local anesthesia will be infiltrated., You may feel some temporary stinging in the puncture area.. Once this possible discomfort has passed, you shouldn't feel pain in the rest of the procedure.
When taking the sample, the needle makes a small noise, similar to a stapler. We will let you know so you don't get scared when you hear it.. In any case, you will not notice pain.
Once the sample is obtained, a breast compression for a few minutes, where you can feel pressure, to avoid as much as possible the subsequent appearance of hematoma on the skin. Finally we will place a compressive bandage, that we recommend that you wear during 24 hours, and remove after that time, wetting it well until it practically comes off on its own.. We will not place stitches, since it is not necessary.
What are the most frequent complications?
Most often there are no complications.. It is likely that in the following hours you will feel discomfort in the puncture area, being able to take analgesia habitual, like paracetamol or ibuprofen each 8 hours (avoid taking aspirin).
Sometimes, despite the compression, a may appear hematoma, that will be resolved as the days go by. We advise you to wear a tight sports bra at least for the first few days. 24 hours, along with the compressive bandage that we will have placed on you after the puncture.
Is special care necessary after BAG??
You will go home with the compressive bandage that we put on you at the end of the puncture.. We recommend that you bring a tight sports bra with you to put on when you finish.
Past 24 hours, you can remove the bandage, Wetting it well until it comes off on its own, and thus not damage your skin.
It is preferable that the same day of the puncture be a calm day, where you do not make great efforts or lift weight. Don't do sports that day. If it is not absolutely necessary, do not drive..
In the first 24 hours you may notice discomfort in the puncture area, so you can take regular analgesia such as paracetamol or ibuprofen every 8 hours, avoiding taking aspirin.
You can also use local ice.
The next day, in addition to removing the dressing, You can now shower and lead a normal life..
Sometimes a bruise occurs in the area., It will most likely disappear in a few days..
How long will it take for the biopsy results to be available??
The samples will be analyzed by a specialized pathological anatomy team in this type of pathology, that will issue a report with the diagnosis obtained, which will take approximately a week.
Once the result is, You can pick up the report at the pathology service itself or they will send it to you by mail, as you have indicated.
With the result of the puncture you must go to your requesting doctor (gynecologist, surgeon, family doctor…) to explain the next step to follow.