Breast Imaging

The doctor may order one or more of the following imaging studies as part of your continued breast care.

Mammogram

A mammogram is an x-ray exam of the breast.  It is used to detect and evaluate breast changes, in women who have no breast complaints or symptoms and in women who have breast symptoms (problems such as a lump, pain, or nipple discharge).  Mammograms are most often used to look for cancer in women who have no symptoms.  These are called screening mammograms.  Mammograms done on women who have lumps or other symptoms, or who have a suspicious change seen on a screening mammogram, are called diagnostic mammograms.

  • Screening Mammograms
    A screening mammogram is an x-ray exam of the breast on a woman who has no symptoms.  The goal of a screening mammogram is to find cancer when it is still too small to be felt by a woman or her doctor.  Finding small breast cancers early by a screening mammogram greatly improves a woman’s chance for successful treatment.A screening mammogram usually takes 2 x-ray pictures (views) of each breast.  Some patients may need to have more pictures to include as much breast tissue as possible.
  • Diagnostic Mammgorams
    A diagnostic mammogram is an x-ray exam of the breast in a woman who either has a breast problem (example: breast lump, nipple discharge, etc.) or has had something abnormal found during a screening mammogram.  During a diagnostic mammogram, more pictures are taken to carefully study the area of concern.  In most cases special pictures are enlarged to make a small area of suspicious breast tissue bigger and easier to evaluate.  Many other types of x-ray pictures can be done, depending on the type of problem and where it is in the breast.  For example, a diagnostic mammogram may show that an area that looked abnormal is actually normal when closer examined, and the woman can then return to routine yearly screening.

MRI of the Breast

Magnetic resonance imaging (MRI) is an imaging test that uses magnetic energy rather than x-ray.  If diagnostic mammogram and ultrasound results are normal but the clinical breast exam reveals an area of concern, an MRI may be helpful.  However, an MRI takes longer to perform than other imaging tests and involved the intravenous injection (IV) of dye to help differentiate between benign and cancerous breast lumps.  Cancerous tissue requires a greater blood supply than does normal tissue.  Because MRI images show greater contrast in areas of increased blood supply, a radiologist can use the images to tell which areas may or may not be cancerous. 

PET Mammogram (PEM)

Positron emission mammography (PEM) is a relatively new and advanced application of positron emission tomography or PET scanning, which for decades has been helping doctors diagnose and treat disease.  PEM is a specialized and improved form of PET for imaging breasts.  Unlike large PET systems that can scan a person’s entire body, PEM systems are small and concentrate their imaging abilities on a single breast.

Because it focuses on a small area, the PEM system’s camera and detectors are closer to the area affected with cancer, which produces a very sharp, detailed image of tumors and cancerous tissue.  With PEM, doctors can see cancers as small as 1.5-2mm, about the width of a grain of rice.  No other medical imaging device acheives this kind of clarity.

The images allow radiologists, breast surgeons and oncologists to study molecular abnormalities inside the tumor cells, which aids significantly in staging a cancer and determining the appropriate treatment.  Its high resolution allows doctors to evaluate breast cancer more precisely so women receive the most effective treatments available.  It also allows for the earlier detection of elusive cancers such as DCIS (ductal carcinoma in situ).

PEM gives physicians a uniquely accurate map of cancer deposits, upon which they can base their treatment and.or surgical plans.  Armed with this information doctors can better determine candidates for breast-convserving surgery or lumpectomy.  Also, knowing the exact location and extent of the cancer guides doctors during surgery and helps assure that they remove all of a tumor or cancerous tissue and help avoid repeat surgeries.

Who should have a PEM scan?

  • Newly or previously diagnosed breast cancer patients
  • Women who are affected by obesity, claustrophobia or medical implants such as pacemakers which preclude them from having a breast MRI

 

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