3D – Digital Mammography – Tomosynthesis
What is digital tomosynthesis?
Tomosynthesis is a new 3D technology of breast depiction with higher diagnostic accuracy in the duagnosis of breast disease contrary to the conventional mammography, as it has the potential to distinguish normal tissue from the problem, making it easier to detect any suspicious lesions, even the small sized ones.
What is the difference between the technology of tomosynthesis and the conventional digital mammography?
The main problem with the conventional mammography is that when the breast is pressed during the examination, the various elements in the breast are compressed against each other. As a result, the exam can sometimes not be able to spot any important evidence. With the aid of the state-of-the-art technology of tomosynthesis, breast is depicted through multiple detailed incisions of one millimeter. This means that nothing can get away. Therefore, digital tomosynthesis is established as another more reliable examination for a woman.
What are the advantages of digital tomosynthesis?
a. The chances of false positive or false negative diagnosis are minimalised
b. It increases the diagnostic accuracy of small lesions at an early stage
c. Fewer repetitions of examinations
d. Fewer biopsies
e. Less pressure is applied on the breast, thus less pain
What is true in terms of the radiology we are exposed to? Is it more than the conventional digital mammography?
The time required for the digital tomosynthesis is slightly more in comparison to the time required in digital mammography, and the level of radiation the individual is exposed to remains low and safe. Women who avoid mammography out of fear that radiation exposure may harm them should know that mammography radiation is more or less the same as the radiation they are exposed to when they sit in the sun on a sunny day.
Can I have digital tomosynthesis examination without going through mammography?
Digital mammography with tomosynthesis is, according to the American Medicine Organisation (FNA), an independent depiction technique that is complementary of the digital mammography for a better diagnosis. Digital mammography still remains the basic examination and should be complemented by tomosynthesis when and if it is deemed appropriate.
Which women should have a digital tomosynthesis exam?
Due to its ability to penetrate the mass this method is indicated for women who have dense breast tissue at a young age but also to women with hereditary history.
Digital tomosynthesis is also indicated to cases where mammography has revealed something that requires a further investigation.
How is a breast ultrasound conducted?
The ultrasound is conducted with the use of a special ultrasound device with the appropriate ,for the breast, head. The woman is usually placed in a supine position and with the hands behind the head. Placing the small head of the ultrasound device on the breast, it reproduces anatomical incisions of the breast in a black and white image. The breasts are examined in all their surface as well as the armpit area. The method is completely painless, harmless (does not have any radiation) and relatively short. The ultrasound should be applied by doctors who are experienced in this method and are well aware of the breast diseases.
When is the breast ultrasound conducted?
The breast ultrasound is conducted every time we want to investigate a finding that came up from a clinical examination or a mammography. It is a complementary examination that provides us with important information and helps us make a reliable diagnosis.
Additionally, the method can be applied in always in combination with a clinical examination to:
Women under the age of 35
Cases where a small incision is required to be made in a radiation anomaly through the guidance of an ultrasound.
In a pre-surgical procedure to locate a radiation anomaly using a wire for a better planning of the breast surgery.
Is the breast ultrasound dangerous?
The ultrasound is not dangerous at all, since the patient is not exposed to radiation. It can be applied to anyone of any age and be repeated as many times it is necessary.
Can the breast ultrasound replace mammography?
The ultrasound is conducted as a supplement of the clinical examination and mammography. It cannot replace mammography and the myth that is widely heard that you can have a mammography one year and an ultrasound the next is just a myth. The golden rule of prevention will always be mammography.
Can the breast ultrasound replace mammography in the early diagnosis of breast cancer?
The ultrasound lacks in identifying small-sized lesions in comparison with mammography. Mammography and let alone the digital one, can detect anomalies of few millimeters whereas the ultrasound requires a bigger sized mass. Furthermore, it lacks in the ability to detect micro-depositions that are part of an early finding to many breast cancers. Since our goal is to detect breast cancer at the smallest size as possible, the ultrasound lacks that ability in relation to the prognosis. Consequently, mammography remains the examination of choice for the regular check of women for breast cancer.
3D - Automated Breast Ultrasound
What is the 3D- automated ultrasound?
Specially evolved ultrasound examination, that is conducted using modern ultrasound machines equipped with powerful computers and specific multi-crystal heads. Through this method the radiologist has the opportunity to study the three-dimensional anatomy and pathology in real time. This possibility allows the operator to have at his/her disposal all three coordinates of the organ or pathology (cyst, tumor etc.) to be studied depicted on screen simultaneously as well as a three dimensional reconstruction of the internal section of the organ or lesion. Breast and tumor vascularisation and the internal wall of vessels are three dimensionally studied in real time in order for the examiner to immediately make a safe diagnosis.
What are the applications to the breast?
The 3D head device of used in breast examination is has the highest frequency in the world market (6-18Mhz) with the highest discreet ability (192 crystals) Due to its specially anatomical structure, it significantly excludes fake shadows from the dense breast tissue. It has an excellent reliability in young women, pregnant women and women of dense breast masses. The 3D study of the lesions gives details of the circumference, the internal structure and the formation of the tissues that surround the lesion, which are very important elements in locating and diagnosing small tumors. The 3D study of the vessels of the breasts and tumors allows the diagnosis of anomalies in the structure of the vessels. The 3D guidance of surgical procedures of the breast (inscisions, biopsies using a thin needle, pre-surgical detections) is of high accuracy due to the effective location of the needle in relation to the lesion.
The combination of digital mammography with a 3D breast ultrasound can detect 99% of the cancers of even subclinical stage (size of only a few millimeters). The check should be annual for ages over 40 whereas for ages under 40 an annual ultrasound is recommended and at the age of 35 to have the first mammography.
What is breast elastography?
Elastography is a form of depiction based on the stiffness or hardness of the tissue. Imagine a combination of clinical palpation and of the ultrasound. Contrary to a physical examination that only allows for a subjective judgement of the stiffness of a lesion, breast elastography has the possibility to measure the stiffness and tell us how suspicious a mass can be.
Breast elastography is a recent developed ultrasound technique that can depict and measure the elasticity of the tissue. In breast ultrasound, elastography has proven to be useful in the differentiation of benevolent lesions of the breast from the malignant ones.
Elastography has proven to enhance the diagnostic results of the ultrasound and improves the specialty of the conventional method.
In fact, more recently it has proven that is provides useful information that can be used as a pre-surgical prognostic factor or as an evaluation of the reaction in chemotherapy.
How is breast elastography used?
Elastography is now a helpful tool used in breast ultrasound. It is easy to be used in a clinical practice by only adding some extra time in the usual exam. To ensure the highest possible results in our diagnosis of breast cancer, out technique offers the highest quality images that specialist radiologists can extract from and interpret accordingly.
One of the best applications of elastography is the reduction of excess biopsies of the breast. Whn the mammography and the ultrasound identify a lesion as “possibly suspicious” this method can clear out if a biopsy is necessary or not.
Additionally, elastography can provide additional information about the prognosis of breast cancer, by assessing its answer to therapeutic treatments eg chemotherapy.
Stereotactic Breast Biopsy
What is breast biopsy?
Biopsy is the examination under the microscope and the histological identification of a small portion of tissue from the area that a “suspicious” lesion is detected. So far, this process only took place through a surgical procedure. Today, the possibility of stereotactic biopsy reduces to a minimum any unnecessary surgical biopsies.
Stereotactic breast biopsy is the most modern method and is based on an automated 3D digital technology. If a suspicious small lesion is detected (even if it is 1-2 millimiters) it can offer histological identification of the lesion without surgery. It takes place using local anesthesia and a small incision.
How is the stereotactic biopsy conducted?
It takes place at the location of the mammographer. Your breast will be placed on a special socket and will be compresses just like in a mammography.
Through an x-ray the spot in which we want the biopsy to occur will be located. (with the accuracy of a millimiter).
From there and under the impact of local anesthesia, we will make a small incision where the needle will reach the desirable point and extract a small tissue sample for the biopsy.
From that point on we will place a small clip at the point where the biopsy took place in order to be able to check its position during the mammogram. The clip is extremely small (barely noticeable to the naked eye) and is made of inert material that does not cause any problem.
As soon as the procedure is completed we will conduct the mammography examination to make sure that the biopsy will give the desirable result.
The whole process is conducted with the use of a computer and of the latest state-of-the-art automated robotic technology, to minimise any errors.
The tissue that was extracted will be sent to pathology laboratory to be examined under a microscope. The final result of the histological examination consists of a series of time-consuming procedures that last five working days.
Can this lead to surgery?
Stereotactic biopsy relieves us from surgical biopsy. If, however, the results of the histological examination deems the need of a holistic treatment as necessary then some sort of surgery might be required.
How long does it last?
The length of the biopsy is 60 seconds. It is however a very precise procedure that demands accuracy. For this reason, preparation can last by up to 30-60 minutes.
Does it hurt?
No. Prior to the needle insertion, we will perform local anesthesia so as to not feel any pain. The procedure is not painful; however many women complain as the position is uncomfortable and creates body stiffness. Therefore we suggest that as soon as we place you in bed, you find the most comfortable position for you. Please inform us if you have an allergy to any medicine.
Are there any implications?
A bruise might appear around the trauma but will go away very quickly.
Please let us know if you are pregnant, or suspect that you might be pregnant.
Also you should let un know if you are regularly taking any aspirin or any anticoagulants. It might b necessary to stop taking the medication for a few days prior to the biopsy to avoid the risk of bleeding.
You do not have to come with an empty stomach. You can eat something light and it is suggested that you avoid drinking milk.
Treating the wound after the biopsy
The wound will not exceed half centimeter therefore no stitches are necessary. We will place a medical adhesive which you will be able to remove in a few days. The adhesive is waterproof thus you can wash as always.
A bruise might occur which will be absorbed on its own in a few days.
It is recommended that you do not get tired on the day of the biopsy. If you are working we will provide you with a sick leave.
If you feel any pain you can take a simple pain killer.
Breast Biopsy with Ultrasound Guidance (CORE BIOPSY)
What is Core biopsy?
Breast biopsy under the Ultrasound Guidance is conducted when other examinations, like digital mammography or palpation indicate suspicious findings or a particular type of changes in the breast. It is a process where a small sample of tissues is extracted from the breast using a special biopsy needle. The ultrasound equipment is used to locate the area of the breast that will need investigating and to guide the biopsy needle in the correct position. The tissue sample will then be sent to a pathology laboratory for histological identification.
The directed breast biopsy is a simple and reliable procedure and tends to replace FNA (cytological examination using a thin needle) since the quantity of the tissue that is collected is larger and the result is reliable. The extraction of the tissue is done quickly only after the use of local anesthesia. The return or normal life is immediate with avoids any suffering of the organisation for a short time. A significant advantage of this process is that it barely distorts the structure of the breast, something which makes the interpretations of future mammographs easier.
I've heard that needle biopsy causes cancer to spread. Is this true?
This is completely untrue. There is no spreading and this has been proven in major research since the 1970s. Needle biopsy is essential for accurate diagnosis and should always be done before surgery. It’s completely safe.
Bone Density Measurement (Osteoporosis Test)
Who should take the bone density measurement test?
The American National Osteoporosis Foundation states that the bone density measurement test should be taken if:
You are a woman over the age of 65
You are a man over the age of 70
You are 50 years old and you had a bone fracture
You are a woman in menopause with risk factors of osteoporosis
You are a post menopause woman under the age of 65 with risk factors of osteoporosis
You are a man 50-69 years old with risk factors of osteoporosis
A bone density measurement might also be deemed necessary if any of the following is applied to you:
You had an x-ray of the spinal chord which indicated a fracture or loss of bone mass
You had back pain with potential fracture in the bones of your spinal chord
You lost 1.3 centimeters and over in height within a year
You had a total loss of 4 centimeters from you initial height
How often should I take the bone density measurement?
People that take osteoporosis medicine should repeat the bone density test every 1-2 years. After the commencement of a new medical treatment for osteoporosis, many doctors will recommend that you repeat it in a year.
What is the Thyroid ultrasound?
Thyroid ultrasound is a painless examination since the ultrasounds are simply soundwaves of high frequency. It is part of the depictional examination of choice for diseases of the thyroid and parathyroid glands while its usefulness in assessing cervical lymph nodes and salivary glands is important.
When should the exam take place?
The reasons in which an endocrinologist or a pathologist requests this exam is for spotting any swelling in the cervix or if there is a suspicion of hyperthyroidism or hypothyroidism due to the presence of symptoms such as dehydration, nervousness, great weight gain or loss, tiredness, bulging eyes).
What does the thyroid gland test show us?
The dimensions of the thyroid gland
Whether or not the parenchyma is homogeneous (its texture)
The presence of masses
Normal situations where the ultrasound diagnoses nodular bronchitis, Hashimoto’s thyroiditis, neoplasia etc. Through the ultrasound of the thyroid, adenomas of parathyroid glands are also diagnosed.
How often should the thyroid ultrasound be conducted?
The frequency is according to the medical history of the patient but is also based on the family medical history although the examination can be repeated again and again according to the instructions of the doctor with no fear or any harm being present.
What is the preparation of the exam and how long does it last?
There isn’t any specific preparation needed for conducting the exam. The duration of the exam is around 15 minutes.
Clinical Breast Exam from a Doctor / Surgeon
What does the clinical breast examination involve? (palpation)
First of all an overview of the breasts. With the woman initially in a sitting position with the hands on her waist the circumference of the breasts, the colour and the features of the skin, the existence of any lump or intrusion, the nipples and the symmetry of the breasts are checked. Following that, the specialist asks the examinee to raise her hands upwards observing if there is symmetry in the passive movement of the breasts as the hands are raised or if any of the breasts is lagging behind compared to the other which would indicate a malignant tumor that adheres to the chest wall causing a relevant stiffness of the breast. The specialist would also observe if any lumps or intrusions appear that did not appear before in the passive position of the breasts.
Then, the patient lies on her back with the hands resting above the head. The doctor performs the examination by gentling pressing the breast on her chest and her sides with mild circular movements of the fingertips so as to detect the existence of masses and study its nature.
After that, is the examination of the nipples follows. Their symmetry or possibly any intrusions, the colour and the feature of the skin are observed. Any potential fluid excretion from the nipples is also checked, the type and the colour of the fluid. It is forbidden to press the nipples unless the reason for the visit is the excretion of the fluid from the nipple. If no fluid is excreted during the examination a mild pressure is allowed on the nipple to confirm the symptom and the extraction of cytological examination of the fluid.
The examination of the breasts is completed with the palpation of the armpit and neck for the existence of any lymph nodes. As previously mentioned, the existence of palpable lymph nodes in the armpit or their detection in a mammography is a usual phenomenon in most cases. Axillary lymph nodes might have been there years ago as a result of old infections. It is also likely that they are enlarged in cases of traumas, surgeries or inflammation on the hand, fingers or nails. In these cases they are slightly painful. We are only worried if the co-exist with a suspicious mammograph finding, are only present in one armpit, are painless, hard, stiff and did not pre-exist.
At which point of the menstruation cycle is it better to have the examination?
As mentioned before, in every woman, since the breasts change in size as menstruation days approach, a palpable mass may make its appearance and then disappear after a woman’s period is over. Therefore, the most suitable days for a clinical examination in pre-menopause women is as soon as their period is over by up to a week later. It is recommended that they should arrange for an appointment for a precautionary breast examination in one of those days once a year. Of course, if they notice something suspicious on their breast during that time they should see their doctor earlier. For older women who do not have periods, no such limitation exists.
How often should breast examination take place?
Clinical examination of the breasts should take place as a precautionary measure once a year to women over 30 or more often if there is family history of breast cancer and according to the instructions of the specialist. Despite the fact that breasts are an organ that is exposed and therefore easily accessible, their examination is not simple especially in young women. There are breast nodules and masses that even an experienced examiner has trouble distinguishing them with certainty if they are benevolent or malignant. Detailed study of the patient’s history is of high importance that should be made ahead of the clinical examinations. This will help to diagnose especially in cases of diagnostic doubts. With a good medical history an experienced mammologist already has in his/her mind the most likely diagnosis before he/she even touched the hand of the patient.
Will regular breast examination be a specialist mammologist mean that if cancer is spotted it is curable?
Not necessarily. Clearly the sooner a malignant breast tumor is spotted, the less chances of metastasising elsewhere and the sooner the treatment starts the bigger the chances of being cured. The mammologist can palpate a breast tumor when it is very small years before the patient calls and months or even years before non specialised doctors palpate it. Thus this will give her more chances of saving her life. It is also certain that even when the most specialised medical hand locates a malignant tumor, this was not created a few days ago but it must have pre-existed in smaller, non-palpable size at an average of two years. Cancer is a long-standing process. Truth is that it started at some point by one cell that for some reason started to multiply slowly but uncontrollably. Therefore, for a long time, depending on the kind, is neither palpable or detected through imaging examinations or blood tests. How fast or slow its evolution is during that time depends on the genes. These hide its aggressiveness. Timely detection of the cancer by a mammologist will lead to an early start of the treatment and will significantly increase the possibility of beating cancer.
At what size does a tumor becomes detectable?
Women who self examine can detect a breast tumor if their diameter exceeds 3 centimeters. Doctors who are not trained in breast diseases can palpate it when it is around 2 centimeters. A mammologist can palpate it when it is around 1 centimeter. Mammography can even detect cancer at an initial stage that has the size of a few millimeters as long as it is about a tumor that is visible in mammography.