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Ask The Expert Archive

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Breast Imaging Archive Questions

Below are Dr. Campassi’s answers to Breast Imaging questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 11 of 11.


Q : 1

I understand that glandular tissue appears as white on an ultrasound and problem areas appear black. Does the fatty area also appear as black?

The appearance of breast tissue on an ultrasound is mixed. The glandular component is hypoechoic, meaning gray, while the stromal component is echogenic, meaning white. The fat is also gray. The abnormalities are usually gray, often darker than the fat. In addition to the "color," there are other criteria such as shape and orientation within the breast that help to distinguish normal anatomy and an abnormal finding so we can identify breast cancer. If you consider that ultrasound is operator dependent, then you understand that breast ultrasound has a limited application for screening. Mammography and MRI are better studies.

Q : 2

I was called back for a second mammogram on my left breast. They took three more views and then said it looked fine. Should I get a second opinion?

Approximately 10 percent of screening mammograms require additional imaging evaluation with dedicated mammographic views and/or ultrasound. The vast majority of the time, the additional evaluation clarifies that what was seen on the screening mammogram was normal or benign. A biopsy is rarely necessary. To have additional information regarding your particular instance, I advise you discuss it with your physician who received the report.

Q : 3

My PCP and I felt a new mass in my right breast. The nipple is a little inverted also. I had a mammogram and ultrasound, but the final report is not in yet and I don't think the mass showed up. I saw the Breast Center nurse practitioner and asked her about a biopsy. She brushed off my concerns and did not want to order a one. I have a family history of breast cancer. What would cause a palpable mass not to show up on imagining? Can cancer be felt, but not show up?

A new mass needs a complete evaluation with ultrasound and, above age 30, mammogram to confirm or exclude the presence of an abnormality and guide you to the next step. If no abnormality is seen, but there is concern from the clinical exam because the lump is new, or because - for example - there are associated changes of the nipple, a breast specialist/surgeon should be consulted. At consultation, the breast surgeon would examine your breast, review your mammogram and ultrasound, and then explain if a biopsy is indicated.

Q : 4

My MRI biopsy came back with "chronic inflammation involving some of the ducts and parenchyma." What causes the chronic inflammation? Could it get worse? The MRI was ordered because of my family history and suspicious areas on previous scans. I also have very dense breasts.

Any imaging guided biopsy needs correlation between the imaging findings and the pathology results. The radiologist and pathologist usually discuss the finding and then the radiologist makes the appropriate recommendation. As a general advice, I would suggest you to ask this question to a breast pathologist or to the radiologist who performed your biopsy. Alternatively, your primary care physician could help you get the information you are looking for.

Q : 5

What's the difference between a "screening routine mamo" and a "diagnostic" one? I am being told different things. The place that did mamo said a diagnostic mamo uses a greater magnification than screening. Wouldn't they look close at everyone to prevent overlooking a diagnosis? I read that the diagnostic has more films taken. I only had 2 taken on each side.

I understand your confusion. The main difference is that a screening mammogram is done in women who don't have any symptoms. They come to the office or radiology department, have 2 views of each breast and then leave. The radiologist will then read their mammogram later. A diagnostic mammogram is done when a woman has a problem, either on her screening mammogram or on her clinical breast exam because in this case, there may be a need for special views that are not necessary for women who don't have any problems. If you don't have any breast problems, and you need your regular annual mammogram, you had the right test.

Q : 6

If you have a mammography for health maintenance can you also have digital mammogram for a mass that the doctor can't tell if it is on the chest wall or in the breast? Do I need to ask specifically for the digital mammogram?

A digital mammogram is done with the same positioning and images of a film screen mammogram. The difference is the detector that is used to acquire the images and the way it is viewed. A mammogram usually does not include a "chest" mass. I advise you to have a physical exam with your physician so he can tell you what he thinks the mass is and which test would be appropriate.

Q : 7

I recently had a mammogram, and the radiologist saw something and did an ultrasound. She told me it might be a blood vessel. I asked her to do a biopsy, but she did not and told me to come back in 6 months. I had breast cancer 8 years ago and don't want to delay anything. Should I have insisted on a biopsy?

I would advise you discuss the findings with your referring physician who should have received the report from the radiologist. A biopsy is indicated only when it is appropriate and the benefits are greater than the risks.

Q : 8

Does your facility treat men with breast cancer?

Breast diseases are infrequent in men and are benign more often than cancer. Yes, our Breast Imaging Center evaluates men and women with breast symptoms utilizing ultrasound and/or mammogram. A group of specialists at the Breast Evaluation Program and the Breast Cancer Center at University of Maryland evaluate and treat men with breast problems.

Q : 9

My 17-year-old niece recently discovered a mass on her left breast labeled suspicious by a radiologist who recommended biopsy. Her pediatric oncologist dismissed the need stating, "kids this age don't get breast cancer" and recommended an ultrasound in six months. Do you think this is an appropriate approach?

As a rule, a palpable breast lump undergoes biopsy, regardless of age. The reason being that it is something "new" or not felt before and, therefore, it is important to find out what it is and rule out breast cancer. Statistically, a breast lump in your niece's age group is benign. However, cancer can occur at young age. A fine needle aspiration or a needle biopsy can be performed with ultrasound guidance to confirm that the needle is sampling the lump. If performed by an experienced breast specialist, the ultrasound guided biopsy is very easy, painless, well tolerated and accurate with only very rare minor complications.

Q : 10

I am 45 years old and just had a mammogram. I was asked to return for further evaluation. During my return for further evaluation, I had a sonogram done of my right breast and then the imaging center did a more focused mammogram of the area on my right breast where they found a mass. The radiologist stated that with further evaluation, he did not believe this mass was anything to be concerned about. The imaging center advised me to return in 6 months for a follow-up mammogram. What do you think?

Let me explain that approximately 10 percent of women undergoing screening mammograms are called back for additional evaluation. Usually the additional evaluation shows that the finding seen on the screening mammogram is benign appearing or probably benign, only rarely a biopsy is needed. Having said so, it is important for each woman to understand what the finding and the likelihood of malignancy is. I suggest you ask for clarification from the radiologist who evaluated your screening and diagnostic mammogram. If you are considering a second opinion, I advise you to contact your primary care physician and ask to be referred to a radiologist specializing in breast imaging. It is important to discuss this decision with your primary health care provider who knows your clinical history, the facilities in your area, and the specialists he trust or has a positive collaboration with.

Q : 11

How long should a breast cancer survivor continue to have a diagnostic mammography? When is it OK to go back to screening?

A screening mammogram has the same mammographic views of a diagnostic mammogram, so the image quality is the same and the routine projections are the same. The main differences regard the time of interpretation and the communication of the results. A diagnostic mammogram is interpreted by the radiologist while the patient is in the office and the patient is informed of the results at the time of her visit. A screening mammogram is usually interpreted by the radiologist after the patient has left the office and she receives a results letter at a later time. There is no standard requirement for performing a diagnostic or a screening mammogram in breast cancer survivors. The vast majority of breast cancer survivors undergo routine mammographic views that can be done as screenings, regardless of the time that has passed since their diagnosis of breast cancer. We suggest our breast cancer survivors have an annual diagnostic mammogram during the first 5 years after their diagnosis and then resume annual screening mammograms. It is extremely important for all breast cancer survivors to receive annual mammograms.


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