DIANOSTIC INVESTIGATIONS

What is a mammogram?

A mammogram is a specialised X-ray of the breast. It uses low amounts of radiation and the risk of this is very small. It is used widely in breast diagnostic investigations and is the investigation used for women who undergo screening through the national NHS breast screening programme.

What are the Benefits?

A mammogram can detect small or subtle changes in breast tissue which may too small to be felt by either you or your doctor which may indicate a breast cancer or pre-cancerous cells. It is an investigation which tends to be used most commonly in women over the age of 40. Women younger than 40 may be offered a mammogram in certain circumstances, but other tests tend to give more useful information for younger patients.

What does the procedure entail?

A mammogram is carried out by a radiographer who will position your breasts on the specially designed mammography machine. Some patients may find the scan uncomfortable or painful as the breast tissue needs to be held firmly to ensure a good image is obtained, but this will only last a few seconds. Both front and side images of the breast are taken. After the scan, you’ll be able to go home immediately. We ask patients not to use spray deodorant or talcum powder on the day of the mammogram, as this may affect the quality of the X-ray.

Results

Results will usually be sent to me within a few days of the mammogram being carried out. We will have discussed how we deliver these results to you at your consultation before the mammogram is carried out.

What is an ultrasound?

Ultrasound uses high frequency sound waves to create pictures of the inside of the body, the same type of scan many women have during a pregnancy to check that their baby is healthy. Ultrasound has been used widely in breast investigations for many decades and does not involve the use any radiation.

What are the benefits?

Ultrasound gives different information to a mammogram (X-ray). It is used to look at discrete areas of change or interest such as a breast lump and also the lymph nodes under your arm. It may also be used in helping the radiologist to take a tissue sample of an area within the breast if a cancer is suspected. It is used widely in women of all ages.

What does the procedure entail?

During an ultrasound scan you can lie comfortably on your back on a medical examination couch. A clear gel will be applied to breast skin which helps the machine to get the best quality pictures of the tissue being examined. The radiologist will move the scanning probe over the breast or lymph node area to examine them, and may discuss carrying out a biopsy if they feel this might be helpful in making a diagnosis.

Results

Results will usually be sent to me within a few days of the investigation being carried out. We will have discussed how we deliver these results to you at your consultation before the ultrasound scan is carried out.

What is an MRI?

MRI (magnetic resonance imaging) is a type of body scan which is used widely in the medical investigation of many different types of soft tissue including breast. The machine obtains its information by using strong magnets and does not use any form of radiation.

What are the benefits?

Breast MRI can be useful in younger patients being treated for breast cancer as X-rays alone may not give clear information about breast tissue. It may also be used in screening young patients who have not got breast cancer but may be at a higher risk of developing it if they have been found to have a mutation in a breast cancer susceptibility gene. MRI can be used where the size of a tumour is not clear using X-ray and ultrasound, and also for a particular type of breast cancer called lobular breast cancer.

What does the procedure entail?

Patients will need to be able to lie on their front to have a breast MRI, with the procedure normally taking about 45 minutes to one hour. An injection into a vein is often given half way through the scan to allow as much information as possible to be obtained from the scan. This will all be explained to you before the scan by a radiographer who will also check that there are no reasons not to have the scan (such as having a heart pacemaker).

Results

Results will usually be sent to me within a few days of the MRI being carried out. We will have discussed how we deliver these results to you at your consultation before the MRI is carried out.

What is Breast Tomosynthesis?

Tomosynthesis is an advanced type of mammogram which uses a low dose of radiation to create a three-dimensional picture of the breast.

What are the benefits?

Tomosynthesis may better identify small tumours in patients who have very dense breast tissue on conventional X-ray examination.

What does the procedure entail?

Tomosynthesis is similar to a conventional mammogram, but X-rays are taken from multiple positions to allow a computer to generate a 3-D image of the breast.

Results

Results will usually be sent to me within a few days of the tomosynthesis being carried out. We will have discussed how we deliver these results to you at your consultation before the tomosynthesis is carried out.

What is a Breast Biopsy?

A biopsy is a procedure where a sample of tissue is removed from the body and examined under a microscope by a pathologist to help in making a diagnosis.

What are the Benefits?

Whilst many scans and X-ray tests give us a very clear understanding of a patients likely diagnosis, the most accurate way of coming to a diagnosis is often to look at a piece of tissue from an area where a patient is experiencing symptoms or where an abnormality has been found on a scan.

What does the procedure entail?

Most biopsies which are undertaken in patients having breast investigations can be done in the X-ray department by a specialist breast radiologist and no longer routinely involve having an operation. The breast skin overlying the area to be biopsied is injected with local anaesthetic to leave it temporarily numb and make the procedure more comfortable. The radiologist can then carry out the biopsy, often using an ultrasound machine to guide the biopsy. Gentle pressure is then applied to this area for a few minutes to minimise bruising, and a dressing can be applied.

Occasionally, if the area which needs to be biopsied is not amenable to a biopsy in the X-ray department then a surgical biopsy may be recommended. This is often done with the patient asleep under a general anaesthetic in the operating theatre, but can often be done as a day case procedure.

Results

Results from a breast biopsy may take anywhere from two to seven days to come back depending upon the nature of the biopsy. I will offer all patients who undergo a biopsy a further appointment to discuss the results of their biopsy, and ensure that all biopsy results are discussed within the breast cancer MDT meeting.