Comprehensive Breast Center

DIAGNOSTIC IMAGING SERVICES

The Comprehensive Breast Center at St. Luke's and Roosevelt Hospitals combines state of the art diagnosis and treatment of breast cancer in a supportive and healing environment.

The Center occupies a bright, modern and beautiful suite of offices on West 59 th Street, directly across from Roosevelt Hospital. The same location houses our radiology colleagues. It is not unusual for several different specialists to gather in one room to present their respective findings and recommendations to the patient. This structure best serves the interest of those who seek our expertise in treating breast cancer. Our patients benefit from consultation among various specialists under one roof and whose collaboration can quickly rule out or confirm a suspected malignancy, and treatment options outlined during a single visit.

A visit to our Comprehensive Breast Center begins with a review of the patient's medical history and a physical examination by one of our breast cancer specialists. A clinical breast exam can usually establish rather quickly if and what additional tests are necessary. Our staff will be happy to assist in arranging for the procedures and tests that you will need.

Mammogram

Mammography is a type of imaging that uses a low-dose of radiation for the examination of the breast.. A mammogram is an important screening tool that is particularly useful in detecting asymptomatic breast cancers at an early stage when they are most curable and breast-conserving therapies are available. Mammography also can help diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge.

Mammography is performed by a specially trained radiology technologist who will guide you through the steps of the procedure and can answer many of the questions you may have about the procedure itself. To take a picture, the breast will be compressed between two plates that are attached to a specially designed X-ray machine. Occasionally, women who undergo mammography will require magnification or compression views. Such views enable the radiologist to better evaluate tiny calcium deposits called microcalcifications, which are generally not detectable during a clinical breast exam.

The procedure is relatively painless, although you may experience some discomfort as a result of pressure exerted on your breast by the plates. The compression is necessary to achieve the highest possible detail. You should not hesitate to express feelings of discomfort to the technologist performing the mammography, or ask to speak to the radiologist if the technologist is unable to answer questions to your satisfaction.

Most women over the age of 40 are advised to have a mammogram annually. Women with a family history of cancer, especially of the breast, may need to have mammograms much earlier. At times, even when results of the mammogram are not suspicious, your surgeon may recommend further tests based solely on the physical examination. And if the radiologist finds a spot or area that seems suspicious, additional diagnostic studies may also be recommended.

Ultrasound

As good a screening tool as mammography is, mammograms do not detect all breast cancers. Sometimes they show false-positive results. In women with dense breasts or scar tissue from previous surgery and other conditions, a mammogram may not produce the best pictures.

Ultrasound, or sonography, is a procedure used commonly during pregnancy but it is also used frequently to help distinguish the difference between a liquid-filled cyst from a solid mass in the breast. To do an ultrasound evaluation, the breast is covered with a gel that will allow an instrument, called a transducer, to move smoothly across its surface. The transducer produces sound waves that will pass through a cyst but bounce off a solid tumor and thus create distinct images on a screen.

If the mass turns out to be a cyst, aspiration of the fluid or observation may be appropriate. If the mass is solid, a biopsy of the area to remove a sample tissue or cell may be necessary. A specially trained pathologist will examine the biopsy sample under a microscope and determine whether the tissue or cells are benign (no sign of cancer) or malignant (a probable sign of cancer). Sometimes cells that are not positive for cancer appear somewhat abnormal, and this may require regular followup to monitor any changes. If the cells are malignant (cancerous), your surgeon will discuss various treatment options with you.

Image-guided Biopsy Procedures

If a breast mass is present, your surgeon will determine the type of biopsy needed. The choice of procedure depends on whether the suspicious area can be felt (palpable) such as a mass or thickening, or not (non-palpable) such as microcalcifications, a very tiny mass or vague density as seen on a mammogram.

Ultrasound Fine Needle Aspiration Biopsy

In order to do an image-guided biopsy, the radiologist, working with your doctor and a cytopathologist, uses ultrasound to accurately guide a very thin hollow needle into the suspicious area of the breast. If the mass is a cyst, the fluid will be aspirated and the cyst will collapse. If the mass is palpable and solid, the cytopathologist will participate directly in the biopsy and determine if a sufficient amount of tissue has been collected. The cytopathologist can microscopically examine the tissue and make a diagnosis immediately, eliminating the agony of waiting for the result. Even if no malignant cells are found a surgical biopsy may still be necessary because there may be cancerous cells in the areas not sampled. If malignant cells are found, your surgeon will recommend a course of action for your treatment.

Stereotactic Mammotome® Core Biopsy

The difference between fine aspiration needle biopsy and core needle biopsy is the size of the needle used. With stereotactic Mammotome® core biopsy, it is not just a matter of size of the device but the special way of targeting the area to be biopsied and how the sample tissue is extracted.

A Mammotome is a handheld vacuum probe with a rotating cutter. The radiologist uses a specially designed stereotactic mammography machine that takes two views with intersecting coordinates to precisely guide the positioning of the Mammotome. Once in the area to be biopsied, the probe's vacuum system gently draws tissue into a sample chamber. The procedure is done under local anesthesia and requires a small incision, so tiny that it usually does not require stitches. As with other types of biopsy, a cytopathologist examines the tissue microscopically to make the diagnosis. Likewise, if malignant cells are found in the sample, your surgeon will recommend a course of action for your treatment.

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