Just about everyone knows someone who has been diagnosed with breast cancer.  According to the American Cancer Society, one in eight women will be diagnosed with the disease. The good news is that breast cancer is treatable, if found early. The five-year survival rate currently exceeds 95 percent, thanks to regular clinical breast examinations and annual screening mammograms. The key is catching breast cancer in the early, treatable stage.  

Atlanta Radiology has designed a specialty breast program that includes subspecialists who have an interest in mammography, breast MRI, ultrasound and breast biopsy.  These procedures are performed at the Ed and Dora Voyles Breast Health Center on the St. Joseph's Hospital Campus, a state-of-the-art facility dedicated to breast health.

Mammography is a specialty, low-dose x-ray that examines breasts.  It is used to help diagnose breast cancer and other breast diseases.

Digital mammography, or full-field digital mammography (FFDM), uses solid-state detectors that convert x-rays into electrical signals, similar to those found in digital cameras. The electrical signals are translated into images of the breast that can be seen on a computer screen or printed on special film similar to conventional mammograms. Digital mammography is helpful diagnosing disease in patients under age 50, women of any age with very dense breasts and pre- or peri-menopausal women.   

Screening or Diagnostic Mammogram – Which One to Use? Mammography is critical to early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them. A screening mammogram is for a woman who is asymptomatic, meaning that neither she nor her physician have found any signs of breast abnormalities.

Current guidelines from the U.S. Department of Health and Human Services (HHS), the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40. The National Cancer Institute (NCI) recommends that women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should check with their physician to see if they should begin screening before age 40.

A diagnostic mammogram is ordered when a patient presents with abnormal clinical findings—either a breast lump or lumps—that have been found by the woman or her doctor. Diagnostic mammography may also be done following an abnormal screening mammography to better determine if there is a problem.

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MRI is a non-invasive way of looking into the body without the use of x-ray. Instead, it uses magnets and radio waves to create images. Breast MRI combines state-of-the-art three-dimensional imaging with computer-aided detection (CAD) to look deep into the breast to uncover abnormalities. While breast MRI is not a replacement for mammography or ultrasound imaging, it is a very helpful tool in evaluating patients with very high known genetic risks for breast cancer and in:

• Imaging dense breasts often found in younger women and those with fibrocystic breast changes when mammography and ultrasound fail to detect or characterize a palpable abnormality
• Determining the extent of a known cancer. MRI is the most sensitive and specific method for complete local staging of breast cancer.
• Differentiating between surgical scar and recurrent cancer in patients who have already been treated for breast cancer
• Identifying mammographically occult cancer in high-risk patients
• Evaluating response to cancer treatment

Breast MRI does not take the place of screening mammograms, as recommended by the American College of Radiology and American Society of Breast Surgeons.  Women who have breast MRI should continue to have an annual mammogram.

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Breast Ultrasound or sonography uses high-frequency sound waves to produce pictures of the breast and does not expose the patient to radiation. Images are captured in real-time, showing movement and blood flow in the vessels. This painless test evaluates blood flow or lack of flow in a breast mass, providing clues as to the cause of the mass. It is very helpful as a supplementary test to help determine the nature of a breast abnormality that was seen on mammography. The procedure can often determine if the suspicious area is solid, which may or may not indicate a cancerous site, or a fluid-filled sac, such as a cyst. The modality may also be helpful for women with dense breasts, have silicon breast implants, are pregnant or have genetic risks for breast cancer.

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Mammography is first step in evaluating breasts, but in some instances, it cannot tell whether a growth is benign or cancerous. MRI and ultrasound may be used as a next step, but a biopsy allows for a definite determination.  Instead of a surgical biopsy, many women are opting either stereotactic biopsy, ultrasound-guided biopsy or MRI-guided biopsy.  In these less invasive methods, a hollow needle is passed through the skin into the lesion with the help of imaging equipment. The small sample is analyzed to see if the lesion is malignant or benign, so that treatment can begin. 

Stereotactic Biopsy
A special computerized mammography machine uses intersecting coordinates to pinpoint the area of tissue change. This method, called stereotactic biopsy or x-ray-guided biopsy, removes just enough of the suspicious area for a pathologist to review. It is most often used when mammography shows a mass, cluster of microcalcifications or area of abnormal tissue change, but no lump is palpable. Our radiologist can perform a core biopsy, which uses a large-bore needle to remove an adequate sample of breast tissue, and a vacuum-assisted needle biopsy device (VAD), which suctions a tissue sample.

X-ray-guided biopsies are performed when:

• A woman’s mammogram shows a suspicious solid mass that is not palpable.
• A woman’s mammogram shows a suspicious cluster of small calcium deposits.
• The structure of the breast tissue is distorted.
• A new mass or collection of calcium deposits is present at a previous surgery site.

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Ultrasound-Guided Biopsy
This form of biopsy is a very accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure, which is minimally invasive, also eliminates radiation exposure that comes from using stereotactic biopsy. Tissue specimens are removed using either an automatic spring-loaded or vacuum-assisted device (VAD).

The procedure is used most often to determine whether tissue is benign or malignant. In some cases using VAD, radiologists may be able to remove the entire lesion. Ultrasound-guided biopsy is normally faster than stereotactic-guided breast biopsy and it is possible for the radiologist to follow the motion of the needle as it moves through the breast to the suspicious site. Another benefit is that this form of biopsy can evaluate lumps under the arm or close to the chest wall, unlike stereotactic biopsy.

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MRI-Guided Biopsy
MRI-guided biopsy is used when an abnormality is not clear with mammography or ultrasound scanning. The radiologist may collect a tissue sample using either core needle (CN) or vacuum-assisted (VABB) biopsy.

The core needle biopsy, using a somewhat larger needle, can withdraw small cores of tissue from the abnormal area in the breast. The needle is inserted three to five times to obtain samples, making it more beneficial in determining treatment options if the pathology indicates cancer cells.  

In a vacuum-assisted breast biopsy (VABB), pressure is used to pull tissue into the needle without having to withdraw the probe after each sampling. Using this method results in larger samples for pathology.

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Osteoporosis is a chronic condition that occurs when there is a depletion of bone calcium and protein. The results are loss of bone mass and increased bone fragility with an increased risk of fracture. Nearly 80 percent of those affected by the disease are women; however, men are also at risk for developing the condition. Currently more than 10 million people in the United States have osteoporosis and another 34 million are at high risk for the disease. Nearly 1.5 million adults have fractures, which are a direct result from the condition, making it one of the most common diseases affecting older adults. The only way to accurately diagnose osteoporosis is with a bone mineral density (BMD) test.  

Our partner hospital, St. Joseph’s Hospital of Atlanta and outpatient facilities uses the “gold standard” recommended by the International Society of Clinical Densitometry (ISCD). The DEXA – dual energy x-ray absorptionmetry – scan measures the spine, hip and total body, producing computer-generated images of various skeletal sites, yielding precise bone density measurements that are unmatched by other screening equipment. The painless, non-invasive scan, which takes a few seconds, quickly identifies if a patient is at risk for fractures. Atlanta Radiology radiologists are subspecialty trained to interpret bone density studies, ensuring that patients get the most accurate results.  

The ISCD recommends screening for:

• Women over age 65
• Men over age 70
• Anyone with a fragility break
• A patient with a disease, condition or medication associated with osteoporosis
• Anyone who is considering therapy for osteoporosis, if bone density testing would facilitate the decision
• Women who have taken hormone replacement therapy for an extended time
• A patient who is undergoing treatment for osteoporosis, to monitor the effects of the therapy

We offer bone density testing at the Ed and Dora Voyles breast health center.

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Gynecological cancers are often very curable, if diagnosed and treated at an early stage. MRI technology is one of the newer modalities used to help diagnose, evaluate and stage cancer of the bladder, cervix, endometrial lining, ovary and rectum. The clarity of soft tissue imaged achieve using MRI helps to differentiate normal anatomy from pelvic tumors and its spread. MRI is also an excellent imaging choice for diagnosing non-cancerous gynecological disorders.

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A hysterosalpingogram is a specialty exam that can help determine why a woman is having a problem conceiving. The procedure, performed using a contrast agent and fluoroscopy (x-ray in motion), helps the radiologist evaluate the shape of the uterus, if there is a blockage in the fallopian tubes and if there is  scarring in the peritoneal cavity. Often, tumors, adhesions, fibroids are detected and evaluated for treatment. The procedure is also used to determine if a tubal (sterilization) surgery can be reversed or to open the fallopian tubes if there is a disease-related obstruction.

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