Diagnostic Breast Imaging Procedures: Interventional Mammography
After diagnostic mammography procedures, the following interventional procedures may be performed to obtain more information about the abnormality found on the mammogram or ultrasound.
Ductography
Ductography or galactography is an examination of the milk ducts to evaluate nipple
discharge. Nipple discharge is a common complaint. Most of the time it is due to benign changes and not a sign of breast
cancer. When nipple discharge occurs spontaneously without squeezing the nipple and the discharge is coming from one duct of the breast it should be
evaluated.
This procedure is virtually painless: the woman might experience a sensation of
fullness. A tiny tube is placed in the opening of the duct and a small amount of liquid dye is injected into the
patient. A mammogram is then taken. The liquid dye or "contrast" makes the duct visible on the
mammogram. If there is an abnormality inside the duct it is often visualized with this
exam.
Pneumocystography
This is performed when an abnormal cyst is found during ultrasound. A needle is inserted into the cyst using ultrasound guidance and the fluid is
withdrawn. Air is then injected through the same needle back into the cyst. A film-screen mammogram is then performed to visualize the wall of the
cyst.
Stereotactic Imaging
A computer aided mammography attachment or unit which produces an x-ray or digital image and provides an exact location of an abnormality within the
breast. The images are taken from two angles. By measuring the shift in the position of the abnormality being
biopsied, a computer is able to calculate the exact location, including the depth from the skin
surface. A computer controlled apparatus can then place the needle at a precise target
point. These procedures require only a small amount of local anesthetic in the skin and take less than half the time of a surgical
biopsy. It can be used to aid in Fine Needle Aspiration Biopsy, Core Biopsy or Needle
Localization.
Biopsy
This is an outpatient procedure where a sample of breast tissue is removed for examination by a
pathologist, to determine if the cells are cancerous or non-cancerous. Keep in mind there are many types of benign as well as malignant masses that may require a
biopsy.
Needle Biopsies
Needle biopsies are biopsies that are performed with a needle, to remove a small tissue
sample.
Fine Needle Aspiration
This procedure removes fluid from a cyst or cells from a solid mass. A small gauge needle is
inserted, into the mass or cyst. The attached syringe is used to withdraw either fluid or cells if the mass is solid . Often a local anesthetic is used to numb the
skin.
Large Core Needle Biopsy
This is typically performed in conjunction with ultrasound or mammography. A small incision or skin nick is made where the biopsy will be
taken. A needle with an empty sampling core is inserted by the physician. Tissue samples are
withdrawn. The samples are sent for pathologic diagnosis.
Percutaneous Biopsy
This is most commonly performed with ultrasound or digital mammography. A device is used to stabilize and compress the breast providing accurate needle
placement, the breast is anesthetized prior to the insertion of the core needle
device, and images are used to guide insertion. Multiple tissue samples are
taken, through a single incision. This procedure is quicker, more comfortable, and less invasive then open
biopsy, and typically lasts less than 60 minutes.
Needle Localization
This procedure is most commonly done prior to surgery for removal of a nonpalpable abnormality (mass or
calcifications). A mammogram is taken to locate the abnormality. The breast remains in compression while the radiologist inserts a needle toward the exact position of the area to be
localized. When the needle is correctly in place, a small guide wire will be inserted through the needle to mark the position. The needle then may be
removed. When the guide wire is accurately in place, the wire will be taped to your
skin. With the breast localized in this manner, the surgeon can remove the suspect tissue while minimizing the removal of healthy breast
tissue.
Open Biopsy
An open biopsy is a surgical procedure, where the surgeon makes an incision deep enough into the breast to reveal the suspected tissue and remove it. Either a general or local anesthetic is
used. This can usually be accomplished as a surgical outpatient procedure. If the area of interest is
large, a tissue sample is removed, if the sample is small, the entire mass, or
lump, may be removed. The sample is taken to the laboratory for examination.
Sentinel Lymph Node Biopsy
Nuclear medicine is increasingly playing an important role in Sentinel lymph node
biopsy. The latest approach to check for breast cancer spread outside the breast is called lymphoscintigraphy and sentinel node
biopsy. Typically an axillary node dissection (removal of the lymph nodes under the
arm) is a routine part of the surgical treatment for most invasive breast
cancers. This is done to determine the extent of cancer spread. The sentinel node biopsy will help reduce problems associated with axillary node dissection such as lymphedema
(swelling of the arm).
The sentinel node is the first lymph node to receive lymphatic fluid drainage from the tumor site, thereby having the highest risk of cancer
spread. If this node is identified and shown to be negative for cancer cells, the remaining lymph nodes may not have to be
removed. This reduces the chance for any long term problems. The negative lymph nodes are examined by a pathologist using special techniques to find extremely small cancer spread
(metastases). If the sentinel node is shown to be positive for cancer cells, then the rest of the nodes are usually
removed.
During the lymphoscintigraphy and sentinel node biopsy procedure, a small amount of radioactive material or a blue dye is injected around the tumor site to help give us special images of the lymph
nodes. This helps your physician determine which node to sample.
The surgeon places a small incision in the underarm area looking for a sentinel node containing the blue dye and/or uses a special scanner to locate the radioactive labeled lymph
node. This node is removed and sent to pathology to determine if a further auxiliary dissection is
necessary.
