Screening and Diagnosis
Mammography Screening
Stanford offers mammography screening for early-detection of breast cancer. The Stanford breast center uses all full field digital mammography, a state-of-the-art technique that produces electronic mammograms. Using digital mammography, pictures of the breast are displayed on high-resolution 5 megapixel monitors for Stanford radiologist breast specialists to read, and which are analyzed by computers for small cancerous tumors. Unlike standard mammography that records images on film, digital mammography records images by electronics so that the image can be manipulated by computer to look for small masses or suspicious calcifications that may be the only sign of an early cancer. Both analog (film) and digital (electronic) mammography methods have been approved by the Food and Drug Administration (FDA), and both still use compression and x-rays to take the mammogram.
Stanford radiologists also second-read all mammograms using computer-aided detection (CAD) computer programs. CAD uses neural net algorithms that search through the electronic digital mammograms for abnormal masses or suspicious calcifications. Research at Stanford has shown that CAD programs in conjunction with radiologist readings may increase early breast cancer detection on mammograms.
Diagnosis of Breast Cancer
When a woman has a breast problem, her health care provider usually takes a careful history of the woman’s breast problem, does a careful breast physical examination, and orders diagnostic tests, including imaging studies.
Many times even if the problem does not seem worrisome, a consultation with a breast surgeon will be recommended to evaluate the breast and interpret the significance of any diagnostic tests.
Digital Mammography, CAD, Ultrasound and MRI
At the Stanford Cancer Center, diagnostic imaging tests are tailored to a woman’s specific complaint and overseen by breast imaging specialists who are certified by the Mammography Quality Assurance Act, enforced by the Food and Drug Administration (FDA). Breast imaging studies usually include mammography, which is the most widely used method for detecting breast cancer but may also include high resolution breast ultrasound or, as needed, contrast-enhanced breast Magnetic Resonance Imaging (MRI). At Stanford, all breast ultrasound studies are performed by doctors and use high frequency ultrasound transducers. Stanford is also renowned for its pioneering Breast MRI program, and Stanford researchers are recognized authorities in Breast MRI cancer diagnosis. With the backing of Stanford engineering and physicist support, Stanford was one of the first institutions in the United States to develop diagnostic breast MRI and is a leader in MRI-guided breast biopsies.
Biopsy
If a breast lump or mass is worrisome for cancer, a physician will perform a biopsy of the suspicious area. A biopsy is a procedure to remove cells or tissue from the suspicious area so that a pathologist can determine if it is cancerous. Biopsies can be done with a needle to remove cells from the lump or mass as an outpatient procedure. Biopsies can also be done by surgery to excise all or part of the mass in a hospital on an outpatient basis.
Needle Biopsy
Two types of needle biopsies can be performed: fine needle aspiration biopsy or needle core biopsy.
To get cells or fluid out of a lump, a physician may insert a very thin fine-needle through the skin into the mass. This is done when the doctor can feel the mass with their fingers. If the mass is a benign cyst and filled with fluid, the fluid can be drawn into a syringe. If the lump is solid, the doctor takes cells into the needle and sends them to the pathologist to be examined for cancer.
It is often desirable to obtain tiny pieces of tissue to better characterize the abnormality. This second approach is called needle core biopsy. Mammography, ultrasound or Magnetic resonance Imaging (MRI) can be used to guide these larger needle biopsies when the abnormality is detected by one of these radiologic techniques.
When a suspicious breast mass is nonpalpable (cannot be felt) and has been detected by mammography, ultrasound or MRI, it is routinely recommended that you see a breast surgeon and decide the best approach for you. Both radiologically-guided needle biopsies or surgical biopsies can be performed to determine the nature of these abnormalities. Stanford technology allows most women with these suspicious breast masses to undergo imaging-guided needle biopsy by one of these techniques when ordered by their doctor.
In a stereotactic core needle biopsy, Stanford’s breast-imaging specialists use x-rays and computer-aided guidance to insert the needle directly into suspicious breast lumps or microcalcifications, retrieving thin tissue sliver samples for the pathologist to examine. For especially suspicious findings, Stanford radiologists will insert a special metal marker to identify the breast biopsy site for any subsequent surgery, insuring that the entire suspicious region is removed without question and increasing the patient’s chances for survival.
In ultrasound-guided biopsy, Stanford radiologists use high frequency ultrasound transducers to insert a special needle directly into the breast mass while watching the needle’s progress on monitors. This ensures that the correct region is sampled.
At Stanford, MRI-guided needle biopsy is a special procedure which is done in only a few institutions in the United States. Stanford is uniquely equipped with one of the only open MRI magnets available in the country for breast biopsy. For MRI-guided biopsy, the woman lies between two MRI magnets which have been built in an “open” configuration, alleviating claustrophobia from the usual “closed” bore MRI magnet configuration.
The unique Stanford MRI magnet is especially designed so that open part of the MRI magnet allows specially trained breast MRI doctors to remain at the patient’s side during the biopsy. Using MRI, strong magnetic fields (not ionizing radiation) guides the doctor to insert a needle into the suspicious breast mass. The MRI-guided needle biopsy takes samples of the suspicious breast mass. Alternatively, if the patient is going to have surgery instead, the doctor can insert a small wire for the surgeon to remove subsequently.
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