The purpose of diagnostic mammography and diagnostic ultrasound is to address a specific problem related to the breasts that may or may not be related to breast cancer. Sometimes the radiologist will only need to use diagnostic mammography or diagnostic ultrasound alone to address the problem and to make a reliable diagnosis. Other times the radiologist will need to combine diagnostic mammography with diagnostic breast ultrasound to completely evaluate the problem. Rarely there are problems which are best addressed with breast MRI. Examples of the more common problems may include findings seen on a screening mammogram requiring recall for supplemental imaging, a breast lump, nipple retraction or other nipple changes, skin thickening or dimpling of the breast, skin redness, focal breast pain, or a spontaneous bloody or watery nipple discharge. An appointment is made so that the radiologist works with the technologist to direct and evaluate the diagnostic mammogram views or the ultrasound evaluation as they are acquired. The radiologist discusses the results and recommendation with the patient at end of the appointment. Most diagnostic mammogram and ultrasound evaluations are normal and turn out to be false alarms. In these cases, the patient is reassured and released to continue annual screening. However, if further evaluation is required such as a 6 month follow-up imaging examination or a needle biopsy, the radiologist and nurse will explain the procedure and make sure all questions are answered. The patient will then be scheduled to return for the follow-up procedure or for the biopsy procedure.
A certified technologist will take several X-ray images to help solve the problem. Before taking the diagnostic mammogram views the technologist reviews the case in detail to learn the nature of the problem or concern. The mammogram views may include taking the standard views done for a screening mammogram, but she will almost always take special views such as spot views to focus on a small area, magnification views to zoom in on very small findings, and different angles and positioning to clarify findings and certain areas of the breasts. She works with the radiologist to plan and apply the most efficient and effective technique to provide images that will make the appropriate assessment that will lead to an accurate diagnosis.
Diagnostic Breast Ultrasound
A certified technologist will scan the targeted area or areas of concern in the breasts using a hand-held probe while analyzing the ultrasound imaging on a screen real-time. Before scanning, the technologist reviews the case in detail to learn the nature of the problem or concern. She then targets all the appropriate areas of the breast obtaining and annotating images using strict standard technique to document the presence or absence of significant normal or abnormal findings. All ultrasound evaluations involve much clicking and typing on the images by the technologist, which is normal. Once the images with the documentation are acquired, the radiologist confers with the technologist and evaluates the imaging to make a reliable assessment that will lead to an accurate diagnosis. Sometimes the radiologist will need to examine the patient while scanning with ultrasound to complete the evaluation.
Diagnostic Breast MRI
Breast MRI is rarely used to address breast problems since diagnostic mammography and breast ultrasound should provide a reliable assessment which will lead to the most efficient way to arrive at an accurate diagnosis. However, there are some situations where breast MRI is the best way to evaluate for breast cancer. Three of these special situations include: 1. evaluation of scar tissue in the breast that looks suspicious for cancer by mammography especially after surgery and radiation treatment for breast cancer, 2. evaluation of the breast when breast cancer is found in a lymph node but a primary cancer cannot be found in the breast by mammography or ultrasound, and 3. evaluation of a spontaneous bloody or watery nipple discharge when a ductogram cannot be done. Also, Breast MRI may be used to evaluate implants for suspected rupture.