Breast imaging uses x-ray and ultrasound to examine the breast. The most common tests that we carry out are mammography, ultrasound and biopsy.
Types of Mammography
A mammogram is an x-ray picture of the breast. It is used to detect and diagnose breast disease in women who either have breast problems such as a lump, pain, or nipple discharge, as well as for women who have no breast complaints. The procedure allows detection of breast cancers, benign tumours and cysts before they can be felt.
Mammography cannot prove that an abnormal area is cancerous, but if it raises a significant suspicion, a biopsy may be performed.
This type of examination is mainly performed on women under 40, as well as men. The examination is painless. A breast ultrasound takes about 15 minutes, depending if one of both breasts are being examined.
Fine Needle Aspiration Cytology (FNA):
Tissue / Cells are removed from the breast using a very fine needle and syringe. This will feel like a normal injection. You might have a bruise for a few days following the procedure.
Needle Core Biopsy:
Tissue samples are removed from the area using a hollow needle. This procedure will obtain small cores of breast tissue which will give an accurate diagnosis when processed in the pathology laboratory. The examination will be performed by a radiologist and a radiographer. A student radiographer may also be present, if you have no objection to this. This area will be covered up with a small dressing which can be removed a day later. A biopsy can take up to 30 minutes to complete.
Wire Guided Biopsy:
A wire-guided biopsy is necessary when there is no lump to feel in your breast but something has been seen on your mammograms, and surgery is necessary. The procedure is carried out in the mammography suite on the day of your operation. The wire guides the surgeon to the exact part of the breast that needs removing. The examination will be performed by a radiologist and a radiographer.
Mammogram – The investigation involves exposure to x-rays. X-rays consist of a type of radiation known as ionising radiation. The doses that are used in medical x-rays are very low and the associated risks are minimal. We keep the doses as low as possible and make sure that the benefits of having the x-ray outweigh any risk.
Also, x-rays can be harmful for an unborn baby and should be avoided by women who are or who may be pregnant. It is recommended that the examination is performed within 10 days of the first day of the onset of your menstrual period.
Ultrasound – There are no confirmed adverse biological effects on patients or instrument operators caused by exposures to ultrasound.
Biopsy – As with any skin-piercing procedure, there are risks of infection, nerve damage and bleeding. Some people are allergic to the local anaesthetic we use. Please let us know if you have problems with the anaesthetic you receive from your dentist.
Other risks involved depend on the procedure you will receive.
There are no known radiation risks for ultrasound-guided biopsies.
Mammogram-guided biopsies involves exposure to x-rays. X-rays consist of a type of radiation known as ionising radiation. The doses that are used in medical x-rays are very low and the associated risks are minimal. We keep the doses as low as possible and make sure that the benefits of having the x-ray outweigh any risk. Also, x-rays can be harmful for an unborn baby and should be avoided by women who are or who may be pregnant. It is recommended that the examination is performed within 10 days of the first day of the onset of your menstrual period.
What to Expect
Mammogram – Most mammograms are performed in the standing position in the privacy of the mammography room, located in the Breast Care Centre.
The radiographer positions the breast onto a flat x-ray plate, then from above another plate will press down and flatten your breast for a short time while the picture is being taken. Most women may find this uncomfortable or painful, but the breast is only compressed for a very short time. Two images will will be taken of each breast. If your breasts are particularly tender at certain times of the month you may wish to change your appointment.
The whole procedure takes about 10-20 minutes.
Ultrasound –The sonographer or the radiologist will ask you to lie on a table. He or she will apply some water-based gel to the breast that is going to be examined, so that the sound waves can be transmitted through the tissue and reach the scanning instrument that is placed on your skin. This instrument is called a transducer, and will be moved in different areas to view the problem from many different angles. You will be able to see the scanned images on the screen while you are having the exam performed.
You will not feel any pain during the scan. Your arm will be placed above your head for the examination. Your other breast will be covered.
If you find it difficult or uncomfortable, please tell the sonographer or radiologist.
The ultrasound gel will be removed with paper tissues. If your skin still feels sticky any remaining gel can be washed off with soap and water, but it also dries quickly on its own. If the sonographer or the radiologist gets gel on your clothes, please do not worry! The gel does not stain at all, and it just needs to be dry to become invisible again.
An ultrasound scan generally takes 10-20 minutes, depending on if both breasts or just one breast is being examined.
Biopsy – Biopsies and fine needle aspirations are often performed on the same day as your breast ultrasound.
Wire Guided Biopsy – You will either be seated or lying down for this examination. The equipment chosen will be able to show the exact area of the breast where your lump is. Local anaesthetic is used to numb the skin, then the radiologist will place the wire into the breast with its tip in the abnormal tissue. Once the wire is in place, images are taken again to check its position. Having the wire put in is not as painful as it sounds – the wire will be covered with a dressing so its position is secure until your surgery. You will then be returned to the ward and taken to theatre later. Whilst you are asleep the surgeon will remove the piece of tissue around the end of the wire, removing the wire at the same time.
Once the examination is completed you will be taken back to your cubicle to get dressed. You may then go home and eat and drink normally.
The results of your examination will not be given to you on the same day. To receive these results you will need an appointment see either the consultant who referred you, or your own GP. You will be told after the examination which of these doctors you need to see.
For patients who underwent a Biopsy, after the local anaesthetic wears off, you might feel a dull pain at the site of the biopsy. This is normal, and you are welcome to take over-the-counter pain relievers such as ibuprofen or paracetamol. Please do not take any aspirin-based medications, as these may cause bleeding or increased bruising. You are also welcome to apply a cold pack as needed to relieve the discomfort and swelling.
We ask you to put in a day of rest after the procedure: daily tasks such as shopping or cooking are allowed, but we ask you not to carry heavy loads, exercise or anything else that might be strenuous. After 24 hours following the procedure, you are more than welcome to resume your normal activities.