We have talked about breast mammography but many times women will be asked to get an ultra sound of the breast. Sonography (same as ultrasound) of the breast is an imaging modality used to help determine if an area is solid or cystic, ie: filled with fluid. We worry more about areas that are solid and less about areas that are primarily fluid (a simple cyst for example). It is obtained to better evaluate an area that is in question either on exam (I feel something), some area seen on mammography, or on MRI. There is absolutely no radiation associated with sonography. This imaging is more "operator dependent" and its always nice to have the radiologist present at the time so the images can be reviewed right then and there. If you would like to go at a time when a radiologist is there, just ask when the test is being scheduled but realize this may require some flexibility on the part of the patient. The test is usually done with the patient in a comfortable lying position and requires the application of "jelly" or lubricant to the skin. The probe is gently passed over the skin of the breast and up into the armpit to examine the lymph nodes as well. Sometimes a "targeted sonogram" or a "second look" sono is done looking at a specific area of the breast.
Breast MRI is relatively new in comparison to other common breast imaging. It is highly sensitive but somewhat less specific. As a surgeon it can change the operation I am going to do for a breast cancer twenty percent of the time. It is costly, averaging three thousand dollars per test and usually requires pre authorization from the insurance company. there is no radiation exposure and no real" open" MRI because the breasts have to be placed into cones usually with the patient lying on her abdomen. As with any MRI one must keep perfectly still and it can be noisy. Some of the current recommendations for use in screening "asymptomatic women" are those at "higher risk" than the regular population. These include those with a known cancer gene mutation BRCA1-BRCA2, a 1st degree relative (mother, sister, daughter) who had breast cancer, especially premenapausal or bilateral (right and left breast), any relative with ovarian cancer history, any patient with a history of Lobular Carcinoma In-Situ found on a previous biopsy. Anyone who has had a previous breast cancer themselves can often get MRI's as a part of their regular diagnostic studies yearly if their physician feels it is appropriate. MRI's are also one of the best ways to evaluate problems with breast implants.
There are several less commonly used breast imaging technologies but mammography, sonography and MRI are the "the most common." Remember there is no perfect xray however and tissue sampling may still be in order depending on the physical exam, and the wishes of the patient. Next time we'll talk about types of breast biopsies.
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