DIAGNOSTIC INVESTIGATIONS

An operation in which abnormal breast tissue or a lump is removed (excised) through the smallest and most appropriate incision, a small amount of surrounding tissue (margins) may also be taken to ensure full clearance.

Stereotactic or Guidewire Excision Biopsy

This type of excision biopsy is indicated when patients have an abnormality that is visible on a mammogram or ultrasound but cannot be felt in clinical examination. To assist the surgeon, the site of the abnormality to be biopsied is marked by a consultant radiologist, with a guide-wire or skin marking (localisation), using either mammography or ultrasound.

Sentinel Node Biopsy

This technique has been the subject of a number of clinical trials around the world. It is used to identify whether cancer has spread to the lymph nodes. It involves injecting a small amount of radioactive material and a blue dye into the breast, which identifies the sentinel node. Michelle will then remove this lymph node at the time of surgery. If the sentinel node is clear, it usually means that the other nodes are clear and removal of further lymph nodes under the arm may not be necessary.

Axillary Node Clearance

Prior to surgery, your armpit will have been scanned to see if cancerous cells are present within the lymph nodes. If cancer is confirmed in the armpit (axilla) you will be recommended to have an axillary node clearance where all the lymph nodes are removed through the axilla. This is usually undertaken at the same time as surgery to the breast. . If the breast cancer is near the armpit, a single incision can be used. During a mastectomy, the axillary nodes will be removed through the mastectomy incision. The lymph nodes removed will be analysed under the microscope by a histopathologist.

MRI Guided Biopsy

The intended benefit of this biopsy is to find out what is going on in your breast, following on from your MRI scan. The biopsy is being performed under MRI guidance when the area identified cannot be seen with ultrasound or mammograms, and as a result, can only be biopsied using the MRI machine.

The first part of the procedure is much like your previous MRI scan. Contrast may need to be injected into a vein. You will need to keep very still, so that the area to be biopsied can be found. A small amount of local anaesthetic will be injected into your breast to make a small area of the breast go numb. A biopsy needle is then inserted into the breast and small samples of breast tissue are removed and sent to the laboratory to be examined under the microscope. It can take up to 2 weeks to get the results back from this biopsy.

A very small metal marker clip is routinely place into the site of the biopsy. This means that if the area in question turns out to be cancerous or pre-cancerous and requires removal at an operation, the same area can be accurately found again. It also means that other forms of imaging, such as mammography or ultrasound, can be used to find the clip.

The clip is 2mm in size and made of titanium, so will cause you no side effects. It will not set off alarms at airports, and can remain in the breast forever, without you being aware that it is inside your breast.

Radiofrequency / Magnetic Seed Guided Wide Local Excisions

Michelle is able to remove small cancers using a tag or marker seed which is inserted into the breast, by the site of the cancer. The tiny marker, about the size of a grain of rice, is designed to accurately mark the site of a cancer and help with its removal during surgery. When a probe is passed near the tag or seed, it becomes detectable in the operating theatre. These cancers can’t be felt and are often picked up via the Breast Screening Programme on mammograms. The marker seed is placed by a consultant radiologist any time before surgery, enabling greater flexibility for planning your surgery.

About one in eight women in the UK are diagnosed with breast cancer during their lifetime. There’s a good chance of recovery if it’s detected in its early stages. Breast screening aims to find breast cancers early. It uses an X-ray test called a mammogram that can spot cancers when they are too small to see or feel.

As the likelihood of getting breast cancer increases with age, all women who are aged 50-70 and registered with a GP are automatically invited for breast cancer screening every three years.

What happens during breast screening?

Breast screening is carried out at special clinics or mobile breast screening units. The procedure is carried out by female members of staff who take mammograms.

During screening, your breasts will be X-rayed one at a time. The breast is placed on the X-ray machine and gently but firmly compressed with a clear plate. Two X-rays are taken of each breast at different angles.

Michelle operates on over 50 NHS breast screening patients per year and is fully breast screening trained.

Regular breast screening enhances the likelihood of early detection and successful treatment of breast cancer. Screening is carried out by mammograms. A mammogram is an X-ray of the breast. It uses low amounts of radiation and the risk to your global health is very small. Screening via the NHS Breast Screening Programme runs from the ages of 50 to 70. Women may be classified as “moderate” or “high” risk, depending on their family history, and may be offered additional screening from an earlier age.

Benefits

The mammogram can detect small changes in breast tissue, which may indicate cancers that are too small to be felt either you or your doctor.

The procedure

A mammogram is carried out by a radiographer who will position your breasts on the specially designed mammography machine. In order to obtain a good, clear picture the breast must be held tightly between two pieces of plastic. You may find the scan uncomfortable or painful as the breast tissue needs to be held firmly to ensure a good image is obtained, but this will only last a few seconds. Both front and side images of the breast are taken. After the scan, you’ll be able to go home immediately. Please do not use spray deodorant or talcum powder on the day of the mammogram, as this may affect the quality of the X-ray. For more information, and if you have any queries about the procedure, speak to your consultant. Continue taking your normal medication unless you are told otherwise.

Results

Results will usually be sent to the doctor who referred you within two days of your mammogram.

Ultrasound uses high frequency sound waves to create pictures of the inside of the body. It can show internal organs as well as blood flow, and as a result ultrasound is used to look for any changes in organs and tissue.

Having an ultrasound

For an ultrasound scan you will be asked to lie on a table, usually facing upwards. A clear gel will be applied to the the breast or armpit, which helps the machine to make secure contact with the body. The radiologist will scan the area and obtain pictures. Ultrasound is complementary to mammography and is always the first investigation of choice for younger patients.

Tomosynthesis is a breast cancer screening technology that allows doctors to see inside the breast more clearly. Tomosynthesis is just like getting a mammogram, but it can allow for better detection of cancers, especially in dense breast tissue.

WHAT ARE THE BENEFITS?

Tomosynthesis is especially useful in examining dense breasts and can improve the radiologist’s ability to find small breast cancers. In some women it can reduce the need for a biopsy and if an abnormality is found, it can be pin pointed more accurately than with a regular mammogram

WHAT DOES THE PROCEDURE ENTAIL?

Tomosynthesis is similar to a having a mammogram. The breast is positioned the same way it is for a mammogram but the X-ray machine moves in an arc over your breast, taking pictures as it moves. A computer then generate a 3-D image of the breast. Tomosythesis takes around 45 seconds longer than a normal mammogram and the dose of radiation is just under three times that of a mammogram.

RESULTS

Results will usually be available within a few days of the tomosynthesis being carried out. We will have discussed how we deliver these results to you at your consultation before the tomosynthesis is carried out.

WHAT IS A BREAST MRI?

MRI (magnetic resonance imaging) uses strong magnets and radio waves to make detailed pictures of the inside of the breast. It does not use any form of radiation.

WHAT ARE THE BENEFITS?

To screen for breast cancer: For certain women at high risk of developing breast cancer, a screening MRI is recommended along with a yearly mammogram. MRI is not recommended as a screening test by itself because it can miss some cancers that a mammogram would find.

To help determine the size of breast cancer: Breast MRI is sometimes used in women who already have been diagnosed with breast cancer, to help measure the size of the cancer, look for other cancer in the breast, and to check for cancers in the opposite breast. However, not every woman who has been diagnosed with breast cancer needs a breast MRI.

Women with breast implants: A breast MRI can check whether breast implants have ruptured.

WHAT DOES THE PROCEDURE ENTAIL?

You will need to be able on your front to have a breast MRI, with the test normally taking about 45 minutes to one hour. An injection of a contrast material called gadolinium is injected into a vein in your arm, before or during the scan to allow as much information as possible to be obtained. This will all be explained to you before the scan by a radiographer, who will also check that there are no reasons not to have the scan, such as having a heart pacemaker, clips used on a brain aneurysm, a cochlear (ear) implant or metal coils inside blood vessels.

The test is painless, but you will need to stay very still inside the narrow tube. The machine is quite noisy, so you will be given some headphones to wear to help cancel out some of the background noise.

RESULTS

Results will usually be available within a few days of the MRI being carried out. We will have discussed how we deliver these results to you at your consultation before the MRI is carried out.