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Digital MammographyDigital Mammography allows for sharper images, as well as image manipulation after the exam where contrast can be adjusted and small regions enlarged without loss of quality. This reduces the number of repeat X-rays, though special views are still sometimes necessary. From the patient’s standpoint, the procedure is virtually identical to traditional mammography, but the exam is shorter, with less radiation exposure. Also, procedures such as needle localizations are much quicker using digital mammography. A landmark, multi-institutional study has shown that digital mammograms detect more cancers in younger women and women with dense breast tissue. UltrasoundThe usual role of ultrasound is to serve as back-up to clinical exam, mammography and, more recently, MRI. When abnormalities are detected through any of these methods, targeted ultrasound to the area in question gives further information, helps with the diagnosis, and may serve as the patient-friendliest form of biopsy, if needed. Ultrasound can also be used to screen all the breast tissue in asymptomatic patients, usually younger women and those with dense breast tissue, though this role has been eclipsed largely by breast MRI. Stereotactic and Ultrasound Mammotome™ BiopsyStereotactic and Ultrasound Mammotome™ Biopsy are two ways to determine if cancer is present in the breast without a surgical biopsy. The Mammotome™ is a needle device having a larger diameter than the original core biopsies, allowing for more accurate pathology. In addition, the needle is introduced only one time (as opposed to the original method of multiple insertions), then vacuum-assistance allows the tissue to be removed through this small nick in the skin, all of which is performed in the office under local anesthesia. The Mammotome™ device can be used for abnormalities identified on Ultrasound or by Mammography (stereotactic). Since the introduction of the Mammotome™, there have been many variations introduced to the market, but they all accomplish the same thing – more accurate pathology than the original small-diameter core biopsies or fine needle aspirations. Occasionally, it is still necessary to perform open surgical biopsies, especially if the Mammotome™ biopsy results are equivocal and more serious pathology is suspected in the breast. Breast MRIBreast MRI is a noninvasive procedure that examines the inside of the breast
through hundreds of serial images, where an injected contrast agent called gadolinium will enhance
a cancer. There is no flattening or compression of the breast during MRI, and there is no radiation
exposure. Regardless of breast density, if cancer is present, breast MRI will detect it 90-95% of the
time in reported series. This is compared to mammograms, which detect cancer 70% of the time, depending
on breast density, but this number can go below 50% if the breasts are markedly dense on mammography.
Breast MRI-guided BiopsyBreast MRI-guided Biopsy is available for the first time through the Aurora™ breast-dedicated MRI, with FDA approval occurring February 2003. The technical difficulties encountered in allowing MRI-guided biopsies held back the use of breast MRI in clinical practice for many years. It is still easier on the patient (and doctor) to perform biopsies of abnormalities using ultrasound or X-ray guidance. However, if an abnormality (“area of enhancement”) appears only on breast MRI and requires biopsy, this can now be done using the breast-dedicated MRI equipment. Risk Assessment Program, Risk Reduction Counseling, and Genetic TestingRisk Assessment Program, Risk Reduction Counseling, and Genetic Testing is available
under the direction of Alan B. Hollingsworth, M.D. and Sharon Nall, R.N., M.S., O.C.N., Clinical Nurse
Specialist. Dr. Hollingsworth pioneered risk assessment in the state of Oklahoma and serves on the
National Breast Cancer Risk Assessment Working Group. High Risk Surveillance ProgramHigh Risk Surveillance Program was a concept launched in Oklahoma in 1993 when Dr. Hollingsworth felt that women with risk factors should have the option of aggressive surveillance with frequent clinical exams and liberal use of ultrasound to augment mammography. The role of ultrasound has expanded in this group and, more recently, breast MRI has been added to the tools that can diagnose those cancers missed by screening mammography. Dr. Hollingsworth makes recommendations for interval screening with ultrasound and/or MRI based on a formula derived from the degree of mammographic density coupled with degree of risk elevation. However, realizing that the majority of women who develop breast cancer have NO identifiable risk factors, Dr. Hollingsworth has spent the past decade trying to facilitate the work of basic scientists who seek a screening blood test for detecting early breast cancer. “Eventually, it will be blood-based testing that tells us which women need breast MRI,” states Dr. Hollingsworth. Sentinel Lymph Node BiopsySentinel Lymph Node Biopsy is now considered a standard of care in the management of patients with early breast cancer. A radioactive dye and/or a blue dye is injected at the tumor site (or beneath the nipple) prior to surgery, and the dye(s) lets the surgeon know which lymph node or nodes are most likely to harbor cancer. In this way, the number of lymph nodes removed from the armpit can be reduced drastically compared to surgery done in years past if the sentinel node is negative. To our knowledge, Mercy Health Center is the only Oklahoma hospital to carry out its own in-house research protocol on Sentinel Node Biopsy. Now that it is considered “standard of care,” Mercy has credentialing requirements for surgeons to assure that all breast cancer patients treated at our hospital have surgeons skilled in this procedure. Multi-Specialty ApproachMulti-Specialty Approach is unique to those breast centers that are
associated with hospitals or cancer centers. Breast diagnostics are intimately linked to
therapeutics. Breast diagnostics involve radiologists, surgeons, and pathologists.
Breast therapeutics involve these same specialties, with the addition of medical oncology,
radiation oncology, and plastic surgery, as well as support systems. It is difficult to
practice quality breast care in a vacuum – each and every step can impact the other
specialties and can ‘burn bridges’ if not coordinated. The coordination of seven specialties
is a monumental task, to say the least, but Mercy Women’s Center is dedicated to this
approach. Blood Testing and other Research OpportunitiesBlood Testing and other Research Opportunities: Now that
breast MRI can find virtually all breast cancers, we are left with a very difficult
problem – MRI is far too expensive to use to screen the general population. And, if
we limit screening to high-risk patients only, we automatically refuse study on the
MAJORITY of women who are going to develop breast cancer. To that end, Dr. Hollingsworth
has been pursuing a blood test to detect breast cancer at its earliest stage, effectively
selecting patients for breast MRI (if standard imaging is normal), independent of risk
factors. At Mercy, patients undergoing MRI and/or biopsies will have the opportunity to
participate in these research studies Bone DensitometryBone densitometry may seem out of place at a breast center, but bone density comes into play (along with breast cancer risk factors) regularly when making decisions about hormone replacement therapy or SERMS (selective estrogen receptor modulators), both of which can improve bone density, but have different effects on breast cancer risk. Non-hormonal measures for improving bone density are also important to know. In addition to information from your primary care physician, Mercy Women’s Center offers the expertise of Sharon Nall, R.N., M.S., O.C.N., Clinical Nurse Specialist.
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