Breast cancer screening and diagnostic examinations are tailored to each patient’s particular risk factors. They may include digital mammography with tomosynthesis, breast ultrasound and breast MRI, as well as image-guided biopsies under each of these imaging types in a personalized, compassionate, and caring manner.
- 2-D & 3-D tomosynthesis diagnostic & screening mammograms
- Breast Ultrasound
- Breast MRI
- Breast Biopsies
A screening mammogram is done in two dimensions (2-D) and tomosynthesis (3-D) and is covered by insurance. Screening mammography is done if the patient has no symptoms, and no problems are suspected. If a problem is discovered, a diagnostic mammogram will be performed. If the breasts are too dense to make an accurate determination, additional screening is done with ultrasound. A breast MRI may be ordered for a high risk patient.
In 2013, the FDA approved synthetic 2-D which has the same resolution as regular 2-D with less radiation exposure.
Sylvester Comprehensive Cancer Center uses full-field digital mammography 2-D or synthetic 2-D and tomosynthesis (3-D mammography). With tomosynthesis, radiology technologists are able to obtain breast images from multiple angles, enhancing the accuracy of cancer detection and reducing the potential need for repeat scans.
Prior to the availability of tomosynthesis 3-D mammography, 70-75% of biopsies proved not to be cancer.
Diagnostic mammography has a deductible and is done if the person has a symptom like nipple discharge, a lump, has a localized pain or had unilateral mastectomy. Diagnostic results are provided at the time of evaluation, by a physician to each and every patient to minimize the anxiety and discomfort of unknown results.
Sylvester is the only cancer center in South Florida offering the new technology of contrast-enhanced mammograms in breast cancer detection. It’s the same equipment as a mammogram, but includes upgraded software. Intravenous iodine contrast is used to enhance the images. The ideal candidates are women at intermediate risk of developing breast cancer: any women with a personal history of breast cancer, a family history of breast cancer, a prior high-risk lesion at biopsy, or even women with high breast density.
Contrast-enhanced mammograms are also an option for women at high risk who need a breast MRI, but have issues like severe claustrophobia, implantable devices that are not compatible with the MRI, or they have gadolinium allergies. It is also less costly than MRI.
Having dedicated breast radiologists who specialize in mammography greatly increases the accuracy and ability to spot abnormalities. If a possible abnormality is spotted or if the breast is especially dense, they may order additional testing, such as high-resolution ultrasound or breast MRI.
High-resolution breast ultrasound is a non-invasive screening that may be requested if you have dense breasts and are at a higher risk of breast cancer, or if the mammogram showed an abnormality. Ultrasound creates pictures of the breast tissue using sound waves instead of X-rays. These pictures show the breast tissue in different orientations to provide a better picture of dense breast tissue.
Many physicians prefer a breast MRI in addition to a mammogram, especially for patients with a 20 to 25% or higher lifetime risk for breast cancer. A breast MRI captures multiple images of your breast, using magnets instead of radiation to capture the images. Breast MRI images are combined, using a computer, to create detailed pictures. Before the MRI, a dye (contrast agent) is injected through an intravenous (IV) line in your arm to make an abnormality easier to see. There are studies underway to determine if the residual contrast stays in other parts of the body.
A breast MRI may be used with a mammogram as a breast cancer screening tool:
- At high risk of breast cancer
- Who have a very strong family history of breast cancer
- Who carry a hereditary breast cancer gene mutation
- Who had radiation therapy of the chest for lymphoma 8 years or more before
For women who have had a mastectomy for cancer and a breast implant, a mammogram is not done on that side because the chances of cancer are minimal. With symptoms, the breast MRI is a better option.
A breast MRI may also be performed after you have a biopsy that's positive for cancer and your doctor needs more information about the extent of the disease.
Breast disease may appear in many forms: it could be benign (not cancer) and may or may not need treatment. The breast care experts at Sylvester work together in multidisciplinary teams to analyze the make-up of your particular growth and determine the best course of action to give you the best health outcome.
Biopsies are usually image-guided localization procedures using stereotactic mammographic, ultrasound and MRI guidance. During the procedure, a small sample of the suspicious breast tissue is removed (biopsied) and tested. Biopsies can be performed in several ways, depending on the circumstances:
- Image-guided core needle biopsy: The radiologist uses the hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area, guided by ultrasound or stereotactic imaging. Typically, three to six samples are obtained during the procedure with a tiny vacuum or spring cutting device.
- Cyst aspiration: Your imaging exam may reveal fluid-filled sacs or cysts within your breast. The good news is that these are usually not cancer. If the cysts are painful, your surgeon or radiologist can insert a needle and drain them.
- Surgical biopsy: Sometimes an incision, or a small cut, is required. During this procedure, the surgeon may be able to remove the entire mass (excisional biopsy) or a sample to test (incisional biopsy).
After a cancer diagnosis is made, several tests can be performed on the biopsy sample to determine the exact type and treatment options:
- Estrogen and progesterone receptor test: This test measures the amount of estrogen and progesterone (hormone) receptors in your cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer may grow more quickly. Test results show whether treatment to block estrogen and progesterone is needed.
- Human epidermal growth factor type 2 (HER2/neu) receptor test: This test measures how many HER2/neu breast cancer cells are present in the specimen sample. If there is more HER2/neu protein than normal, the cancer is more aggressive and may grow or spread more quickly and a special chemotherapy is indicated.
- Oncotype DX and MammaPrint: These tests help predict whether stage I or stage II breast cancer that is estrogen receptor positive and HER 2nue negative are at increased or decreased risk. If the risk of the cancer spreading is high, your oncologist may recommend chemotherapy to lower the risk of the cancer spreading later, in addition to an estrogen-blocking agent. If it is low, you won’t need chemotherapy; just an estrogen blocking agent.
Why Choose Sylvester Comprehensive Cancer Center?
Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.
Renowned Braman Family Breast Cancer Institute at Sylvester. We offer one of the nation's best breast cancer diagnosis and care programs, with treatments customized to your individual needs.
Breast Imaging Center of Excellence designation by the American College of Radiology. The Breast Imaging Centers of the University of Miami, Sylvester Comprehensive Cancer Center, and Miller School of Medicine have two facilities that consist of a group of board-certified and fellowship-trained breast-dedicated radiologists with experience and training in all imaging modalities for the evaluation and detection of breast pathology.
The only cancer center in South Florida offering the new technology of contrast-enhanced mammograms in breast cancer detection. It uses the same equipment as a mammogram with upgraded software and intravenous iodine contrast to enhance the images.
State-of-the-Art Lennar Foundation Medical Center Women’s Imaging Center in Coral Gables. Every woman receives personalized care with a one-stage visit for every screening and diagnostic mammogram. Ultrasound and even biopsies can be done at the same visit.
- Sylvester Comprehensive Cancer Center (Miami and Deerfield Beach locations)
- UHealth Tower
- Lennar Foundation Medical Center (Coral Gables)
- Jackson Memorial Hospital