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Second Opinion of a Breast Cancer Diagnosis
Cancer Genetics Program
Breast Surgical Oncology at Beth Israel Brooklyn
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An accurate and immediate diagnosis and staging of breast disease is essential for optimal treatment planning and peace of mind. At the Appel-Venet Comprehensive Breast Service, our breast cancer team is equipped with the latest understanding and knowledge about breast cancer, and we are dedicated to using the least invasive tests possible to get a diagnosis at the earliest possible stage.
Our Breast Service provides the most advanced breast imaging services, and our patients have the advantage of being able to undergo the diagnostic process in one location, which saves time and lessens anxiety. In fact, patients can often get their diagnostic tests all in one day, and then immediately discuss treatment options with a multidisciplinary team of experts.
Some of the diagnostic procedures we offer include:
A clinical breast examination by one of our breast cancer surgeons is most often the first step to making a reliable diagnosis of any unusual condition. Depending on the results of the exam, the surgeon may recommend further testing or may conclude that your condition constitutes one of several natural changes and recommend follow-up with continual Breast Self Exams and regular clinical breast exams.
If the breast mass is palpable, our onsite cytopathologist will participate directly in the fine needle aspiration and will be able to feel the lump and the texture of the tissue when the needle goes into the lump. This helps in the diagnosis and also allows the pathologist to look at the slide immediately and determine if there's enough tissue to make a diagnosis, thereby eliminating the anxiety of waiting for a result.
The advantage of fine needle aspirations is that the pathologist is looking at individual cells, so less tissue is taken out of the breast. However, this is a specialized procedure, and requires the expertise of a pathologist with special training.
A mammogram, an X-ray picture of the breast, tells surgeons a great deal about breast conditions. The Breast Service utilizes the latest state-of-the-art technology for mammograms, and our expert radiologists work closely with surgeons to get the most accurate diagnosis.
Beth Israel now utilizes Breast-Specific Gamma Imaging (BSGI), a new tool that can help identify cancerous breast tissue undetected by mammography. By operating on a cellular or molecular level, BSGI is not affected by tissue density and can help detect cancers at very early stages and allow for optimal intervention and treatment. Clinically proven effective in multiple studies, BSGI technology is particularly useful in serving as a complementary tool for radiologists and breast cancer specialists to detect breast cancer in women with difficult-to-read mammograms, such as those with dense breast tissue, breast implants, or scar tissue from previous breast surgery.
Breast ultrasound, also called sonography, is similar to the ultrasound used during pregnancy. For breast conditions, ultrasound helps to distinguish a liquid-filled cyst from a solid mass in the breast. During an ultrasound, the breast, covered with jelly, is evaluated using a transducer—an instrument that produces sound waves as it slides across the breast. If the mass is a cyst, either aspiration or observation may be recommended.
Magnetic Resonance Imaging (MRI) is a non-invasive procedure that uses radio waves and magnetic fields to diagnose disease. A breast MRI creates multiple cross-sectional images of the breast, which are then read by one of our expert radiologists. During a breast MRI, patients are asked to lie on a table, which is then advanced into the tube-like MRI machine. Patients will need to lie still while the scans are being performed, and a contrast agent will be injected beforehand in order to highlight breast abnormalities.
PET/CT imaging is an advanced technology that combines the benefits of two scanners—the Positron Emission Tomography (PET), which shows the metabolic function of cancer cells, and the Computed Tomography (CT), which shows the anatomy in detail. Used as an addition to mammography, PET-CT scanning is especially useful for detecting advanced breast cancer and for staging purposes as well. After receiving an intravenous injection of a tracer drug , a patient will lie on a table that passes slowly through the scanner. Unlike the tube-like MRI machine, the PET/CT scanner features two large rings placed closely together.
To diagnose an abnormal area in the breast, our surgeons may attempt to aspirate it by inserting a very tiny needle, using ultrasound to guide the needle for accuracy. If the lump is a liquid-filled cyst, aspiration will drain the fluid and collapse the cyst. Most cysts are benign, so this will probably be the only treatment necessary.
If the abnormal area is a solid lump, a surgeon may perform a fine needle aspiration, during which the ultrasound-guided needle is put into the lump to take out a smear (much like a pap smear) for examination under a microscope by one of our specially trained pathologists. Even if no cancerous cells are found, a surgical biopsy may still be necessary; but if malignant cells are discovered, treatment planning can begin immediately.
If the breast mass is not palpable, an ultrasound-guided fine needle aspiration can be used to guide the needle into the lump so our cytology pathologists can examine the cells.
This process is similar to the fine needle aspiration described above, but uses a larger needle in order to obtain fragments of abnormal tissue, not just cells. A cylinder of the lump is taken out, and a pathologist will slice up the sample and examine the pieces microscopically in order to make a definitive diagnosis.
A stereotactic core biopsy is similar to the ultrasound-guided core biopsy described above, except that the needle is guided to the suspicious location using a special computerized mammography machine. Using this stereotactic biopsy unit, the radiologist inserts a needle under the guidance of the mammogram into the suspected area and then takes a sample through the needle. In the hands of one of our expert radiologists, the stereotactic technique is extremely accurate at pinpointing mammographically-detected suspicious areas. This eliminates the need for a surgical biopsy when pathology is benign, which occurs in about 80 percent of the patients.
An excisional biopsy is sometimes recommended after a needle biopsy in cases where the tissue obtained is not adequate to confirm either a cancer diagnosis or a benign lesion. Also known as a surgical or open biopsy, the purpose of the excisional biopsy is to remove the entire suspicious mass plus a rim of tissue surrounding the mass. The tissue that is removed is then sent to the pathologist, who determines if it is benign or malignant. If the breast abnormality is not palpable, but the mammogram results are suspicious and a surgical biopsy is required, our surgeons will perform a needle-localized excisional breast biopsy. Using ultrasound or mammography, the radiologist inserts a thin needle into the breast before surgery to guide the surgeon in locating the suspicious area for removal.
Our breast surgeons have extensive expertise with ductal lavage, a technique used to assess the risk of breast cancer in women who have had breast cancer or are at high risk. This procedure involves collecting cells inside the milk ducts—where most breast cancers begin—to find abnormal, risk-elevating changes. During this outpatient procedure, a tiny catheter is placed into the nipple and fluid is aspirated from the milk duct, then sent to the laboratory and analyzed. This procedure can help detect otherwise unsuspected precancerous cells and allow for early detection of breast cancer, which remains the key to a favorable outcome.
For patients who are having problems with nipple discharge, we may also perform Mammary Ductosopy with Ductoscopically Duct Excision After precisely identifying the tiny lesions within the milk ducts that are causing nipple discharge, our surgeons will then remove the problem area to stop the discharge and analyze the tissue for cancer cells, while preserving normal breast appearance and breast-feeding capability.
One of our ductoscopy procedures was videotaped recently—to view it, go to www.or-live.com/bethisrael/1144 and click on “View Webcast.”
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