As a leading Sydney provider of radiology and nuclear medicine services, San Radiology & Nuclear Medicine is well-equipped to provide the full suite of imaging services vital for diagnosis and treatment of any breast condition including breast cancer. We provide a number of different breast imaging techniques. The decision to use one particular type of imaging technique, or a combination of imaging techniques is based on a number of factors including your age, the presence of symptoms or signs, family history, past personal history of breast pathology, breast density and so on. Your doctor will likely have discussed this with you.
In younger women, typically under 40, it is not uncommon to initially investigate breast concerns with an ultrasound. Mammography may or may not be performed in this age group, and often this occurs after the ultrasound. In women over 40, imaging usually includes both mammography and ultrasound. Other studies for the breast can be used in varying circumstances, including contrast mammography and MRI. Biopsy of the breast may also be necessary in some situations and radiologists (doctors trained in medical imaging) perform these with imaging guidance.
Breast imaging services
Diagnostic 2D mammography and 3D mammography (tomosynthesis)
A mammogram is an x-ray of the breasts performed on a purpose-built machine. It may be performed for screening or diagnostic reasons. Screening mammography is done when there are no symptoms or reasons for concern and can be performed in women over the age of 40 to detect abnormalities that are not able to be felt. If you have symptoms or signs that are concerning, your doctor will recommend diagnostic imaging typically including mammography and possibly ultrasound, particularly if you are 40 years of age or older. These symptoms or signs may include pain or tenderness, a lump or thickening, skin changes, dimpling or nipple discharge.
If you are under 40 years of age, a breast ultrasound is often the first imaging test performed to investigate a symptom or sign. If you are over 40 years of age, an ultrasound is often performed in combination with a mammogram. An ultrasound uses high frequency sound waves to produce images rather than using x-rays, and because it uses different technology to look at the breast, it provides different and additional information to a mammogram.
Contrast mammography is a relatively new technique and is a variation on a mammogram, where the mammogram is performed after an injection of x-ray dye, also known as a contrast agent. Contrast mammograms can be used to further investigate issues raised with traditional mammography and ultrasound, to evaluate the extent of disease in an already documented cancer, and to provide greater diagnostic confidence for women with dense breasts or with symptoms.
Magnetic Resonance Imaging (MRI) uses very strong magnets and radiofrequency pulses to produce images of the breasts or various other parts of the body. Unlike mammography, there is no radiation involved in an MRI. MRI of the breast can be used to screen women deemed at high risk for breast cancer. It is particularly useful in younger women with a strong family history or a genetic mutation such as the BRCA1 or BRCA2 gene for example. In younger women with these genetic factors, or in women who have been treated with chest irradiation for lymphoma, MRI is preferred over mammography as it avoids the use of radiation to the breast.
Breast lymphoscintigraphy (sentinel node localisation) is a procedure used to identify and mark the lymph nodes (there may be more than one) which are the first to receive lymphatic fluid drainage from around the tumour in the breast. This is performed prior to breast surgery in order to help the surgeon determine which lymph nodes (if any) need to be removed for further examination by a pathologist.
Preoperative hookwire localisation
Hookwire localisation is performed when there is an abnormality in your breast that cannot be felt but requires surgical removal. To assist this process, a fine wire with a small hook on one end is inserted into your breast under imaging guidance. The hooked tip is positioned in the abnormality and remains in this location to enable your surgeon to accurately remove only this area of interest, minimising scarring and breast deformity.
Core biopsy / Vacuum assisted core biopsy
Core biopsy of the breast, both with or without vacuum assistance, is a safe and minimally invasive method of obtaining a sample of breast tissue that a pathologist will then examine under a microscope. These procedures may be requested by your doctor if they, or you, can feel a lump or change in the breast, or may be recommended by a radiologist after evaluating your breast imaging such as mammography and tomosynthesis, ultrasound and/or MRI. The aim is to determine the underlying reason for a clinical change or imaging abnormality. These biopsies are done to gain answers without subjecting you to a surgical biopsy which requires a general anaesthetic and a larger incision.
Fine needle aspiration biopsy
A fine needle aspiration biopsy of your breast is a safe, minimally invasive method of obtaining a sample of breast tissue cells from an area needing further investigation. It may be requested by your doctor if they, or you, can feel a lump or change in the breast, or may be recommended by a radiologist after evaluating your breast imaging results either from mammography and tomosynthesis, ultrasound and/or MRI. These tissue cells are then examined under a microscope by a pathologist to determine the underlying reason for the change or imaging abnormality and determine what further treatment, if any, is required. These biopsies are performed to obtain answers without subjecting you to a surgical biopsy which requires a general anaesthetic and a larger incision.
Breast tissue marker (clip)
A tissue marker is a very small object that is inserted into the breast either at the time of a biopsy, or to mark a previously diagnosed abnormality. There are a number of different types of markers available and the radiologist uses the marker clip most suitable for your particular requirements. There are different materials used in the various markers that are available and the markers come in a variety of shapes. Different shapes are useful if there are multiple areas to be marked in the same breast.
Breast Cancer Imaging
Imaging services may be used to assist the investigation of areas of concern in more detail prior to surgery or other cancer treatments. These services are generally minimally invasive and include procedures such as core biopsies or fine needle aspiration biopsies, where the imaging is used to help guide the procedure. A radiologist may recommend these types of procedures to obtain more information without requiring the patient to undergo general anaesthetic and to better inform cancer treatment plans.
Based on Sydney’s North Shore, our imaging team are part of our renowned San Breast Care service. Our radiology specialists provide expert assistance throughout the diagnosis and cancer treatment processes, contributing valuable information for the patient’s care. The San’s breast imaging specialists utilise the appropriate procedure to accurately identify and assess breast cancer prior to treatment, providing vital information and interpretation of results for use by the patient’s cancer specialist team.