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When a lump or other abnormality is discovered, or a screening mammogram shows an area of concern, additional tests may be performed. These tests often are referred to as a diagnostic workup.
At Swedish, we respond quickly to requests for diagnostic workups. We know this can be an anxious time and we work with patients to get procedures scheduled as soon as possible.
We have full-service breast centers on our four main campuses for patient convenience and timely appointments. Each center has dedicated staff members with advanced certification in their area of expertise.
Our expert breast radiologists use state-of-the-art equipment to offer the latest in imaging, including diagnostic mammograms, ultrasounds and MRIs. All of our breast imaging procedures are accredited by the American College of Radiology, and Swedish has been designated a breast imaging center of excellence.
If you are experiencing current breast problems or have had an abnormal screening mammogram, a diagnostic mammogram may be the next step. A diagnostic mammogram uses the same technology as a screening mammogram (digital mammography and/or breast tomosynthesis), but may involve additional images, such as magnified views of the area of concern. If you are scheduled for a screening mammogram and have a lump or other breast concern, make sure to let the technologist doing your study know because additional imaging may be necessary.
This imaging method uses sound waves instead of radiation to produce an image. Ultrasound often is used along with mammography to provide additional information about a lump or an area of concern. It is useful in distinguishing between normal or benign areas and those that need further evaluation.
Magnetic resonance imaging uses a magnetic field and radio waves to create images. An MRI provides different information than a mammogram or ultrasound. It may be used along with a mammogram and ultrasound to evaluate areas of concern such as breast tissue and lymph nodes in the armpit.
When nipple discharge is present, a sample of the fluid may be collected and examined for cancer cells under a microscope. Another way to examine nipple discharge is to take a special X-ray called a galactogram or ductogram after injecting dye into the affected duct.
If an area of concern is identified, a biopsy likely will be recommended. At Swedish, most biopsies are done in a minimally invasive manner, under a local anesthetic and using imaging guidance by our specialized breast radiologists. If a surgical biopsy is needed, our experienced breast surgeons provide care.
There are two non-surgical needle biopsy methods used to remove breast tissue for examination:
Needle core biopsy
This is the most common method for obtaining a tissue sample. A sampling needle is inserted into the breast under a local anesthetic to obtain tissue for review by a pathologist. Our radiologists will select an imaging method for the biopsy, based on the location and characteristics of the area of concern and breast density:
- Ultrasound: Ultrasound is an imaging method that uses sound waves to produce a picture of a part of the body. A physician watches the image on a screen to guide the needle to the tissue to be sampled.
- Stereotactic imaging: This imaging procedure uses mammograms taken from two angles to help a physician guide the needle to the breast tissue.
- Magnetic resonance imaging (MRI): This technique captures multiple pictures and combines them into a detailed three-dimensional image. The physician uses these images to guide the needle to the breast tissue to be biopsied.
- Tomosynthesis: This procedure creates a three-dimensional picture using X-rays from many angles. A physician uses the images to guide the needle to the targeted tissue.
Fine needle aspirate
A small needle is inserted into the breast and suction is used to collect cells for study. This is done in selective situations such as some lymph node biopsies.
In some instances a surgical, or excisional, biopsy will be recommended. This requires a short procedure in the operating room that can usually be done with sedation and local anesthesia.
To learn more about diagnostic workups or to schedule an appointment, call 206-215-6400 to talk with our breast team.