Frequently asked questions about breast tomosynthesis.
What is breast tomosynthesis? Breast tomosynthesis, or 3D mammography represents a significant breakthrough in breast imaging technology. A screening and diagnostic tool designed for early breast cancer detection, 3D mammography is done in conjunction with a traditional 2D digital mammogram.
Tomosynthesis uses x-rays to produce a three dimensional picture of the breast that a radiologist can view in 1-millimeter slices, making it possible to visualize breast tissue at a level of detail never before possible. The additional 3D images allow radiologists to provide a more comprehensive evaluation of a patient’s breast tissue during screening while reducing the need for follow-up imaging.
How are the 3D images obtained? 3D images are obtained when the x-ray beam swings in an arc over the breast, capturing multiple images in a single pass, from a variety of angles.
Who should get breast tomosynthesis? Everyone who is a candidate for 2D mammography is also a candidate for tomosynthesis. Patients with dense breast tissue may benefit most, but every woman’s breast health is better evaluated with 3D mammography.
What about radiation exposure? Even for studies where the 2D and 3D images are both obtained, the total dose is still below the limit under the Mammography Quality Standards Act (MQSA) set forth by the FDA.
What are the advantages of 3D mammography? A significant research study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found that tomosynthesis imaging, or 3D mammography, reveals significantly more invasive cancers than a traditional, 2D mammogram. Invasive cancers are more likely to spread or cause death. 3D mammography also reduces the number of women called back for additional imaging, which reduces patient anxiety and helps lower health care costs.
The study's findings included:
- A 41% increase in the detection of invasive breast cancers
- A 29% increase in the detection of all breast cancers
- A 40% decrease in false positives
- A 15% decrease in women recalled for additional imaging
How do I get a 3D mammogram? To schedule your annual screening mammogram call Inland Imaging at 509.455.4455.
Does health insurance cover 3D mammography? 3D mammography is currently covered by Medicare and Medicaid as well as by a number of private insurance carriers. If your health care plan does not currently cover the cost of the 3D mammography portion of your screening mammogram, we offer two options for your screening exam.
- 3D screening mammogram — you will be billed approximately $100 for the 3D portion of the exam that is not currently covered by your insurance plan.
- Traditional 2D screening mammogram — fully covered by your insurance carrier with no out of pocket expense to you.
We thank you for trusting us with your screening mammogram and assure you that we’re working with your health insurance provider to expand their coverage to include 3D enhancement of your mammogram.
Have more questions about 3D Mammography? Check out an Q&A with our own Dr. Robert Lloyd by Pullman Regional Hospital.
If your mammogram showed an abnormality in your breast, a breast biopsy may be your next step. This non-surgical procedure involves using a biopsy needle to remove a small sample of tissue from the area of concern. The results will help your physician determine if that suspicious-looking spot on the mammogram is going to need more attention.
Imaging-guided breast biopsy is often an excellent alternative to a surgical biopsy. Performed on an outpatient basis, the procedure is accurate, cost-effective (one-third the cost of surgery), does not require hospitalization or general anesthesia, and does not cause significant scarring.
With the guidance of breast-imaging technology, a specially trained radiologist will insert a thin, hollow breast-biopsy needle into the area of concern to remove a small sample of the suspicious tissue. A local anesthetic is applied to numb the area.
Depending on your mammogram results, the biopsy may be guided by stereotactic (X-ray) technology, ultrasound or MRI. A typical biopsy takes approximately one hour.Stereotactic Biopsy
For a stereotactic biopsy, you will lie on your stomach with your breast suspended through a hole on a specially designed breast biopsy table that is equipped with digital mammography equipment to pinpoint the exact biopsy location. The table elevates during the non-surgical procedure to allow easy access to the breast by the radiologist.
Tissue samples are extracted using a vacuum-assisted biopsy instrument. After the tissue samples are removed, a small clip is inserted to identify the biopsy area. A post-biopsy mammogram is performed to document the location of the clip. The entire procedure takes about an hour, but the actual biopsy time is much less.
Ultrasound may also be used to guide a needle and other necessary instrumentation to the biopsy area. You will lie in a position that provides the best access to the targeted area, usually on your back or side. After the tissue samples are removed, a small clip is inserted to identify the biopsy area. A post-biopsy mammogram is performed to document the location of the clip. The entire procedure takes about an hour, but the actual biopsy time is much less.MRI-guided Biopsy
Magnetic resonance imaging (MRI) is useful in the biopsy of abnormalities that can’t be seen clearly on ultrasound or X-ray. During the procedure, you will be given contrast material through an IV to help the radiologist better see the biopsy area. After the biopsy, a small clip is inserted into the area where the tissue sample was removed. The biopsy is followed by an MRI and mammogram of the targeted area.
Following the biopsy, you should avoid strenuous exercise, heavy lifting, reaching, pulling or tugging for 48 hours. You will receive additional post-care instructions after the procedure.
Your biopsy results will generally be available from the pathology laboratory within 72 hours. Be sure to review the results with your physician.
Magnetic resonance imaging (MRI) is a powerful tool in the diagnosis of breast cancer. Its high-resolution imaging provides superior views of abnormalities in the breast that might otherwise go undetected by other imaging technologies. In fact, the American Cancer Society recommends MRI exams in addition to annual mammograms for women at an especially high risk for breast cancer.
Inland Imaging’s dedicated high-resolution breast MRI and biopsy table features the very latest in breast MRI technology, providing maximum patient comfort and superior image quality.
For a breast MRI exam, you will lie face down on the specially designed breast MRI table, which is configured to allow the breasts to be positioned comfortably through two openings called breast coils. Sometimes, patients are given a contrast material through IV, which improves viewing of the targeted area.
A Breast MRI without IV Contrast takes approximately 45 minutes. For a Breast MRI with IV contrast, expect the exam to take 45-50 minutes.
How do I prepare?
- Wear loose, comfortable clothing. You may be given a gown to wear during your study.
- Leave metal objects at home. This includes jewelry, eyeglasses, dentures and hairpins. You may be asked to remove hearing aids and removable dental work.
- Receive a blood test. If you are over 60 years of age and IV contrast is indicated, this may be needed prior to your MRI exam.
- Inform your physician and the technologist of prior surgeries, metal implants, pacemaker, or aneurysm clips.
- Inform your physician if you are claustrophobic or unable to lie down on your stomach for an extended amount of time due to pain so that appropriate pre-medication can be ordered.
- Notify the technologist immediately if you are a woman who is nursing or may be pregnant.
- Contact Inland Imaging for special prep instructions if any of these risk factors apply to you: renal disease, over the age of 60, history of high blood pressure, diabetes or liver disease.
Ultrasound uses sonar, or high-frequency sound waves, to capture real-time images of organs inside the body. The noninvasive and generally painless exam is often used to determine if a suspicious area is a fluid-filled cyst or a solid mass that requires further testing. The imaging tool is also used to guide breast biopsies.
For most breast ultrasound exams, you will lie face-up or on your side. A clear gel is applied to the skin to eliminate air pockets between the transducer and the skin. An ultrasound technologist firmly presses the transducer against your skin, moving it back and forth over the specific area.
Generally the exam is completed within 15-30 minutes. In some cases, at the conclusion of your exam you may be asked to dress and wait while the ultrasound images are reviewed. Breast ultrasound is used frequently in conjunction with diagnostic mammography to help identify and clarify clinical and mammographic findings.
Positron Emission Mammography (PEM)
Positron emission mammography (PEM) can capture sharp, detailed images that pinpoint the exact size, shape and location of a breast tumor—making it a particularly useful tool for physicians as they develop treatment or surgical plans for breast cancer.
It works with an injection of a short-lived radioactive sugar into the body. The substance accumulates at the cancerous tissue in the breast and emits an energy that is detected and analyzed by special imaging technology.
In some situations, PEM offers certain advantages over the more conventional MRI exam:
- It is a good option for a patient who has a large body habitus and cannot fit in an MRI machine, has a pacemaker or other metallic implants, or is claustrophobic.
- It can be helpful in patients with breast implants.
- It is less susceptible to the hormonal effects of the menstrual cycle.
- It can help problem solve complex MRI findings.
- Its higher sensitivity makes it an effective tool in the evaluation of DCIS (ductal carcinoma in situ), a common form of non-invasive breast cancer.
About 90 minutes before the PEM scan, a nurse or technologist will check your blood sugar level to ensure it is within the acceptable range to perform the study.
A small amount of radioactive sugar will be injected into your arm. You will then sit or lie quietly in a chair or recliner while your body absorbs the radioactive sugar substance. You will be given a short hospital gown to wear during the scanning procedure.
After 90 minutes, you will be brought into the PEM scanning room and seated in a chair. The technologist will scan each breast separately, positioning each in the PEM scanner, similar to a mammogram but with less compression
A typical PEM exam requires at least two scans per breast. The entire exam, including the time prior to the actual procedure, takes two to four hours.
The radioactive sugar injected into your arm is routinely used for other medical imaging procedures without negative reactions or side effects. The radioactivity in the sugar fades quickly and leaves no detectable trace after 24 hours.
- Do not eat or drink anything other than water and non-diabetic medication six hours before your appointment.
- Inform your doctor and clinic staff if you are diabetic or have low blood sugar (hypoglycemia). Generally, this will not prevent you from having a PEM scan. Bring a snack with you to the appointment to eat once the nurse or technician gives you permission to do so.
- Wear loose, comfortable clothing.
Your PEM exam will be evaluated by a radiologist, who will send a report to your physician within 24 to 48 hours after the exam. Your physician will then inform you of the results.
When a lump can’t be felt during a physical exam or is not suitable to a needle biopsy, breast wire localization may be performed prior to surgery to help a surgeon find the tissue that needs to be removed. Using imaging technology to guide the procedure, a wire is inserted at the site of the abnormality. Surgeons can use electronic images during surgery to view the location of the wire.
First, the breast area will be cleaned with a sterile solution and you will receive a local anesthesia to numb the breast tissue. Guided by mammography, ultrasound, or MRI—whichever method provides the best visualization of the area—a radiologist will insert a small hollow needle into the breast.
Once the needle is positioned, a small wire (hook type) is placed through the needle and adjacent to the area of concern. Sometimes, the radiologist may inject blue dye or a sterile charcoal solution to help the surgeon see the abnormal tissue more clearly.
The wire will stay in the breast until your surgeon removes it along with the abnormality. After the surgery, the abnormality will be examined to verify removal of the wire.
Images are sent directly to your surgeon after the initial placement of the wire. The radiologist may also contact the surgeon directly after the procedure to discuss the findings. Your surgeon will inform you of the pathology results.