Breast Imaging

This is performed either as part of an asymptomatic national screening program or a diagnostic mammogram on a referral basis for women, or men when unusual signs or symptoms in one or both breasts are present. For example a lump, tenderness, nipple discharge, or skin changes. The mammogram confirms if the changes are benign or if they indicate a possible breast cancer and further tests and treatment may be required.

Most mammograms are performed in a standing position.  Two images at different angles are taken of each breast using specialist equipment in order to pay special attention to optimal technique, body positioning and breast compression.  A mammogram takes about 10 minutes.

Women in England who are aged 50 to their 71st birthday are currently invited for breast screening at 3-yearly intervals.

The breast screening program is a routine mammogram that is used to detect breast cancer before any symptoms are evident, using a low-dose X-ray. This allows for early treatment and intervention.

Ultrasound is a safe, non-invasive and painless procedure that uses high frequency
sound waves to create an image. Ultrasound examinations do not use radiation. It is the preferred imaging technique in patients whose breasts contain dense glandular tissue such as those younger than 35, thus eliminating exposure to radiation.

Ultrasound images are captured in real-time and can therefore show the structure of the breast. Doppler ultrasound is a special technique that evaluates blood flow or lack of flow in any breast mass. This may in some cases provide additional information as to the cause of the mass. 

If changes in the breast(s) are detected by a mammogram or ultrasound scan, the patient may be referred for a cell or fluid sample (fine needle aspiration) or tissue sample (core biopsy) to identify what is causing the changes. These samples are analysed under a microscope in the laboratory.

A breast fine needle aspiration (FNA) removes some fluid or cells from a breast lesion (a lump, or other area of concern) with a fine needle and syringe similar to that used for blood tests. The sample of fluid or cells is examined in a laboratory for analysis.  FNA is a quick way to distinguish between a fluid-filled cyst and a solid mass and to possibly avoid a more invasive biopsy procedure. A FNA may be used to aspirate (draw fluid from) a cyst to relieve discomfort if the cyst is large or tender.

A breast core biopsy is the removal of several small samples of breast tissue using a special type of needle inserted into the breast, usually under the guidance of ultra sound. The samples will be taken from within a lump or if an abnormality in the breast cannot be felt as a lump, samples will be taken from the area of concern and sent to a laboratory for analysis. 

Depending on the location of the abnormality other imaging techniques such as mammography or MRI may be used to guide the positioning of the needle to obtain the tissue sample.

Breast specialists (both surgeons and radiologists) commonly place metallic markers within breast tissue, some of which are permanent. These include: marker coils following biopsy; magnetic seeds to localize for planned surgery; and surgical clips/staples which identify the tumour bed for radiotherapy after surgery.

The breast unit and breast screening unit are occasionally asked if these clips are compatible with MRI (Magnetic Resonance Imaging). As a general rule, all of the above devices are MRI-compatible and safe. Biopsy coils and surgical staples are composed of nonferromagnetic titanium or stainless steel, are MRI-compatible and produce little or no artefact on imaging. Magseeds® are composed of surgical-grade stainless steel and although MRI-compatible will generate considerable artefact.

Ms. Natalie Chand
Consultant Oncoplastic Breast Surgeon
Clinical Lead, Breast Unit

Dr Anna Parker
Consultant Radiologist
Director of Breast Screening and Breast Imaging