ULTRASOUND-GUIDED BREAST BIOPSY

Ultrasound is an excellent way to evaluate breast abnormalities detected by mammography. In some cases it is not possible to tell from the imaging studies alone whether a growth is benign or cancerous. That is why ultrasound-guided breast biopsy is so effective. It is a highly accurate way to evaluate suspicious masses within the breast that are visible on ultrasound, whether or not they can be felt on breast self-examination or clinical examination. The procedure prevents the need to remove tissue surgically, and also eliminates the radiation exposure that comes from using x-rays to locate a mass.

THE EXAM

Ultrasound-guided biopsy is most useful when there are suspicious changes on the mammogram that can also be seen on an ultrasound exam. After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the radiologist guides a biopsy needle directly into the mass.
A very small nick is made in the skin at the site where the biopsy needle is to be inserted. The radiologist, constantly monitoring the lesion site with the ultrasound probe, guides a biopsy needle or the vacuum assisted needle directly into the mass and obtains specimens. Usually at least five to 10 samples are taken using the core biopsy method.

PREPARATION & SPECIAL INSTRUCTIONS

If you are taking aspirin or a blood thinner, your physician may advise you to stop these medictions five days before the procedure. Regular medications should be taken as prescribed by physician. A comfortable two piece garment should be worn. Please avoid using talcum powder or deodorant on the day of your biopsy.

WHAT TO EXPECT

You will be awake during your biopsy, and should have little or no discomfort. Generally the biopsy is completed in less than an hour. It is not necessary to close the tiny skin incision with sutures; a small compression dressing will do. Most patients are able to resume their usual activities later the same day. A pathologist will examine the tissue specimens after they are processed. A definite diagnosis will be available within a few days. When the final biopsy findings are available, you may have a session with your physician to discuss the results and decide together on the next step. If cancer is diagnosed, you probably will be referred to a tumor specialist or surgeon.

STEREOTACTIC BREAST BIOPSY

A stereotactic breast biopsy is an alternative to open surgical biopsy. It produces digital images of the breast allowing the radiologist to locate suspicious lesions to the accuracy of one millimeter. It is more cost effective than the surgical biopsy and leaves only a small scar at the site of the incision. Stereotactic core biopsies shorten the time from initial detection of lesions at mammography to final diagnosis and breast conserving therapy. Some indications for a stereotactic breast biopsy are:

• A suspicious mass that cannot be felt on breast exam
• A mammogram showing suspicious clusters of small calcium depositsA distorted structure of breast tissue.
• A new mass or area of calcium deposits present at a previous surgery site.
• The patient or physician strongly prefers a non-surgical method of assessment.

Stereotactic breast biopsy provides the same reliability as surgical biopsy, but provides these significant advantages:

• No anesthesia required
• Less time required
• More cost effective
• Much less complicated

PREPARATION AND SPECIAL INSTRUCTIONS

The patient should discontinue use of aspirin or blood thinners five days prior to the exam. Regular medications should be taken as prescribed by physician. A comfortable two piece garment should be worn. Please avoid using talcum powder or deodorant on the day of your biopsy.

WHAT TO EXPECT

The patient will lie on a specifically designed table which allows for visualization of the breast. A paddle-shaped instrument compresses the breast during the biopsy. The skin is washed and a local anesthetic is injected. A small incision is made in the skin. The tip of the biopsy needle is then advanced through the incision to the calculated site of the lesion. Stereo images (digital mammography images) are taken to confirm that the needle tip is actually within the lesion. Five to twelve samples are collected and sent to a laboratory for pathology evaluation. A final set of stereo images are obtained and a small clip is placed at the biopsy site so that it can be easily located if the lesion is cancerous.

Most biopsies take about one hour per suspected site. Most women report little or no pain afterward. There may be a small scar from the tiny skin incision. It is not unusual for a small amount of bleeding to occur where the needle was placed. The breast will be bandaged and a cold pack will be applied to relieve swelling and bruising. A non- steroidal pain reliever, such as Tylenol, may be taken as needed.

OSTEOPOROSIS

Osteoporosis is a disease in which bones become fragile and brittle and are prone to fracture. Osteoporosis affects 44 million Americans, mostly women, but also men. Osteoporosis increases the risk of fractures which can be disabling or even deadly. Osteoporosis is treatable and may be preventable. People need to know their risk for osteoporosis and talk to their doctors about diagnosis, prevention and treatment.
There are two ways to find out if you have osteoporosis: by breaking a bone or by getting a bone density test. Just as it is important to know your blood pressure and cholesterol, it is also important to know your T-score. Osteoporosis is diagnosed with bone density testing. At RIS, we offer state-of-the-art bone density testing with a Hologic DEXA scanner. The lumbar spine, hips and wrists can be tested. A "T-score" is obtained for each body part tested. By World Health Organization (WHO) criteria, a T-score greater than minus (-) 1.0 is normal, minus (-) 1.0 to (-) 2.5 is osteopenia and less than minus (-) 2.5 is osteoporosis.

OSTEOPOROSIS RISK FACTORS

1. Age -- increased age, increased risk.
2. Gender -- female greater than male.Family history.
3. Race -- Caucasian, Asian, greater than Hispanic, African-American.
4. Body weight -- low body weight, increased risk.Menopause.
5. Lifestyle -- cigarettes, excess alcohol, increased risk.
6. Medications -- steroids, certain anti-seizure medications, etc.

WHO SHOULD UNDERGO BONE DENSITY TESTING

• All postmenopausal females, females with history of premature menopause.
• Patients with an unexplained fracture.
• Patients on medications which increase risk of osteoporosis such as steroids.
• Patients considering hormone replacement therapy or other treatment for osteoporosis.
• History of osteoporosis, followup of treatment for osteoporosis.
• Osteoporosis on radiographs.

PREVENTION OF OSTEOPOROSIS

Eat a balanced diet rich in calcium and Vitamin D.Take daily multivitamins and calcium supplements.Do weight-bearing exercise.Reduce smoking and alcohol intake.Hormone replacement therapy and medications may also be indicated. Discuss medical treatment options with your referring physician.Avoid unsafe conditions which can lead to falls and fractures.Discuss your medications and their effect on your bone density with your referring physician.Bone density testing is recommended to know where you stand as far as bone health.

PREPARATION FOR YOUR EXAM

There is no special preparation. You may eat normally. There is no need to disrobe if you wear clothes without buttons, zippers or other metals. Loose fitting clothes such as workout outfits, sweatpants, and sweatshirts are recommended.You should not have this exam if you have had any kind of barium study within the last week. You will be asked to fill out a questionnaire prior to your scan to help your radiologist in interpreting your bone density test.

WHAT TO EXPECT

The test will take approximately 15-20 minutes. You will be lying on your back throughout your exam. The actual scanning of the spine, hips and wrists only takes a few minutes. The exam is painless with no injections. Your exam will be reviewed by our radiologist who specializes in bone density interpretations and results will be sent to your referring physician. For more information on osteoporosis you may contact the National Osteoporosis Foundation.