Mammography is a special x-ray examination used to assess breast disease in symptomatic women and as a screening tool in the wider population.
Mammography can show small cancers up to two years before a lump is palpable, and when combined with FNA or biopsy can determine whether a lump is cancer or benign. Early detection increases the overall effectiveness of cancer treatment. Lake Imaging now offer Mammography, 3D Mammography (Tomosynthesis) and Hookwire localisation.
Around 10% of all breast cancers will not be identified by mammography alone. Ultrasound is often used to further assess breast tissue and improve detection rates.
The key difference between a screening mammogram and a diagnostic mammogram is the reason why a mammogram is requested. A screening mammogram is for review of asymptomatic women taken either once a year, or every two years. In women aged 50-69 years, a screening mammogram is the best way to detect unsuspected cancer at an early stage.
A diagnostic mammogram is used to assess suspected abnormalities, such as a lump, nipple discharge, change in breast size or shape, or implant rupture.
At Lake Imaging our mammography and ultrasound equipment, and image processors are subject to quality assurance programs to ensure we maintain high standards, for optimal patient care.
It has been known for some time that breast density can have a masking effect, making it more difficult to diagnose breast cancer on a mammogram.
However, we now also know that breast density is a marker for a significantly increased risk.
Many women are already aware of this and may be questioning their breast density. Qualitative reporting of density is no longer enough.
Lake Imaging is pleased to offer Volpara™ Density Measurement. This sophisticated software program delivers accurate volumetric measurement of breast density, obtained during the diagnostic mammogram. Your referring doctor will now receive notification of breast density in the mammogram report, with a recommendation as to whether supplemental screening may be needed, based on risk.
Volpara Health Technologies Limited is a leading provider of breast imaging analytics and analysis products that improve clinical decision-making and the early detection of breast cancer. Every day, Volpara software helps clinicians better understand their patients and administrators better understand their practices.
Volpara Health Technologies Limited is a research, development, and manufacturing company based in Wellington, New Zealand. With a diverse research team led by internationally recognised experts in medical physics, as well as proprietary medical imaging technology covered by multiple patents and trademarks, we apply science to the solving of clinical problems around the world.
A referral from your doctor and an appointment is required for this examination.
If you experience tenderness in the breast before your menstrual period, do not schedule the examination during this time. The best time is one week following your menstrual period, unless the examination is urgent. If you have breast implants or require wheelchair access, please advise our staff at the time of making your appointment as we may need to allocate a longer appointment time.
Please avoid using talcum powder and underarm deodorant on the day of your mammogram, because some products cause an artefact on the mammogram. You can eat and drink normally on the day.
You’ll be more comfortable if you wear a two-piece outfit for your mammogram. The radiographer will ask you to remove all clothing and from the waist up and wear a gown. You may need to remove jewellery from the chest and neck region.
Please bring along any previous mammograms so that our radiologist can accurately compare films and assess any changes, since your last mammogram.
A qualified radiographer will take one or two x-rays of each breast, which will be positioned and compressed between two flat plates, for around 15 seconds. The patient might feel uncomfortable, but compression of the breast tissue improves image quality and shows abnormal tissue more clearly. Occasionally, additional x-rays are taken to further define areas not well seen on the initial x-rays.
All Lake Imaging radiographers are accredited and licensed by the Australian Institute of Radiography. We follow the guidelines for Quality Control Testing for Digital Mammography (Version 3) set out by the Royal Australian and New Zealand College of Radiologists in August 2012.
Two experienced radiologists will independently interpret and report on the mammogram. Your doctor will receive a comprehensive report about the findings. You will then need to return to the doctor who referred you to discuss your results. Book your follow-up appointment at least two days after your mammogram.
You can resume normal activity immediately after your examination.
For mammography, the radiation dose a patient receives is very low. The radiographer will set the equipment for the lowest dose of radiation possible, while still achieving high-quality images. Mammography is generally safe for women with implants, but there is a very small risk that the pressure placed on the implant might cause it to rupture. Our experienced mammography radiographers will discuss this with you prior to your mammogram.
If you know you are pregnant or suspect that you might be you should wait until after delivery to have a screening mammogram. If a diagnostic mammogram is needed during pregnancy, the radiation dose is very low and does not affect the developing child. Wearing a lower abdomen lead apron will help reduce radiation exposure to the fetus. Talk to your doctor if you need more information.
3D Mammography (Tomosynthesis) is new breast imaging technology that has been proven to improve the accuracy in diagnosis of breast cancer. It is performed as part of a diagnostic mammogram examination. In addition to the standard mammographic views, a specialised view (tomographic) is taken to produce 3-D images. Tomographic view is completed within seconds from a single sweep of the x-ray arm, creating a series of detailed images which together make up the 3D imaging of the breast.
For the tomographic view, the x-ray arm will move in an arc above the breast for a short time. Some women may experience discomfort with compression; however, if you experience pain during the mammogram you should inform the radiographer. You can also ask for the procedure to stop at any time.
We recommend that you advise the radiographer if you have sensitive breasts, they will work with you to make sure that the mammogram is as comfortable as possible. Unfortunately, compression of the breast is essential to ensure an accurate image and minimise the amount of radiation used.
After the routine views of your breast have been obtained the radiographer will ask you to wait while they are examined by a radiologist to ensure that all the images needed have been obtained.
A breast ultrasound is often requested as a complementary test at the time of the mammogram or at a later date as a means of gathering more information for a complete examination.
Mammography, ultrasound, and magnetic resonance imaging (MRI) examinations sometimes identify abnormalities in the breast that cannot be felt by a doctor.
If the abnormality is to be surgically removed, it is necessary to place a fine wire (called a hookwire), into the breast with its tip at the site of the abnormality. The wire acts as a marker during surgery and enables the surgeon to identify the correct area of breast tissue.
Mammography, ultrasound, or MRI scans are used to guide the hookwire into the correct position. The wire is called a hookwire because there is a tiny hook at the end, which keeps it in position.
A doctor’s referral and an appointment are required for this examination.
Please also bring along your request form, any previous imaging, and your Medicare card/any concession cards to your appointment.
Usually, this procedure will be performed a few hours before you have surgery. There is no preparation required for the hookwire localisation, but there will be preparation for the surgery that follows the hookwire localisation. Preparation instructions/information for the surgery will provided to you by your surgeon.
Before the procedure you be asked to remove all jewellery and clothing from the waist up and change into a loose-fitting examination gown.
The skin of the breast will then be washed with antiseptic before a very fine needle is used to give local anaesthetic to numb the breast in the area for biopsy. The local anaesthetic may sting for a few seconds when it is being given, and after this the area will become numb.
The radiologist will then insert a fine needle into the tissue to be removed. Images will be taken to check the position of the needle, once it is in the correct position, a fine wire is passed through the centre of the needle and the needle is removed, leaving the hookwire in place. A final set of images will be taken to show the surgeon where the tip of the wire lies in relation to the abnormality that is to be removed.
Following the hookwire placement, a piece of the fine wire will be protruding from the breast. This projecting wire will be taped down to the skin and the hookwire remains in the abnormality in the breast. The surgeon will remove the wire together with the abnormality at the time of the operation. Your previous imaging and the images from the Hookwire Localisation will be sent with you to the operating theatre so that the surgeon may refer to them.
The purpose of the hookwire procedure is to provide a physical guide for the work of the surgeon. As it is not an investigation, there are usually no results for the hookwire procedure itself other than a written description of what was done and provision of the guidance images.
After surgery, the surgeon will give you the pathology result for the tissue removed, when you have your appointment with the surgeon after the operation.
Hookwire localisation is a simple procedure to perform, and most women will experience no problems. Problems that can occur on rare occasions are;
• movement of the hookwire after placement and before surgery is performed (which reduces the accuracy of the surgery), and
• Wire dislodgement. This occurs usually because the breast is composed of fatty tissue which provides a poor grip for the hookwire).
If you are travelling to another facility for your surgery with a hookwire in position, you need to take care. Dislodgement may occasionally occur with very little movement. If dislodgement occurs, you may need to have the procedure repeated because the tip of the wire will no longer be situated in the lesion that needs to be removed.
Stereotactic Core Biopsy
A Vacuum-assisted stereotactic core biopsy (VAB) is a biopsy which removes a sample of tissue from the breast for examination by a pathologist. The VAB is performed under mammographic guidance, allowing the area for biopsy to be accurately identified, using a special needle with suction to help get the sample from the breast.
A Vacuum-assisted stereotactic core biopsy is performed to help determine the nature or diagnosis of a breast abnormality and to plan treatment if necessary.
A doctor’s referral and an appointment are required for a breast ultrasound guided core biopsy.
Please let us know when making your appointment if you are taking medication that makes you bruise or bleed easily.
When you arrive at Lake Imaging you will be asked to remove all jewellery and clothing from the waist up, and change into a loose-fitting examination gown.
VAB is performed while sitting or lying in a special chair with the breast compressed in the same way as for a mammogram. Several keyhole images will be taken to accurately identify the area for the biopsy.
The skin of the breast is then washed with antiseptic before a very fine needle is used to give local anaesthetic to numb the breast in the area for biopsy. The local anaesthetic may sting for a few seconds when it is being given, and then the area will become numb. A small incision will be made and several samples taken. The biopsy procedure may sometimes feel uncomfortable but is usually not painful because of the local anaesthetic that has been given. The process of taking the biopsy lasts just a few minutes.
After the samples have been taken, the biopsy area will be held firmly for a few minutes to minimize any bruising or bleeding, and then covered with a dressing that will be checked before you leave.
Please allow about an hour for the procedure.
After the procedure, the biopsy site may be tender or show some bruising. You may place an ice pack over the biopsy site for no more than 20 minutes. We suggest taking Paracetamol for discomfort. You will be able to leave the clinic shortly after the procedure.
• You may drive yourself home after the procedure.
• Most people can return to work the same day.
• You should refrain from exercise for 24 hours following your biopsy.
• Your dressing may be worn in the shower and removed after two to three days.
If your breast becomes red, swollen or tender in the days after your biopsy please consult your doctor or contact the Lake Imaging clinic to review the biopsy site.
Results from VAB are usually available within 48 hours, but may take up to a week. Our nurses will ensure that you have an appointment either in our results clinic or with your referring doctor to get your results as soon as possible.
VAB is a safe procedure, and most people do not find it uncomfortable. Please advise the radiologist if you are experiencing any pain.
After the local anaesthetic wears off, you may experience some discomfort in the breast, but this is usually eased by taking paracetamol.
Fainting during the biopsy is uncommon because you will be sitting or lying during the procedure, but please let the doctor know if you are prone to fainting.
Most people develop some bruising of the skin at the biopsy site lasting for a few days after the procedure. Sometimes a bruise may develop within the breast tissue which may cause a tender lump. This may take one to two weeks to disappear.
Infection can sometimes occur when tissue is cut, but this is rare following VAB. If your breast becomes red, swollen or tender in the days after your biopsy, please consult your referring doctor or contact Lake Imaging to review your biopsy site.