Transcript What`s Next After an Abnormal Screening Mammogram?

What’s Next After an Abnormal
Screening Mammogram?
James A Stewart M.D.
Elizabeth Burnside M.D.
After an Abnormal Screening
Mammogram
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Screening mammograms performed at East/ West
and UWHC
Batch read- 3 days per week which increases
specificity
CAD system- computer-assisted read twice (R2)
Results-Autofax system (sent when signed), fax
or email available
Letter sent to patient within 30 days(compliance)goal is four days
Diagnostic Mammogram
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Diagnostic Breast problem, history of cancer,
implants or males
Performed only at UWHC site
Recommendation from Radiologist given to pt.
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Letter also sent
If U/S recommended- try to do same day- if not same
day we need an order from PCP to schedule
If Stereotactic biopsy recommended- teach, schedule
and call PCP
If MRI recommended- teach, screen, call PCP to
schedule due to referral needed
Ultrasound
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Ultrasound used to determine
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solid vs. cyst
Characterize mammographic or palpable finding
Not used for screening
Done only at UWHC Breast Center site
If area needs aspiration or biopsy- done same day
if at all possible
Call to PCP if fluid or tissue sent to pathology or
cytology
Stereotactic Biopsy
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Stereotactic biopsy done if area visualized on
mammogram only
Done under local anesthesia
Patient in prone position
Digital imaging machine with computer assisted
coordinates
Vacuum-assisted biopsy- closed system with
biopsy site irrigated with saline and lidocaine
Valium helpful
Breast MRI
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Breast MRI indications
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Mammo density
Mammo architectural distortion
Mammo + with US Positive lymph node- neg mammo
Follow-up for prior MRI abnormality
R/O multifocal cancer in recently dx’d pt.
Scar vs. recurrence in pt. w/ prior lumpectomy
Nipple retraction or unilateral discharge w/ neg
mammo or US
Multiple bilateral masses or cysts
Follow-up for response to chemo
MRI Core Biopsy
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Core Biopsy under MRI guidance available
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Only done if not able to visualized under US
or Mammogram
UW is the only site in region to do MRI core
biopsies
Galactogram
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Galactogram- Ductography
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Contrast-enhanced mammography used to
image the breast ducts
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Used to diagnose the cause of abnormal nipple
discharge
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Single duct
Reproducible
Suspicious color (bloody)
Outside Films
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Outside films are not just used for comparisons
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Used by technologists
Improve both sensitivity and specificity
Often are most critical piece of examination
Patient for a diagnostic mammo will need to be
rescheduled if outside films not available
Films used by the Radiologists when reading
exam- may use many years of mammograms for
comparisons
PCP’s Communication
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PCP’s notified for the following;
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For Stereotactic recommendation
For MRI recommendation
US scheduled for another day
US tissue or fluid sent to pathology or
cytology
All positive pathology reports
Positive Pathology Report
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The diagnosis is given to the patient by the
PCP
BCC schedules follow-up appt.
Surgical consult is scheduled with one of
our surgeons in the Breast Center -Dr’s
Breslin, Mahvi or Mack.
Planned Improvement
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Future:
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We plan to ask PCP when a diagnostic
mammo is scheduled whether it is just for a
diagnostic mammo or for a breast diagnostic
work up
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What would you like to see done
differently?
How can we assist you in your practice?