Mammography is the one method of screening for breast cancer which has been proven to save lives. There are other tools that may be used for breast evaluation, including breast ultrasound and breast MRI.
Breast ultrasound is non-invasive, requires no compression, and uses no radiation. Because it uses no ionizing radiation (as is used for mammography), breast ultrasound is the study of choice for pregnant women and children/young adults. Images are created with sound waves and powerful computers, giving us a different view of your breast tissue than on mammography.
Ultrasound may be used to evaluate a specific site of symptoms like a lump or pain. We also use ultrasound frequently to evaluate masses, to determine if they are cysts or solid. We may assess your breast by ultrasound if you have discharge or leaking from the nipple.
Screening breast ultrasound can be used in addition to your yearly mammogram for those with dense breasts. Dense breasts are those with more glandular tissue, making the mammogram more difficult to interpret. In these patients and in some patients with an increased risk for breast cancer due to family history, supplemental screening with ultrasound may be recommended in addition to yearly mammography.
MRI (magnetic resonance imaging) is a sensitive way of finding breast cancer with images created using powerful magnets, radio frequency waves and computers. MRI uses no radiation. You will be positioned on your stomach without compression of the breasts as is used in mammography. Imaging times vary depending on the reason for the test, usually between 25-45 minutes.
Breast MRI may be used to screen for breast cancer in high risk patients in addition to mammograms; to evaluate women with breast cancer to fully show extent of disease; to evaluate women with abnormal findings on mammography or ultrasound; and to evaluate breast implants. Breast MRI is an amazing tool, but does not replace regular mammograms for screening.
To fully assess breast tissue with MRI requires an IV injection of a contrast material containing gadolinium, a heavy metal. If the study is done for evaluation of breast implants no IV injection will be needed. The IV injection is usually well-tolerated with few side effects, although is used with caution in patients with kidney disease.
MRI is recommended in addition to yearly mammography for women in the highest risk categories for breast cancer, including those with genetic risks and history of chest radiation as a teen or young adult.
What to Expect
For breast ultrasound, you will be asked to change into a gown with the upper body disrobed. You will usually be imaged while lying on your back, but may be asked to turn slightly on your side depending on the area of the breast being imaged. Images are obtained by using a special transducer or probe after applying a warm gel to the skin. Breast ultrasound is safe for all and well-tolerated.
For breast MRI, you will be asked to change into a gown. MRI safety will be reviewed prior to entering the suite, and all metal will be removed for your safety. An IV will be started in your arm. You will be positioned lying on your stomach with your breasts positioned without compression in a special device used for imaging the breasts. Your arms will be positioned above your head. Imaging takes between 25-45 minutes, depending on the reason for the test. Expect a lot of noise as the images are generated! Holding still is crucial, as any movement of the breasts may result in blurring and artifacts that might obscure your breast tissue and require repeat imaging. This is especially true for the images that are obtained during and right after the IV contrast is given into your vein.
For any breast imaging, having all of your previous images available is very helpful for accuracy. If your previous imaging has been done elsewhere, we will want to get them for comparison. Obtaining prior images from outside of Diagnostic Imaging Centers can be done by submitting a signed Breast Imaging Medical Records Release Form to our medical records team.