Just as women have diverse shapes and sizes, br east examination can be performed in different ways.  Instead of asking which test is best, one should consider ‘which test is best for me?’

Ultrasound vs. Mammogram

• A mammogram uses a very small dose of radiation (x-rays) to check the inside of the breast. The breast is compressed between two plates to spread the glands and improve the quality of the image.  Two standard images of each breast are taken, and they are compared with previous mammograms to spot differences.
• An ultrasound uses high-frequency sound waves to create a real-time view of the breast tissue, one small section at a time. No radiation is involved. No compression is used. The soundwaves are sent through a wand called a transducer.  It uses similar equipment to that used in pregnancy.

What is a '3D' Mammogram (Tomosynthesis)?

A 3D mammogram uses the latest technology to create a more detailed picture of the breast by dividing the mammogram image into multiple thin “slices/layers”.  The radiologist can scroll through the layers to look at each layer individually,  reducing the amount of overlapping glands, and improving the chances of catching small abnormalities.  This is an important way we aim to identify problems  while they are still in the earliest stages.  At LifeScan.mt we also use Artificial Intelligence (A.I.) technology to assist in identifying small lesions that are difficult to diagnose, increasing the chances of detection problems at the earliest stages.

When is an Ultrasound usually recommended?

• Younger Women:  Below the age of 40, or women who have been recently pregnant or breast feeding, ultrasound is the preferred examination.
• Dense Breast Tissue:  In women with dense breast tissue, sometimes even the 3D mammogram may not be enough to see everything, so an additional ultrasound may be needed to get a clearer view.
• Follow-up on Abnormal Mammogram:  If a mammogram shows an area of concern, an ultrasound can help further evaluate it, distinguishing between solid nodules (which need follow up or biopsy) and fluid-filled cysts (which are usually benign).
• Breast Implants:  Breast examination in women with breast implants, should always include an ultrasound assessment of the implants themselves, to make sure that there are no signs of degradation or intra-capsular rupture – if the implants begin to create a reaction, it may make it more difficult to replace the implants in the future.
• Palpable Lump Not Seen on Mammogram:  If a lump is felt during a physical exam but doesn’t appear on a mammogram, an ultrasound can be used to investigate it further.

When is a Mammogram usually recommended?

Mammogram is usually recommended in women over the age of 40, but your radiologist may recommend starting earlier depending on your body type, family history or ultrasound findings.  It is the recommended test for screening of women who feel no lumps or symptoms and works best when repeated at regular intervals of 12 to 18 months to look for subtle changes between mammograms.

Mammograms can detect some early signs of cancer and 'pre-cancer' such as micro-calcifications and DCIS - tiny calcium deposits which often cannot be seen on ultrasound.  A mammogram may be recommended if certain abnormalities are seen on ultrasound.

A mammogram is obtained in a standard, reproducible method, minimizing the chance of excluding parts of the breast from the examination. For this reason, mammograms are the most reliable method for large scale population screening. 

I am still unsure if I should I have an ultrasound or a mammogram – what should I do?

No matter which test you book, our specialists will discuss your needs and confirm which test is best for your case before it is performed.

What if I receive an abnormal test result?

The radiologist who reviewed your examination will explain your results and typically make a specific recommendation of what additional exams should be done. 

Most commonly an ultrasound is recommended to examine the area of concern, sometimes additional mammogram pictures may be taken. 

If the ultrasound shows something which looks small and benign, a follow up ultrasound after a few months is the most common recommendation. If the abnormality is larger, there is greater concern or if the abnormality looks suspicious, a biopsy may be recommended. 

What is a breast biopsy?

• Core Biopsy involves removing a very small piece of the abnormality so it can be tested under a microscopy to determine if it is cancer.  A core biopsy uses a special spring-loaded needle which is guided toward the affected area using ultrasound or mammogram. Small pieces of tissue are removed.
• Fine Needle Aspiration (FNA) biopsy is where a very thin needle is placed into the area of concern, and fluid or a few cells are removed - this is usually performed in the case of troublesome cysts, or small abnormalities.

The radiologist will give a detailed explanation both before, and during the procedure, but in general;

• The skin is cleaned with disinfectant.
• A small injection of local anaesthetic is given in the area, to numb the skin and prevent any pain during the procedure.
• For a core biopsy, a tiny cut (1-2mm) is made in the skin, this usually heals without leaving a mark.
• Using imaging as a guide, a special needle is guided into the area of concern in order to take a small piece of material for testing.
• Pressure is applied to the area to reduce bruising. A small skin dressing is applied. 
• You will be able to go home almost immediately. You should avoid straining/exercising and swimming for the first 48hrs after the biopsy to reduce the chance of bruising or infection.