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Charles R. Wood

Diagnostic Mammograms
(Special Views)

After having a screening mammogram, approximately one out of 10 women may need a diagnostic mammogram, also called a special view. This is done so that the physician can look closer at a particular area of interest.

If a woman is called back for this type of additional study, she should be prepared to stay a little while longer than for a screening mammogram. This is because the physician will review the films while the patient is available in case more images are needed. Sometimes, in addition to these extra views, an ultrasound may be ordered to look at things from a different perspective. Often times, the radiologist will examine the breast in question.

Ultrasound is simply another way to look at breast tissue. It uses sound waves to determine relative densities of tissue; similar to the way a dolphin uses sonar to "see" its environment. It may help to clarify whether a particular area of interest is solid or cystic (a fluid-filled pocket). Ultrasound of the breast is performed while the woman is lying down. No compression is needed for this procedure. It is very useful for denser breast tissue.

The purpose of these extra images is to help the radiologist determine if any additional steps need to be taken. Often, it is determined that nothing more needs to be done other than to continue monthly breast self-exams and yearly mammograms with clinical breast exams. Sometimes, a three- or six-month repeat mammogram may be requested. Other times, a biopsy is recommended.

When Biopsies Are Necessary

There are several ways to perform a biopsy. The nature and location of the lesion may determine the method chosen.

Stereotactic Guided Breast Biopsy - This non-surgical technique uses advanced computer imaging technology to map the precise location of the area of interest in the breast in order to obtain a reliable diagnosis with a very small amount of breast tissue. Using a specially designed mammography unit, a series of computerized mammograms are taken which allows the radiologist to identify the abnormality in three dimensions and also to determine the coordinates of the biopsy.

The tissue is obtained using a device called a mammotone. The skin is cleansed and the area is anesthetized (numbed). A tiny nick is made in the skin where the biopsy device is to be inserted. The mammotone probe takes tissue from the abnormality only, which assists the pathologist in rendering a definite and accurate diagnosis. This procedure can also be performed using ultrasound techniques.

When the procedure is completed, sterile gauze is applied to the area with pressure dressing. Most experience minimal, if any discomfort and minimal, if any, bruising. The patient visit, including preparation, the biopsy and post-procedure care, take less than two hours.

Ultrasound Guided Core Biopsy - This procedure is done when ultrasound is the best imaging method to guide the radiologist to the area of tissue that needs to be sampled. The skin is cleansed and the area is anesthetized (numbed). The doctor can follow the path of the biopsy device on the video monitor. Tissue samples will be taken and sent for analysis.

Breast (Needle) Localization - If an abnormality shows up on mammography or ultrasound but cannot be felt with the fingers, then a breast localization procedure may be appropriate. This is a surgical procedure that uses a fine wire guided by mammography or ultrasound to locate the abnormality for the surgeon.

First, a mammogram (or ultrasound) is performed to locate the precise location of the lesion. Then, after the skin has been cleaned and numbed, a needle with a wire is placed into the abnormal area. Once this is done, the location of the needle is verified with additional mammography views or ultrasound. Then, the needle is removed and the wire is left in place in order to guide the surgeon to the abnormality. A soft dressing is placed over the wire while the patient is transported to the operating room. The surgeon will then remove the abnormality along the wire, suture the incision and place a dressing over the wound. Once the patient is recovered, she may go home with instructions on how to care for the incision.

Other Diagnostic Tools

Cyst Aspiration - Breast cysts are common and are not cancerous. These fluid-filled pockets may sometimes look like something more concerning and may have to be aspirated (fluid removed) in order to make sure. The physician will place a fine needle into this pocket and remove the fluid. Sometimes, this causes the cyst to disappear completely on subsequent mammograms or ultrasounds.

Galactogram - Also called a ductogram, this diagnostic tool is used to identify a particular duct, a small opening in the nipple, where discharge has been observed. The radiologist will put a tiny catheter into the duct in order to fill it with a radiopaque dye which shows up on film. Mammographic images will then be taken to show the outline of the duct. There are no special preparations needed prior to this procedure. However, it is important to not express any discharge for several days prior to the exam.   

To schedule an appointment, 
call The Breast Center at (518) 926-5333.
For more information, please call (518) 926-6588.

Appointments are usually available in 1-2 days.
Hours: 7:30 a.m. - 4 p.m.; evening hours also available.