The aim of my breast clinic is to provide the highest quality diagnostic service to patients with breast complaints, ranging from simple benign problems to breast cancer. Urgent referrals from GPs are nearly always seen within a week.
Each patient is assessed and treated individually with a full complement of specialised staff, modern equipment, and state-of-the-art services. The following summarises the various aspects of care offered at the clinic. Breast care nurses are always available.
Out-Patient Clinic Pathway
Patients with breast symptoms are seen in a one-stop clinic.
Patients with breast lumps, pain, discharge and other breast symptoms are seen in a one-stop clinic. Initially, I see patients and take a detailed history before an examination. Most patients then undergo breast imaging. Imaging usually involves mammograms, ultrasound scans, or both.
Once all the scans have been reported by the Consultant Radiologist, the patient will see me again and receive the results on the same day. If any abnormality is detected, it may be necessary to perform further investigations, such as a biopsy. Biopsies are also usually performed on the same day, although biopsy results take a few days.
In this way, a diagnosis can be established in a single visit for most women attending the clinic, since most patients do not require biopsies. A specialist Breast Care Nurse is also present to give further information and support to the patient, if desired. She will also chaperone the patient during the examination.
Digital Mammography
Digital mammography produces an X-ray image called a mammogram.
Each breast is compressed between two plastic plates while a beam of X-rays passes through the breast tissue onto an X-ray film. Two different views of each breast are taken. The process may be slightly uncomfortable but only lasts a few seconds for most women.
The mammograms are then immediately reported by the Breast Consultant Radiologist. The radiation dose is very small and does not pose a significant cancer risk.
Occasionally, more detail is required, especially if the breast tissues are dense. In this situation, tomosynthesis mammograms (also called 3D-mammograms) are arranged. This enables the radiologist to look at the breast in slices in a similar way to a CT scan.
Ultrasound
Ultrasound uses sound waves to image the breast.
Ultrasound machines use sound waves to image various areas of the body, including the breasts. The sound waves are transmitted through a probe, which is placed directly over the breast. Lubricating gel is placed on the breast skin to improve contact.
The sound waves are reflected within the breast back to the ultrasound machine, which transforms them into a computer image viewed on a display monitor.
The ultrasound examination is carried out by the Consultant Breast Radiologist, who decides whether any abnormalities are present. The test is very good at differentiating between solid lumps and fluid-filled lumps, or cysts. It is particularly useful in women under the age of 40, since younger breasts are much denser. Ultrasound examination does not usually cause any pain.
Core Biopsy
A core biopsy allows a larger number of cells to be examined.
This test is performed under a local anaesthetic using a special needle to allow a larger number of cells to be examined by the Consultant Pathologist. It is usually performed under radiological guidance, during an ultrasound or mammogram. A local anaesthetic is routinely given before the biopsy.
Although the test often gives a definitive diagnosis, it takes a few days before a result is available due to laboratory processing.
Breast MRI
MRI uses magnetic fields and radiowaves, not X-rays.
Breast MRI is a diagnostic test that is used to view your breast tissues using magnetic fields and radiowaves. The armpit tissues can also be seen on the scans.
Most patients do not require a breast MRI. It is used to provide further information in a variety of specialised situations, such as looking for possible breast implant leak, measuring lobular cancers, or checking response to chemotherapy.
Sometimes, a contrast dye called gadolinium needs to be injected into a vein in the arm during the scan. Multiple images are obtained and these are normally reviewed by two independent radiologists before a final report is issued.
CONSTANT-ENHANCED MAMMOGRAPHY
Constant-enhanced mammography can be required when routine imagery does not give enough information.
This is similar to digital mammography, but patients also receive an injection of dye during the procedure.
Vacuum Biopsy
Vacuum biopsy takes more breast tissue than a standard core biopsy.
The procedure is carried out under local anaesthesia and is most commonly performed under ultrasound guidance. Most lumps can be diagnosed with a normal core biopsy. However, sometimes the diagnosis under the microscope can be difficult to make. In this situation, a vacuum biopsy can be helpful to the pathologist.
The vacuum refers to suction that takes place during the biopsy procedure, which helps reduce bruising.
Stereotactic Biopsy
Stereotactic biopsy is performed using mammogram guidance.
This refers to a core biopsy or vacuum biopsy that takes place under stereotactic guidance, as opposed to ultrasound guidance. Stereotactic biopsies are performed with the patient positioned in the digital mammogram machine and under local anaesthesia.
It is a particularly useful procedure in situations where the only abnormality seen on a mammogram is a cluster of fine calcifications, or tiny white dots.
Marker Clips
A tiny marker can be inserted as a reference point.
During biopsies, the radiologist often inserts a tiny marker as a reference point. This is commonly performed when the abnormality seen is quite small.
Should the pathology of the biopsy show that the area needs to be removed, the surgeon will have a marker to target for surgery. However, if the result is benign, the markers can be safely left alone.
