On any given day, women find themselves in the waiting room at TRA Medical Imaging, preparing for a diagnostic breast imaging exam. Some women have noticed a change in their own breast, others have been referred by their doctors for a concern on their clinical breast exam; and some have been called back after an initial breast cancer screening revealed an area that requires a closer look.
The next step for these women will be a process by which physicians with special training in radiology zero in on a targeted area. “Think of it as something beyond routine,” says Dr. Grant Tibbetts, TRA’s Medical Director at the Olympia Women’s Center on Lilly road. “We go searching for clues using various techniques and technologies. Radiologists are a bit like Sherlock Holmes, gathering information, making discoveries and then coming up with a plan to deal with what we find.”
“We use the patient’s age, medical and surgical history, family history, symptoms, and additional imaging tests such as mammograms, ultrasound, and sometimes MRI as pieces of the same puzzle,” Dr Kathryn Everton, Breast Imaging Radiologist, explains. “Often the radiologist can give patients good news after examining all the needed information as a whole. In some women, this investigation finds a biopsy may be needed for suspicious features.”
“The array of advanced imaging technologies available helps us choose the best tool for the particular patient, symptom, or problem,” says Tibbetts. “In a younger patient, we will often begin with ultrasound, while in older patients we will usually begin with low dose x-ray (mammographic) views of the whole breast which may be followed by ultrasound, as we follow the clues,” Tibbetts explains. “We want to answer the question with confidence in as few steps as possible. When necessary, we offer minimally invasive procedures to obtain tissue for a diagnosis.”
Most women who need additional testing are ultimately found to have no signs of cancer. “For women in whom the findings are suspicious,” Dr Everton adds “the radiologist offers a clear plan forward right after the testing has been completed.” If cancer is found, catching it early can dramatically improve the patient’s odds of survival. “We try to manage things quickly, because when it’s discovered early, breast cancer is often treated successfully, with very high survival rates in a regularly screened population,” says Tibbetts.
In cases where patients are considered high risk or have recently had a cancer diagnosis, MRI may be used to detect small, very subtle, or otherwise hidden cancers.
Tibbetts recalled a recent patient in whom ultrasound guided biopsy confirmed cancer. Prior to her scheduled surgery, the surgeon, in consultation with the radiologist, requested that the patient have an MRI. “From the MRI, Dr. Everton discovered some suspicious clues,” says Tibbetts. “I performed another ultrasound, and together with the MRI we found enough to suggest an additional biopsy.” The answer to this mystery was a second cancer. Discovering it in advance allowed the surgeon to revise her treatment plan right away, so her prognosis remains very good.
“A diagnostic breast appointment is really just using the tools at our disposal to solve a mystery” Dr. Tibbetts says. Because he’s had several women who have had concerns about their breast health, but (often caring for others) put their own care off, he asks “Please take action if you suspect something isn’t right.”
TRA radiologists recommend women of average risk should be screened every year starting at age 40, which is endorsed by American College of Radiology and Society for Breast Imaging. They offer the leading 3D mammography in every site they serve. For more information on these and other services offered at the Olympia Women’s Center, please visit the TRA Medical Imaging website.