Breast Imaging

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Mammography
  • Mammography Screening
  • Tomosynthesis (3D Mammography)
  • Breast Ultrasound (US)
  • Breast MRI
  • Breast PET/MRI

PROCEDURES PERFORMED PER YEAR:

  • 9.000 mammographies and ultrasound (US) breast examinations
  • 500 breast MRIs
  • 300 radioactive I-125 seed localization  
  • Screening Programme
    • 5.000 mammographies
  • Percutaneous Biopsies
    • 600 sonographically-guided breast biopsies/aspirations
    • 100 stereotactic biopsies
    • 20 MR-guided biopsies

The Breast Imaging Unit is a section of the Breast Department, involved in breast cancer diagnosis, management and follow-up, and being an essential member of weekly multidisciplinary tumour board meetings aimed at discussing the treatment strategy and management of every single patient with breast cancer.

 

treatmentS

Breast Imaging and Interventional Radiology Procedures

The main field of interest of the Breast Imaging Unit is represented by the diagnosis of breast cancer. Concerning the diagnosis, the Unit takes part in the mammography screening program of the National and Regional Health System performing more than 5.000 mammographies per year in addition to the 9.000 mammographies and ultrasound (US) breast examinations that are performed in symptomatic and asymptomatic subjects.

In case of doubt or suspicious breast lesions, identified at imaging, the Unit proceeds to cytological or histological percutaneous biopsies such as:

  • Core Needle Biopsies (CNB) under Ultrasound guidance
  • Fine Needle Aspirations Cytology (FNAC) under Ultrasound guidance
  • Vacuum Assisted Biopsies (VAB) under tomo/stereotactic guidance, US guidance, MRI guidance

When necessary, as in the management of particular cases, the Unit is able to proceed to Breast MRI, performing about 500 examinations per year.

Main Pathologies Treated:

  • Breast Cancer Diagnosis

Top Procedures:

  • 2D and 3 D Mammography
  • Image guided Histological Percutaneous Biopsies, included VAB
  • MRI

Breast Imaging Protocols

In case of a malignant disease, the Breast Imaging Unit has the task of local staging and localising the lesion. It has to define lesion dimension, number, localization, surrounding tissues relationship and regional lymph nodes involvement with Ultrasound, tomosynthesis and/or MRI. The Team has to localise un-palpable lesions to guide the surgeon during intervention and verify with X-Ray or an Ultrasound if the lesion is into the surgical specimen. Lesion localisation is performed in collaboration with the Nuclear Medicine Unit, adopting the ROLL (Radio-guided Occult Lesion Localisation) technique. This technique consists of the injection of a radiotracer into the lesion with a needle guided in real time under X-Ray or Ultrasound imaging guidance. In case of neoadjuvant (primary) chemotherapy, to reduce the cancer mass before surgery, imaging has to monitor the tumour response. In the post treatment phase, imaging, such as mammography and Ultrasound, is crucial in the local follow-up.

Another important task of the Breast Imaging Unit is the management of the surveillance program for high-risk women, with breast MRI.

Main Protocols done:

  • Breast cancer staging and localisation (I-125 seed)
  • Neoadjuvant Chemotherapy monitoring
  • Surveillance programme for high-risk patients

Top Procedures:

  • Ultrasound, tomosynthesis and MRI staging
  • Radio-guided Occult Lesion Localisation (I-125 seed)    

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • 2D full field digital mammography FFDM
  • Tomosynthesis (3D digital mammography) TDM
  • Low dose (- 50%) 2D full field digital mammography FFDM with photon counting technology
  • High definition breast US units
  • Stereotactic guidance for VAB of microcalcifications
  • 1.5 T breast MRI (Radiology Department)
  • Stereotactic MRI system for VAB of lesions only visible at MRI (Radiology Department)
  • Hybrid 3 T PET-MRI (Nuclear Medicine Department)