breast exploration

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It is generally performed in the office, and diagnostic accuracy approaches 100%. The false negative rate is 2-10%. However, a negative result does not exclude cancer.</div> <div>  <A NAME="tru"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Tru Cut Needle Biopsy</B> </div> <div> Tru Cut Needle Biopsy is also done in the office, usually requires local anesthesia and takes a larger sample of tissue. This needle is more often used for a large palpable mass. </div> <div>  <A NAME="incisional"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Incisional Biopsy</B> </div> <div> Incisional biopsy involves removing only a sample of tissue surgically from a very large mass for diagnostic purposes. This is performed in an operating room. </div> <div>  <A NAME="excisional"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Excisional Biopsy</B> </div> <div> Excisional biopsy is the term used to describe removal of the entire mass. This type of biopsy is performed in an operating room under local or general anesthesia. </div> <bR> <bR> <bR> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The technic of exploration are evoluating year after year better and more sofisticated the first step of a breast exploration is the self paplaption, which each women should do  starting from 18 years old</B></div> <div> <B><IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">the mammography as the old fashion detection especially starting from the 40, and the last new techic as indtroducing a canera [laparoscope] intra the duct for biopsy and direct visu</B></div> <bR> <bR> <div> <B>Screening</B></div> <bR> <bR> <div> 1. Breast examination</div> <div> Most breast cancers present as palpable mass. 10-15% of cancers detectable only by clinical exam. Best to examine shortly after menses.</div> <div> 2. Mammography</div> <div> i. Recommended frequency (ACS)</div> <div> Baseline exam between 35-40y. Every other year between age 40-50. Annually after age 50. Only 25-35% of women are currently screened following the guidelines. Ultrasound more effective for women < 35y.</div> <div> ii. Efficacy</div> <div> 42% of breast cancers detectable only by mammography. Regularly screened women have 30-40% less breast cancer mortality, and 25% fewer cases are advanced stage at diagnosis. False negative rate 10-15%.</div> <div> iii. Technique</div> <div> Breasts compressed. Radiation dose 0.1cGy. Cancers typically have irregular contour or calcifications of variable size or linear arrangement</div> <div> <B><U>new technics are being put in the market as intraductal videoscopy of the breast to explore and biopsy and evaluate a cancer which is no see on the normal tech</U></B></div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>Breast Self-Examination (BSE)</B><FONT SIZE="3" COLOR="#000000" FACE="Arial" > <IMG SRC="12380530.jpg" border=0 width="128" height="83" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></FONT></div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="627" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 381 ><NOBR><div> <IMG SRC="11ed3770.gif" border=0 width="211" height="375" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER WIDTH="310"><div> In front of a mirror :<FONT SIZE="3" COLOR="#000000" FACE="Arial" > </FONT></div> <div> 1<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Stand directly in front of mirror. </FONT></div> <div> 2<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Place your hands at your side. </FONT></div> <div> 3<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Check your breasts for any changes in size, shape, color, dimpling, or scaling of the skin. </FONT></div> <div> 4<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Check your breasts again. This time place hands on hips, pressing shoulders and elbows forward to flex chest muscles, then raising hands and clasping gently behind head.</FONT></div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="627" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 19 WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 264 WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="264" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="310"><div> In the shower : </div> <div> 1<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Raise right arm. </FONT></div> <div> 2<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. With the flat part of the fingers of your right hand, carefully examine your right breast. </FONT></div> <div> 3<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Using a circular pattern, start from the outer top, pressing firmly to feel your breast tissue under- neath. </FONT></div> <div> 4<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. After a full circle, move one inch inward and circle again. </FONT></div> <div> 5<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Perform circular patterns until reaching the nipple. </FONT></div> <div> 6.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > Check area above the breast and armpit area for lumps or hard knots. </FONT></div> <div> 7<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Repeat same procedure with left breast.</FONT></div> </tD> </tR> </TABLE></div> <bR> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="627" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 316 WIDTH="310"><div> <IMG SRC="12bc8be0.gif" border=0 width="200" height="190" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="12c2c590.gif" border=0 width="300" height="89" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> <tD VALIGN=CENTER WIDTH="310"><div> <IMG SRC="12dc8990.gif" border=0 width="200" height="153" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="12ec8990.gif" border=0 width="200" height="153" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </tD> </tR> <tR> <tD VALIGN=CENTER HEIGHT= 188 WIDTH="310"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="188" ALIGN="bottom" WIDTH="310" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=CENTER WIDTH="310"><div> Lying down :<FONT SIZE="3" COLOR="#000080" FACE="Arial" > </FONT></div> <div> 1<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Prepare a pillow. </FONT></div> <div> 2<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Put pillow under your right shoulder. </FONT></div> <div> 3<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Raise your right hand above your head. </FONT></div> <div> 4<FONT SIZE="3" COLOR="#000000" FACE="Arial" >. Examine your entire breast in the circular motion pattern describe above (in the shower). </FONT></div> <div> 5.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > Repeat with your left breast. </FONT></div> <div> 6.<FONT SIZE="3" COLOR="#000000" FACE="Arial" > Gently squeeze each nipple to check for discharge. </FONT></div> </tD> </tR> </TABLE></div> <div> Breast Self-Exam should be done at the same time once a month. The best time would be two or three days after the end of your period. Report any changes or abnormalities to your physician.</div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="909" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=CENTER HEIGHT= 306 ><NOBR><div> <IMG SRC="1c98c2c0.gif" border=0 width="396" height="300" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <IMG SRC="1bcf1ad0.jpg" border=0 width="497" height="173" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> <tD VALIGN=CENTER><NOBR><div> <IMG SRC="1c6f7f20.gif" border=0 width="247" height="242" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> </NOBR></tD> </tR> </TABLE></div> <bR> <div> <IMG SRC="1bbf4ad0.jpg" border=0 width="500" height="173" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1bee0b60.jpg" border=0 width="224" height="182" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1bffa7b0.gif" border=0 width="250" height="123" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1c0a75c0.gif" border=0 width="167" height="92" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1c1d5b40.jpg" border=0 width="213" height="180" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1c260af0.jpg" border=0 width="96" height="175" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">bending<IMG SRC="1c376b00.jpg" border=0 width="118" height="176" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1c47cd60.jpg" border=0 width="124" height="214" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1c5a1a70.jpg" border=0 width="161" height="167" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <bR> <div> <IMG SRC="212c8c20.jpg" border=0 width="200" height="194" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="213c8c20.jpg" border=0 width="200" height="194" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="214a3e50.jpg" border=0 width="163" height="229" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="215f71f0.jpg" border=0 width="247" height="287" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="216f1050.jpg" border=0 width="241" height="261" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="2177ca10.jpg" border=0 width="380" height="161" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22080e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="221c0000.jpg" border=0 width="960" height="1280" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22280e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22380e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22480e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22580e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22680e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22780e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22880e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22980e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22a80e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22b80e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="22c80e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21813980.jpg" border=0 width="531" height="408" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21980e00.jpg" border=0 width="640" height="480" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21ac2340.jpg" border=0 width="450" height="308" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21bc2300.jpg" border=0 width="450" height="304" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21c2cb80.jpg" border=0 width="300" height="440" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">paget's disease<IMG SRC="21dc23a0.jpg" border=0 width="450" height="314" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="21ec22f0.jpg" border=0 width="450" height="303" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="21fe66c0.jpg" border=0 width="486" height="364" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <div> ABNORMALITIES FOUND ON  <A NAME="mammo"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>MAMMOGRAPHY</div> <div> Abnormalities seen on mammography may be either a mass which is too deep in the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> to feel, or an area of clustered microcalcifications. </div> <div> <B>Masses</B></div> <div> Solid nodules in the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT>. Signs of malignancy are related to the countour or margins of the mass.</div> <div> Well circumscribed masses with smooth margins usually represent <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>benign</U></FONT> lesions such as <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>fibroadenomas</U></FONT> or lymph nodes.</div> <div> Irregularly shaped masses with spiculated margins <I>may</I> be an indicator of cancer.</div> <div> Microcalcifications</div> <div> Calcifications are tiny specks of calcium seen on mammography. Many of these are associated with a benign process and have a typical appearance. </div> <div> Calcifications that are widely scattered, of uniform size and well defined usually represent a benign condition.</div> <div> Irregular calcifications that are heterogeneous in size, that are clustered together may indicate the presence of malignancy. A small mass may or may not be associated with the calcification.</div> <div> What To Do</div> <div> Most abnormal findings on mammography do not have unequivocal signs of either a benign or malignant condition. Therefore, a biopsy may be recommended by either the radiologist or surgeon to obtain tissue for definitive diagnosis.</div> <div> The following biopsy methods can be used:. </div> <div>  <A NAME="needle"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Needle localization and excisional biopsy</B> </div> <div> A procedure in which the radiologist places a thin wire into the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> and marks the spot with the hook of the wire so that the surgeon may be able to find the abnormal area in the <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> to remove. The wire is inserted about an hour before the procedure and the biopsy is performed in an operating room. This is done on an outpatient basis.</div> <div>  <A NAME="stereo"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Stereotactic biopsy</B> </div> <div> A newer technique for biopsying nonpalpable <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> abnormalities. It is a nonsurgical biopsy. A computerized mammography machine localizes the abnormality in three dimensions, and then a biopsy needle is guided by the computer to take core biopsies of the mass or area of calcifications. It is a wonderful alternative to an open biopsy, but it is not appropriate for all abnormal findings on mammography. </div> <div> Biopsy  <A NAME="results"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Results</div> <div> There are several types of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>benign </U></FONT><FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> disorders. Fibrocystic <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT>s affect nearly 50% of American women. Fibrocystic <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT>s include cysts, sclerosing adenosis and hyperplasia. </div> <div> Malignant or <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>cancerous</U></FONT> biopsies generally fall into one of the two major categories of <FONT SIZE="3" COLOR="#800000" FACE="Arial" >breast</FONT> cancer: <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Invasive</U></FONT> or <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>Noninvasive</U></FONT>. A number of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>treatments</U></FONT> are available. </div> <bR> <bR> <bR> <bR> <div> <B>Detection:</B> Screening mammography is the best method of detecting early breast cancer as illustrated on the right figures. </div> <div> <IMG SRC="11353f40.jpg" border=0 width="339" height="244" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="114cc1e0.jpg" border=0 width="204" height="286" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="12ac8f40.gif" border=0 width="200" height="244" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> Currently there are two types of imaging technologies which allow the physician to access mammographically detected breast tumors with a needle: </div> <div> A) <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>stereotaxic needle biopsy</U></FONT> and </div> <div> B) <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>ultrasound guided needle biopsy</U></FONT>.</div> <div> Stereotaxic needle biopsy is a method by which small pieces of tissue may be removed from the breast, under x-ray guidance and local anesthesia, through a skin puncture or a small incision. Of the many suspicious looking shadows found on routine mammogram, less than one-third are actually cancerous</div> <div> Stereotactic needle biopsy is a method by which small pieces of tissue may be removed from the breast, under x-ray guidance, through a skin puncture or a small incision and without surgery. Of the many suspicious-looking shadows found on routine mammograms, less than one third are actually cancerous. Stereotactic needle biopsy allows accurate diagnosis of the majority of these lesions without open biopsy. </div> <div> The stereotactic needle biopsy is an outpatient procedure and may be scheduled through a physician's office. During the procedure, the patient lies on a special examination table while x-rays and a computer are used to identify the exact location of the lesion</div> <div> <IMG SRC="11553e20.jpg" border=0 width="339" height="226" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="11608030.jpg" border=0 width="520" height="259" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="1170f860.jpg" border=0 width="271" height="134" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">and <IMG SRC="11834ea0.jpg" border=0 width="308" height="234" ALIGN="BOTTOM" HSPACE="0" VSPACE="0">then the biospsy if necessary [effective method]</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The skin of the breast is then anesthetized and the biopsy needle inserted. Correct placement is confirmed by x-ray. There are several types of needles and devices for sampling. One type has a notch in it to remove tissue samples (cores) from the area of concern. About five or six cores are taken to ensure adequate sampling. These are then taken to the pathologist for testing to see if the tissue is cancerous or not. Other tests may also be done on the samples should they prove positive for cancer. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Results are usually available two to three days post-biopsy. If the results are adequate and show no evidence of cancer a follow-up mammogram in 6-12 months is recommended. Should the pathology report reveal malignant or suspicious, or in less than 5%, inadequate, the patient is scheduled for surgical removal of the lesion (open biopsy). This is usually done under local anesthesia, with or without intravenous sedation. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This is a method that allows many women to avoid unnecessary surgery. Approximately 3/4 of all breast biopsies currently performed in the U.S. for abnormal mammograms turn out to be benign. Stereotactic needle biopsy is a method by which women at low risk for cancer may safely have a correct diagnosis without surgery. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000008000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The likelihood of a cancer to be missed by stereotactic needle biopsy is approximately 2%, the same rate as open biopsy. </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">During the past decade, high resolution ultrasound has emerged as an alternative to x-ray to visualize breast tumors smaller than 5mm (1/5in) for needle biopsy.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Many physicians nowadays use ultrasound machines to guide the needle to the tumor in the breast, again under local anesthesia to obtain tissue samples. </div> <bR> <div> The definitive diagnosis of cancer or benign condition is made by the pathologist. In very early breast cancers, the pathologist may need larger samples to state whether the cancer is locally invasive or is in situ meaning that the tumor is still confined to the lining of the milk duct and glands. On those occasions, conventional surgery is necessary. </div> <div> <TABLE BORDER="0" CELLPADDING="1" CELLSPACING="1" WIDTH="701" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="VOID" RULES="NONE" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" > <tR> <tD VALIGN=TOP HEIGHT= 19 WIDTH="288"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="288" HSPACE="0" VSPACE="0"></tD> <tD VALIGN=TOP COLSPAN=3 WIDTH="402"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="19" ALIGN="bottom" WIDTH="402" HSPACE="0" VSPACE="0"></tD> </tR> </TABLE></div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Sentinel node biopsy offers a less invasive method to determine whether breast cancer has metastasized. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The sentinel nodes are the first 1-3 lymph nodes in the lymph chain that drain the breast. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This tends to be a route that spreading cancer cells take. Sentinel node biopsy proposes that if cancer were to spread, </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">it would have to pass through them.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The "sentinel" node(s), defined as the first node in the lymphatic basin to receive lymphatic flow, is identified and removed in order to prove the presence or absence of metastases to the remainder of the axilla. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The technique involves the injection of a tracer substance, either a dye or a radio-labeled isotope given at the site of the primary tumor in the breast, prior to its removal or, if the tumor has already been removed, at the biopsy site. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">One to two hours after the injection and prior to surgery, a gamma probe is used to detect areas of increased activity in the axilla, indicating the "sentinel" node where the radioactive tracer has accumulated. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This area is then marked on the skin, local anesthesia and intravenous sedation are given and a small (1-2 inch) incision is made. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">One or two nodes are then removed for examination by a pathologist.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Because only a few nodes are taken, pathologists have been able to not only examine <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>multiple sections</U></FONT> of the excised nodes, but also do special tests to assure the identification of "micro" metastases (early cancer spread). </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The success rate of the tracer test in finding sentinel node(s) is approximately 95% and the accuracy of the sentinel node(s) to correctly diagnose the spread is also 95%</div> <bR> <div> <IMG SRC="11948ba0.jpg" border=0 width="328" height="186" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="11a41b00.gif" border=0 width="321" height="176" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="11b48ba0.jpg" border=0 width="328" height="186" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <B>American Cancer Society Recommendations for Early Breast Cancer Detection</B> </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Women age 40 and older should have a screening mammogram every year. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Between the ages of 20 and 39, women should have a clinical breast examination by a health professional every 3 years. After age 40, women should have a breast exam by a health professional every year. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Women age 20 or older should perform a breast self-examination (BSE) every month. By doing the exam regularly, you get to know how your breasts normally feel and you can more readily detect any signs or symptoms. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If a change occurs, such as development of a lump or swelling, skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk, you should see your health care provider as soon as possible for evaluation. However, remember that most of the time, these breast changes are not cancer. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Although there are some features of a mass that suggest whether it is likely to be benign or cancerous, women examining their own breasts should discuss any new lump with their health care professionals.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Experienced health care professionals can examine the breast and determine whether the changes you have noticed are probably benign or whether there is a possibility they may be due to a breast cancer. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">They can determine when additional tests are appropriate to rule out a cancer and when follow-up exams are the best strategy.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> If there is any suspicion of cancer, a biopsy will be done. </div> <bR> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">The American Cancer Society believes the use of mammography, clinical breast examination, and breast self-examination, according to the recommendations outlined above, offers women the best opportunity for reducing the breast cancer death rate through early detection.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> This combined approach is clearly better than any one examination.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Without question, breast physical examination without mammography would miss the opportunity to detect many breast cancers that are too small for a woman or her doctor to feel but can be seen on mammograms.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Although mammography is the most sensitive screening method, a small percentage of breast cancers do not show up on mammograms but can be felt by a woman or her doctors.</div> <bR> </td> </tr></table></body>