Breast cancer is the most common cancer diagnosed in the Australian female community. 1 in 7 Australian women and 1 in 550 Australian men are diagnosed with Breast Cancer within their lifetime. Nationally, there are approximately 9 related deaths each day.
Increased early detection and intervention has led to an increase in survival rates. Since the introduction of the national screening program for over 40’s in 1994, the death rate has reduced by over 40%.
Mammography
Who should have mammograms?
Mammography is usually the first line of investigation for breast cancer if the patient is 35 years or older. It may be performed in patients under 35 if there are suspicious findings on ultrasound.
Women who are pregnant or lactating should ideally wait 3 months post-breastfeeding cessation because of increased breast density and complexity. However, mammography may be considered if there are concerning clinical or ultrasound findings.
Screening vs Diagnostic Imaging
Screening:
BreastScreen Australia provides free biennial 2D mammography for asymptomatic patients over 40 years old. No referral is required. Screening at private radiology clinics is not covered by Medicare and will incur a fee.
Diagnostic:
Patients of any age who meet Medicare requirements are bulk billed at Qscan Radiology Clinics. Medicare requirements are met if there is reason to suspect the presence of malignancy because of:
(a) the past occurrence of breast malignancy in the patient; or
(b) significant history of breast or ovarian malignancy in the patient’s family; or
(c) symptoms or indications of breast disease found on examination of the patient by a medical practitioner.
Symptoms may include
New lump
Breast or nipple asymmetry
Skin changes – redness, dimpling
Nipple change
Nipple discharge
Unilateral breast pain
Why Choose Qscan Radiology Clinics for Mammography?
Qscan Radiology’s Genius 3D MAMMOGRAPHY™ (breast tomosynthesis) x-ray unit sweeps in an arc while taking low-dose images at multiple angles over a period of approximately 4 seconds. This produces a stack of thin images, which can be scrolled through like images from a CT.
Benefits of Genius 3D MAMMOGRAPHY™ include:
Reduction in tissue overlap
Better definition of lesion margins
Easier visualisation in dense breasts when compared to 2D mammography
Reduction in false positives, thereby decreasing recall rates by 15-40% when compared to 2D mammography.
Abnormalities can be extremely subtle, so it is important to compare previous imaging to assess for changes.
Better definition of lesions: The 3D image on the right clearly demonstrates the spiculation of a suspicious lesion, which is otherwise masked on the 2D image.
All patients, particularly those with dense breasts, are found to benefit from 3D mammography. The rotation of the x-ray and the reconstruction of 0.5-1mm images help to identify structures possibly hidden or obstructed on a conventional 2D machines.
Breast Density: The above images demonstrate variation in fibroglandular tissue as demonstrated in 2D mammography.
Figure A. Almost entirely fatty tissue with the least amount of fibroglandular tissue. Figure B. Scattered fibroglandular tissue. Figure C. Heterogeneously dense breast. Figure D. Extremely dense breast with the most amount of fibroglandular tissue.
Reduction of false positives: In the 2D digital image on the left, there is a potential lesion in the subareolar region of the breast. In the 3D image series on the right, it is evident there is no lesion present.
Breast Ultrasound
Complementary ultrasounds are important to localise and characterise abnormalities, identify lesions occult on mammograms and reassure patients that breast tissue is normal.
Ultrasound is also the first line of investigation for patients under 35 years of age due to it being more sensitive than mammography in the detection of cancer in younger patients.
It is also the first line of investigation for ladies who are pregnant or lactating due to changes in the breast as described above.
Cancer Australia states “MRI is not recommended in the routine investigation of a new breast or nipple symptom. However, there may be a place for MRI, for example when there is a discrepancy in findings across the triple test, in consultation with a specialist.”
Breast PET-CT
PET-CT is playing an increasingly vital role in the staging and restaging of breast cancer, offering oncologists a powerful tool to guide patient management. While conventional imaging methods such as CT, MRI, and bone scans remain essential, PET-CT with FDG (fluorodeoxyglucose) provides unique metabolic insights that enhance diagnostic accuracy and treatment planning.
In staging, PET-CT is particularly valuable for patients with locally advanced or high-risk breast cancer, where it can provide essential information for the treatment of stage III tumours as well as identify distant metastases not detected by conventional imaging. This can lead to more precise treatment decisions, sparing patients from unnecessary surgery or radiation in cases of widespread disease.
For restaging, PET-CT is highly effective in evaluating suspected recurrence, distinguishing between post-treatment changes and active malignancy. It aids in detecting distant metastases early, enabling timely therapeutic interventions. Additionally, PET-CT is instrumental in assessing treatment response, helping to determine whether a patient is benefiting from systemic therapy or if a change in approach is warranted.
With its ability to provide comprehensive whole-body imaging and metabolic assessment, PET-CT is an indispensable tool in modern breast cancer management, helping oncologists personalise treatment strategies and improve patient outcomes.
Case Study: 66-Year-old patient with pre-treatment (Fig. A) and post-treatment (Fig. B) PET-CT of right breast grade 3 triple negative invasive cancer Ki67 60%.
Restaging PET-CT (Fig. B) indicates significant reduction in size and avidity of the lateral right breast primary as compared to pre-treatment imaging (Fig. A). Mild residual uptake shown in Fig. B is non-specific with small volume viable tumour not excluded.
Non-Excisional Image-Guided Biopsy
Fine Needle Aspirations
A fine needle withdraws fluid and/or cells from the breast nodule into a syringe and is then transferred onto slides and prepared for pathology examination.
Core Biopsies
The cells are biopsied from the breast nodule into a syringe under local anaesthesia due to the larger needle diameter. This will then be swiped onto a slide and prepared for pathology examination.
Vacuum Assisted Biopsies (VAB)
A fast and reliable core biopsy for multiple nodules under a single insertion into the breast. This improves biopsy success rate and patient comfort.
Samples are vacuumed directly into the VAB machine tissue container reducing contamination risk and providing easy visualisation of the excised product for faster clinical decision-making and easy transport to pathology for examination.
Breast and Axilla Hook Wire placements
Hook wire localisation, also known as wire localisation or wire-guided localisation, is a technique used to precisely localise and guide the accurate removal of small abnormalities or lesions. It is a safe and effective technique which helps to ensure that the entire abnormality is excised while minimising damage to surrounding healthy tissue.
This procedure is commonly performed in the morning before surgical excision or biopsy, particularly when the abnormality is difficult to feel or not easily visible on imaging.
