Diagnostic Senology

Diagnostic procedure

The procedure is in line with PDTA (Percorso Diagnostico Terapeutico Assistenziale) of Regione Veneto. All patients undergo clinical examination with breast and axillae inspection and palpation by a radiologist. Medical history is gathered with particular attention to the reproductive field and personal (age, past mammary surgery, hormone replacement therapy for menopause, hormonal stimulation for sterility, mediastinal radiotherapy, etc.) and family (first and second-degree relatives with breast or ovary tumor) risk factors. It then passes on to instrumental diagnosis. First approach is decided depending on diverse factors: age, clinical questions and eventual risk factors for breast cancer. In young patients, before the age of 36, for reasons of radioprotection and in absence of risk factors or clinical findings, the method consists in BILATERAL BREAST ULTRASOUND with axillary exploration. After the age of 36 the method consists in BILATERAL 3D MAMMOGRAPHY (TOMOSYNTHESIS). The investigation is always paired with bilateral breast ultrasound and ultrasound axillary study. With this association high accuracy levels can be reached for clinical breast examination. If any palpable of non-palpable alteration is found during diagnostic process and it requires typing (diagnosis of nature), a follow-up with collection of cellular material for cytological exams is organized, immediately and with informed consent by the patient. Fine-needle aspiration is usually ultrasound-guided or, less frequently, under mammographic guidance (stereotactical). First level analysis (clinical visit, mammography and bilateral breast ultrasound) aren’t sometimes sufficient for a definite diagnosis. In these cases, other more complex instrumental methods are used like the study of breast through MRI with or without contrast medium (injected into the cubital vein). The finding of suspect alterations calls for more sophisticated sampling methods for micro-histological material with large needle (TRU CUT) or VACUUM-ASSISTED TECHNIQUE. The result of integrated diagnosis, meaning with the use of different methods, is personally communicated by the radiologist to the patient, when all data is available. If the necessity is found for surgical, oncological, radiotherapy or rehabilitation treatment, the patient is directed to the dedicated specialist, operating in the same structure. This specialist in turn will contact the patient’s general practitioner. The different specialists involved in breast pathology, meet every fifteen days for consultation about the cases and to decide the most appropriate therapy.

Diagnostic methods

Diagnostic methods used by this Service for breast study are the following:

• 2D and 3D mammography (tomosynthesis)
• Galactography
• Ultrasound with probe dedicated to the study of soft tissue
• Fine-needle aspiration for cytological examination (ultrasound guided or stereotactic)
• Large-needle aspiration for micro-histological examination (tru cut)
• Needle aspiration with vacuum-assisted system (Suros), stereotactic with different modalities:
  – prone patient on a cot (2D)
  – 2D and 3D with sitting and prone patient (tomosynthesis)
• Breast MRI with dedicated coil (1,5 Tesla)