1. What’s Next After an Abnormal Screening Mammogram? James A Stewart M.D. Elizabeth Burnside M.D.

2. After an Abnormal Screening Mammogram Screening mammograms performed at East/ West and UWHC Batch read- 3 days per week which increases specificity CAD system- computer-assisted read twice (R2) Results-Autofax system (sent when signed), fax or email available Letter sent to patient within 30 days(compliance)- goal is four days

3. Diagnostic Mammogram Diagnostic Breast problem, history of cancer, implants or males Performed only at UWHC site Recommendation from Radiologist given to pt. Letter also sent If U/S recommended- try to do same day- if not same day we need an order from PCP to schedule If Stereotactic biopsy recommended- teach, schedule and call PCP If MRI recommended- teach, screen, call PCP to schedule due to referral needed

4. Ultrasound Ultrasound used to determine solid vs. cyst Characterize mammographic or palpable finding Not used for screening Done only at UWHC Breast Center site If area needs aspiration or biopsy- done same day if at all possible Call to PCP if fluid or tissue sent to pathology or cytology

5. Stereotactic Biopsy Stereotactic biopsy done if area visualized on mammogram only Done under local anesthesia Patient in prone position Digital imaging machine with computer assisted coordinates Vacuum-assisted biopsy- closed system with biopsy site irrigated with saline and lidocaine Valium helpful

6. Breast MRI Breast MRI indications- Mammo density Mammo architectural distortion Mammo + with US - Positive lymph node- neg mammo Follow-up for prior MRI abnormality R/O multifocal cancer in recently dx’d pt. Scar vs. recurrence in pt. w/ prior lumpectomy Nipple retraction or unilateral discharge w/ neg mammo or US Multiple bilateral masses or cysts Follow-up for response to chemo

7. MRI Core Biopsy Core Biopsy under MRI guidance available Only done if not able to visualized under US or Mammogram UW is the only site in region to do MRI core biopsies

8. Galactogram Galactogram- Ductography Contrast-enhanced mammography used to image the breast ducts Used to diagnose the cause of abnormal nipple discharge Single duct Reproducible Suspicious color (bloody)

9. Outside Films Outside films are not just used for comparisons- Used by technologists Improve both sensitivity and specificity Often are most critical piece of examination Patient for a diagnostic mammo will need to be rescheduled if outside films not available Films used by the Radiologists when reading exam- may use many years of mammograms for comparisons

10. PCP’s Communication PCP’s notified for the following; For Stereotactic recommendation For MRI recommendation US scheduled for another day US tissue or fluid sent to pathology or cytology All positive pathology reports

11. Positive Pathology Report The diagnosis is given to the patient by the PCP BCC schedules follow-up appt. Surgical consult is scheduled with one of our surgeons in the Breast Center -Dr’s Breslin, Mahvi or Mack.

12. Planned Improvement Future: We plan to ask PCP when a diagnostic mammo is scheduled whether it is just for a diagnostic mammo or for a breast diagnostic work up

13. What would you like to see done differently? How can we assist you in your practice?