• Breast changes
• • Breast care team
  • The assessment clinic
  • • Mammogram
    • Ultrasound
    • Biopsy
    • New diagnostic tests
    • Waiting for test results
• Benign breast condition diagnosis
• Breast cancer diagnosis

The following tests are not currently standard practice, but you may be offered them as part of a clinical trial or research project.

You may be offered a new procedure called digital mammography. Having a digital mammogram involves going through the same process as conventional film screen mammography. The difference is that instead of the image being picked up by photographic film, it is converted into a digital signal and displayed on a computer monitor.

It is possible that this technique may improve the detection of tumours in dense breast tissue, although this is not yet clear. Further studies are needed to investigate whether there is any improvement in sensitivity and accuracy. However, having the image on a computer does mean that the image can then easily be enlarged, highlighted, stored, compared with others in the archive and transported across a telephone line for prompt consultation.

The NHS Breast Screening Programme has reviewed various systems of digital mammography, and concluded that some techniques meet the criteria for image quality and radiation dose to be used in screening. Further work is now ongoing to determine the practicality of these techniques in a clinical setting.

This is a new form of mammogram currently in development that it is hoped will be able to detect tumours as small as 4 mm wide - which is significantly smaller than current mammography techniques. This will be particularly helpful when scanning younger women with dense breasts. The smaller the cancer at detection, the less likely it has spread and the greater the likelihood of a successful outcome.

Ductal lavage is a novel 'washing' technique that potentially can identify cancerous and pre-cancerous cells in the milk ducts of the breast. This is a procedure that may be used in the future for women with a high risk of developing breast cancer.

The procedure has two steps indicated below.

1. Research has indicated that ducts that have abnormal cells are more likely to produce fluid than ducts with normal tissue (although the presence of ductal fluid could be entirely innocent). So, in order to identify which ducts are more likely to be abnormal, a breast pump or aspirator is used to apply mild suction to the nipple in order to draw fluid from the milk duct openings. The ducts that are identified in this way are then 'washed' in stage 2.
2. A local anaesthetic is then applied to the nipple and a flexible hair thin catheter is threaded about half an inch into each fluid-producing duct opening. A saltwater solution is infused through the catheter into the duct - and sucked back out. The cells that are rinsed out in the solution can then be collected and analysed.

Trials so far have reported minimal side effects with women reporting the sensation of 'breast fullness', like lactation. Whilst the suction applied to the nipple can be intense, the small tube placed in the milk duct is generally painless.

However, this technique is still in the development stages. The small quantities of fluid available for analysis and the corresponding difficulties identifying and isolating ducts remain important limitations. In addition, this procedure gives a generalised area and not an exact location. To that end it should also be done in combination with some sort of imaging technique for maximum value.

           

• Breast changes
• • Breast care team
  • The assessment clinic
  • • Mammogram
    • Ultrasound
    • Biopsy
    • New diagnostic tests
    • Waiting for test results
• Benign breast condition diagnosis
• Breast cancer diagnosis

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