Senology is a set of instrumental tests (mammography, ultrasound, magnetic resonance, ultrasound-guided or stereotactic surgical procedures) that are commonly used in studying the mammary pathology.

These examinations can be carried out on an asymptomatic patient as well as on a symptomatic one: as we firmly believe that early diagnosis represents the first solution to mammary problems, in the first case these tests are extremely important as a form of prevention, while in the second case they allow for a pre-intervention better diagnosis.

Procedures

The San Rossore Medical Center can take advantage of a wide range of applications to guarantee a more precise diagnosis and to plan the best diagnostic and therapeutic program for patients that need to undergo surgical intervention. The ward specialists also offer a continuous support from prevention to follow-up.

Digital mammography is a new diagnostic method that is carried out with a digital mammograph, that uses digital receptors and computers instead of x-ray films . The electrical signals can be read on computer screens, permitting more manipulation of images that theoretically allow radiologists to more clearly view the results. Digital mammography is of course filed but can as well be printed or saved on cd-rom or other portable devices.

It only lasts a few minutes and no drugs or contrast agent are required. Mammography is the most effective and safe test for the early diagnosis of breast cancer, as it helps identify even the smallest changes in the breast tissue before other symptoms. If such changes are detected at an early stage, chances for a complete recovery are higher.

Advantages:

  • Fine-tuning of ionizing radiation doses
  • The image can be displayed both on film or on computer screens, thus permitting more manipulation of images to theoretically allow radiologists to more clearly view the results
  • Digital filing: examinations are recorded and kept in the computer of the Medical Center for further comparison
  • Remote transmission

Ultrasound is an oscillating sound pressure wave with a frequency greater than the upper limit of the human hearing range (approximately 20,000 hertz in healthy, young adults). The examination is therefore absolutely safe and can be repeated with no risk for human health. Ultrasound devices operate with frequencies from 20 kHz up to several gigahertz. Ultrasound images (sonograms) are made by sending a pulse of ultrasound into tissue using an ultrasound transducer (probe). The sound reflects (echoes) from parts of the tissue; these echoes are recorded and displayed as an image to the operator. In senology, ultrasound completes the mammographic examination and it represents an integration of the clinical evaluation (mammographic medical visit), offering an instrumental support to breast palpation thus allowing the immediate visualization of any anomalies perceived.

Ultrasound is the first-choice examination in women under the age of 40, when mammography would be useless due to a breast composed mainly by glandular tissue.

Advantages:

  • High-frequency (10-13 MHz) ultrasound transducers that offer high-definition images
  • Cutting-edge ultrasound device
  • Special software dedicated to senologic study
  • Echocolordoppler study

This kind of examination is carried out in a big device, that works as a magnet, that uses magnetic fields and guarantees no risk for human health. The device is like a 2-meters long cylinder, into which the patient lies prone, with breasts lying on two cups and arms and hands lying at her sides, in a comfortable position.

The main feature of this technique is its great sensitivity, as it is able to detect a malignant tumor even when mammography or ultrasound aren’t able to diagnose it. By the way, Magnetic Resonance Mammogram is to be considered as a complementary examination to be carried out together with traditional mammography and ultrasound, thus integrating details and info. Magnetic Resonance Mammogram alone could by no means replace these other two examinations because false results may occur, that is why matching and checking different tests and results is absolutely required.

The San Rossore Medical Center offers the most modern Magnetic Resonance equipment that guarantees an accurate diagnosis thanks to high magnetic field intensity (1,5 Tesla) combined with a comfortable space for the patient, who lies in a shorter tunnel (only 125 cm) with a 70cm diameter, thus making this diagnostic examination endurable also for anxious or claustrophobic patients.

Indications:

  • Prevention screening for young women with genetic risk or high familiar risk of breast cancer
  • Research of a primitive tumor in case of existing metastasis of unknown origin, through clinical examination of the breast, mammography and ultrasound.
  • Local staging of malignant tumors already diagnosed with traditional methods.
  • Control of breast cancer response to neoadjuvant chemotherapy.
  • Assessment of surgical patients in case mammography and ultrasound aren’t able to distinguish between scar and recurrent tumor.
  • Study of breasts with prosthesis: augmentation mammaplasty, reconstructive mammoplasty
  • Inconsistencies between images obtained through mammography, ultrasound and clinical examination.
  • Secreting breast

This examination can not be carried out in case of:

  • pace maker
  • iron or other metallic prosthesis

The detection of dubious and/or suspicious lesions involves the need for histological definition, which constitutes a fundamental stage in the patient’s subsequent procedure.

Stereotactic biopsy in IMS tomosynthesis is carried out in the prone position, in clinostatism (lying down), and enables otherwise inaccessible findings to be located and sampled with X-ray guidance.

The findings of the biopsy in tomosynthesis are found to be the same as those detected by 3D mammography, otherwise not always detectable by means of the 2D technique due to the phenomenon of masking explained above. It is therefore a quick biopsy procedure that does not involve the discomfort of a biopsy in sitting position. It is consequently better tolerated by women.

Using this system, the lesion can be reached from various angles, with focussing on the affected layer.

The innovation taking place at the San Rossore Healthcare Facility in Pisa, a centre of excellence in Tuscany, involves use of the prone position, the speed of the examination and the lower dose of ionising radiation administered during the examination.

Mammography with tomosynthesis, also called three-dimensional mammography, is an innovative 3D technique that makes it possible to reduce the number of false negatives compared with tests performed using the 2D technique.

3D mammography is a three-dimensional, high-definition version of digital mammography.

The new mammography, also known as digital breast tomosynthesis, represents a breakthrough in diagnostics: the basic principle is the same as tomography: it uses images captured from various angles, with reconstructions of volumetric figures, thus enabling the doctor to identify possible abnormalities or otherwise unrecognisable conditions.

In practice, unlike a normal mammogram that uses a fixed machine, the instrumentation moves around the breast in tomosynthesis. In principle, volumetric reconstruction provides a means of overcoming one of the main limitations of the two-dimensional imaging, and thereby radiological imaging (digital mammography) in current use, ie the masking of lesions (growths, microcalcifications, distortions, etc.) caused by the overlying normal structures. This situation mostly occurs in young patients with radiologically dense breasts. This has the advantage that any hidden tumour tissue can be more easily detected.

The chance to separate out the different planes using tomosynthesis leads to a reduction in the number of false negatives and false positives due to overlap, resulting in a substantial improvement in the detection and analysis of lesions: their presence or absence can be confirmed with greater certainty.

An interventional procedure on the breast refers to any minimally invasive course of action carried out on the mammary gland in order to influence the subsequent diagnostic or treatment procedure. A radiologist chooses the best, personalised method on the basis of the features of the detected disease, its size, and the method with which this finding can be better viewed.

  • Radio-guided intervention, mammotome
    • Suitable for the histological typing of microcalcifications, opacities, sprains and any lesions visible on the mammogram.
    • Computerised guidance for sampling
    • Microhistological sampling with forced aspiration (mammotome) with the resulting abundance of material
    • Unlike many other centres where this procedure is performed in a sitting position, the stereotactic biopsy at the San Rossore Healthcare Facility is performed on a lying, prone patient: clinostatism, or the lying position, considerably reduces the discomfort of the procedure compared with a sitting position
    • Local anaesthesia
    • Location of non-palpable lesions
  • Ultrasound-guided interventions
    • Indicated in the cytohistological typing of lesions visible in ultrasound
    • Real time ultrasound-guided introduction of the needle for continuous monitoring of correct sampling.
    • Thin needle: cytological sampling
    • Tru-Cut/Mammotome: microhistological sampling
    • Local anaesthesia
    • Rapidly executed
    • Pre-surgical location of non-palpable lesions

Services

A team of professionals with a range of specialist skills, cutting-edge equipment and interdisciplinary cooperation enables both symptomatic and non-symptomatic patients to receive personalized diagnostic and treatment services.

The patient is accompanied through each step of the diagnostic process and therapy. It is a humanized process that takes each case’s unique characteristics into account and ensures that the patient is assisted through every phase, from radiology to cytopathology, from molecular diagnostics to radiotherapy, from oncological surgery to plastic surgery, all the way to rehabilitation and also including psychological support.

The Center for Breast Diagnostics at the San Rossore Treatment Center offers:

Recovery Services

This type of condition generally requires only a short recovery period, preceded by some pre-operative exams. For this purpose, the facility has rooms available that are furnished with one or two beds, each specially equipped to create the most comfortable environment possible and facilitate attentive care during hospitalization.

In addition to the standard equipment, each room also has a private bathroom, remote-control adjustable bed, intercom with microphone, telephone, television connected to Sky satellite services, internet connection, air conditioning and a safe.

Some units also offer a lounge area and an adjoining room for a visitor. For more information, please contact the Recovery Office at: +39 050 586336 or download the Program of Services.

Day Surgery Services

When dealing with benign tumors, the patient’s condition permitting, Day Surgery can be an option. For more information, please contact the Recovery Office at: +39 050 586336 or download the Program of Services.

Outpatient Services

Visits for patients with diagnosed or presumed breast disease are carried out in the outpatient clinic.

For more information, please contact the Receptionist at: +39 050 586217 or download the Program of Services.

Intervention areas

Diagnostic senology, as methodological approach to the diagnosis of breast cancer, includes the following examinations:

  1. routine senologic control in asymptomatic patients;
  2. senologic examination in symptomatic patients suffering from mastodynia or in presence of palpable lesions or cutaneous alterations (reddening, retraction), asymmetry;
  3. organization of the personalized senologic path according to age, pathology, risk factors (familiarity, prior pathologies)
  4. control of patients at risk (BRCA)
  5. control of oncological patients
  6. intervention in case of focal pathology
  7. expert advice on imaging and tests/examinations already carried out but not conclusive
  8. guide in the management of the diagnostic and therapeutic iter (follow-up, surgical evaluation)

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