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deardr
deardr, Doctor
Category: Oncology
Satisfied Customers: 6558
Experience:  I have worked in a Medical School for last 10 years as a faculty.
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Attention Dr.: I'm concerned about the risk of false

Customer Question

Attention Dr. David:
I'm concerned about the risk of false positives with a Breast MRI. How big of an issue is this (how many unnecessary biopsies, etc.)? Diagnostically, how does 3D mammography combined with ultrasound compare? Can 3D detect more occult cancers, like lobular?
I've already had breast cancer/chemo/radiation, so this is follow up testing, not screening. I may not be able to physically complete an MRI, so it may be necessary to use a combination of other imaging in it's place. I understand that ultrasound is mostly useful for distinguishing a cyst from a solid mass. However, I was under the impression that 3D technology versus standard mammography provides better defined, more detailed imaging. If an MRI isn't feasible, is there some other type of imaging you would recommend?
Submitted: 1 year ago.
Category: Oncology
Expert:  Dr. David replied 1 year ago.

This is Dr. David

you don't have to worry about false positive breast MRI scans.

if a breast MRI scan is not feasible, you should have a breast mammogram and breast ultrasound together. together these are the best imaging combination if you can't have a breast MRI scan.

Customer: replied 1 year ago.

Why are there so many references to a high rate of false positives? One surgeon cited this as the reason why he only orders them under very specific conditions. His concern was that MRI can visualize every anomaly, and then what do you do?

Do you have an opinion regarding the benefits of standard versus 3D mammography? How does 3D imaging compare to an MRI in terms of its ability to identify cancers that standard mammograms miss, like lobular?

My MD says no benefit to ultrasound with post treatment, follow up imaging unless more information is indicated following mammogram.

Expert:  Dr. David replied 1 year ago.

if you can't have a breast MRI scan, why are you worried about false positives from a breast MRI scan.

there is benefit of ultrasound along with mammogram post surgery.

http://emedicine.medscape.com/article/347184-overview#a4

Customer: replied 1 year ago.

Because I want the information. And if you read my original question, I stated that I may not be able to do a MRI (because of a back injury; I won't know until I try), but that is the recommended test.

Can you answer my question about 3D versus standard mammography, and how 3D compares to MRI (i.e., whether it can detect anything standard mammograms miss, like lobular).

Expert:  Dr. David replied 1 year ago.

I will opt out and let another doctor help you.

Customer: replied 1 year ago.

Why would you opt out? I thought I was asking clear and logical questions, but you seemed to be questioning me for some reason. I did explain what my issues were, and I asked for you specifically because I feel you're probably the best qualified expert to ask this type of question.

Expert:  deardr replied 1 year ago.

Hello,

I am Dr Ken and I would be happy to help you.

Mammogram can be either conventional or can be done with ultrasound {sonomammogram}. 3D mammogram uses raw data {axial and coronal images} obtained during primary scan to reconstruct a 3D image. MRI is anytime preferable or better modality to detect small cancers or also to look for any recurrence after breast surgery. It not only helps to detect small lesions but also helps to differentiate a cancer from fibrosis {post-operative or post-radiation change}.

However if MRI is not obtainable - due to varied reasons than combination of sonomammogram and mammogram {xray} is recommended.

Best