Women's Imaging

The Division of Women's Imaging at the University of Southern California is composed of several modalities that work together or independently to diagnose women's health problems. These modalities include mammography, ultrasound (US), computerized tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), and interventional procedures.

Lee Breast Center at USC/Norris Hospital

The Lee Breast Center at USC/Norris Hospital is a state-of-the-art research and treatment facility, which was opened in June 1998 following the $5 million dollar contribution by Mrs. Henrietta Lee. At the Lee Breast Center, we have put together a multidisciplinary team of experienced physicians and scientists who are all dedicated to breast cancer research and comprehensive patient care. All of these services are found in one convenient location. Each woman is treated individually, and guided from her first visit through counseling, diagnosis, treatment, reconstruction, and after-care treatment. This comprehensive approach to care provides the latest technology and clinical expertise along with emotional support.

We have implemented a two-step method for diagnosis and treatment of breast cancer. The diagnosis is made with image-guided core biopsy before the patient enters the operating room. The pathology results from each biopsy are evaluated in the weekly "Triple Test" conference by the radiologist, surgeon, and pathologist for concordance, and follow-up recommendations are made. This approach gives the patient access to a multidisciplinary team of breast cancer specialists prior to making a treatment plan. The Breast Center "team" is devoted to a comprehensive evaluation of each patient. We have the most up-to-date biopsy devices, which include digital stereotactic table, hand-held Mammotome, Site-select biopsy, and ductal lavage.

The Lynne Cohen Preventive Care Clinic for Women's Cancers was created through a generous grant from the Lynne Cohen Foundation for Ovarian Cancer Research. It is dedicated to finding an early detection test for ovarian cancer, establishing high-risk clinics for women with family members who have been diagnosed with ovarian or breast cancers and finding better clinical treatments for women struggling with these diseases.

Digital Stereotactic Mammotome Biopsy

During the last decade, digital stereotactic biopsy has evolved to the point that it offers major benefits over traditional open surgical wire guided localization breast biopsy in terms of accuracy, morbidity, and cost. We use the state-of-the-art prone Fischer Mammotest Plus Stereotactic table.

The stereotactic localization of a specific lesion, by x-ray imaging, is based on measurements of the position of the lesion on two images of the breast taken from different angles. With our prone table, the patient lies down with her breast protruding from a hole in the table. This table is comfortable for the patient and decreases the possibility of motion. Once the exact location of the lesion is calculated, the Mammotome 11-gauge Vacuum- assisted probe is used to obtain a tissue sample. This a minimally invasive procedure. A skin incision is made and the probe is inserted into the breast only once, followed by muliple contiguous directional sampling of tissue. The probe never leaves the breast until all the tissue has been removed. A small metallic clip is deployed to mark the biopsy site in case therapeutic lumpectomy or radiation therapy is needed. This biopsy procedure is performed on an outpatient basis under local anesthesia and takes about 45 minutes.

At USC, we have alsoacquired the Imagyn Site-Select device. This is a new state-of-the-art biopsy device that is used to perform a larger tissue extraction (8 gauge) using stereotactic imaging. This technique requires suturing of the skin. For patients with a core biopsy diagnosis of Atypical Ductal Hyperplasia (ADH), the Site-Select is an excellent alternative to open wire-guided surgical excisional biopsy.

Ultrasound-Guided Core Biopsy

Percutaneous core biopsies, traditionally done under stereotactic guidance, may be performed under ultrasound if the lesion is ultrasonographically visible. These biopsies are often quicker, more comfortable (no compression), do not involve radiation exposure, and may target very deep or very superficial lesions more easily than the stereotactic method. At USC/Norris, we may do these biopsies on the same day as the mammogram. For some lesions, such as complex cysts, we perform ultrasound-guided fine needle aspiration.

To perform an US biopsy of a suspicious lesion seen both mammographically and sonographically, a 14-gauge core biopsy needle is usually used. A spring-loaded device deploys this needle. Each core tissue sample is obtained with a separate insertion into the incision site.

USC has acquired the hand-held 11-gauge Mammotome. With this device, we perform vacuum-assisted core biopsy of suspicious lesions under ultrasound guidance. We obtain multiple core samples with a single insertion of the needle into the lesion that are larger than the 14-gauge needle. We can also deploy a metallic clip to mark the biopsy site. This post-biopsy clip placement is especially valuable in localizing a lesion that is seen on the US, but not seen on the mammogram.

MRI of the Breast

MR of the breast takes about 15-30 minutes to perform. The patient lies on her stomach and places her breasts loosely into the breast "coils."

The sequences to evaluate for implant rupture and to evaluate for cancer are different. To evaluate for implant rupture, the patient needs no injection. To evaluate for cancer, the patient gets an injection of gadolinium. The gadolinium enhances areas of the body with increased vascularity, including area of tumor and inflammation.

Positron Emission Tomography (PET) Scan

Positron Emission Tomography is a noninvasive imaging technique that reflects tissue biochemistry and physiology. Based on the increased glucose metabolism of malignant tissue, PET, using the radiolabeled glucose analog 18F-fluorodeoxyglucose (FDG), allows identification of the breast cancer. Preliminary studies show that PET imaging allows accurate and noninvasive detection of axillary lymph node metastases, mainly in patients with advanced breast cancer.

Lymphoscintigraphy

There are several ongoing studies investigating the lymphatic drainage of breast tumors. The sentinel lymph node is defined as the first lymph node to receive lymphatic flow from a primary tumor site. Studies show that the status of the sentinel node, identified using radiolabeled tracer, can accurately predict whether breast tumor cells have metastasized to the axillary lymph nodes.

At USC/Norris, we use this new, minimally invasive technique for staging breast cancer. Prior to surgery, we inject around the patient's areola with a radiopharmaceutical and mark the sentinel node. In the operating room, a portable gamma detector probe is used to identify the sentinel node, which is then resected and examined for metastasis. We have seen excellent results with this procedure.

Ductal Lavage

Ductal lavage (DL) is based on research by Dr. Susan Love exploring the intraductal approach to studying breast cancer. The current technique involves cannulating fluid yeilding ducts and collecting the washing for cytopathology applying mild suction to the nipple with an aspirator to identify fluid-yielding ducts. A multi-institutional trial of DL in high-risk women suggest that malignant cells from patients with DCIS can be collected by DL.

At the Lee Breast Center, our radiologists have completed special training in the practice of ductal lavage. High-risk women may be recommended for this procedure by their physicians.

LAC/USC Medical Center Mammography

LAC+USC Mammography is a major referral center for the Northeast Comprehensive Health Centers (CHCs). The screening mammograms are performed at the CHCs and interpreted by the USC radiologists. Any abnormality identified on the screening mammogram is evaluated at LAC+USC Mammography, where all diagnostic breast imaging studies and subsequent breast biopsies are performed.

Our goal is to diagnose all suspicious breast lesions without having the patient go to the operating room "under the knife" with general anesthesia. The mammographer performs an image guided core biopsy (stereotactic or ultrasound-core) to diagnose the suspicious lesion. Once the diagnosis of cancer is made, the patient can discuss her treatment choices with her physician prior to her surgery.

Each newly diagnosed breast cancer patient is discussed at the weekly Multidisciplinary Breast Conference. In this forum, the surgeon, medical oncologist, radiologist, pathologist, and radiation oncologist work together to form a treatment plan unique to each patient. This comprehensive approach provides the patient with the latest clinical expertise and gives her the best treatment plan.

LAC+USC Women's & Children's Hospital

At Women's Hospital, the radiologist specializes in pelvic and obstetric (OB) ultrasound. We work closely with the surgeons and oncologists to evaluate gynecologic disease and perform ultrasound-guided interventional procedures. We use CT to define the extent of spread of a cancer- local and distant, and MRI is extremely valuable for tumor staging and follow-up after therapy. We perform OB ultrasounds on patients with maternal diabetes and with moderate increased risk. In addition, we perform hysterosalpingograms (HSG), and interpret plain film radiographs on our patients at Women's Hospital.