USC Breast Center
Radiology / Breast Imaging
Division of 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.
Our Radiology Team
Lee Breast Center at USC/Norris Cancer 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.
Mammography continues to be the best screening tool available for the diagnosis of breast cancer. Digital mammography provides a quicker, sharper, and more enhanced image to identifying the cancer more accurately. All of our mammography units at USC are digital.
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 and hand-held Mammotome biopsy devices.
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 8 to11-gauge Vacuum- assisted probe is used to obtain a tissue sample. This is a minimally invasive procedure. A skin incision is made and the probe is inserted into the breast only once, followed by multiple 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.
Ultrasound-Guided Core Biopsy
Percutaneous core biopsies, traditionally done under stereotactic guidance, may be performed under ultrasound if the lesion is sonographically 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 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
Women who have indeterminate findings on either mammogram or ultrasound may benefit from breast magnetic resonance imaging (MRI). MRI may determine if this lesion is suspicious or benign appearing. In addition, women at high risk for developing breast cancer may benefit from MRI screening to determine if there is an occult breast cancer present.
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.
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.
Breast Tomosynthesis: Introduction and Overview
View/download Powerpoint Presentation (.ppt file, 5.86MB)
Services performed same day at Norris Cancer center:
- Digital Mammography
Radiology/Breast Imaging Contact Information
Department of Radiology
1500 San Pablo Street
Second Floor Imaging
Los Angeles, CA 90033
Phone: (323) 442-8541
Fax: (323) 442-8755
1441 Eastlake Avenue, First floor
Los Angeles, CA 90033
Phone: (323) 865-3463
Fax: (323) 865-0114