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Radiology

Why is radiology important?

Breast ultrasound examination

• What do we expect from an ultrasound breast examination?

  Ultrasound can clearly differentiate whether the nodule is cystic or soft tissue. Cystic lesions are clearly demarcated collections of fluid contents, while soft tissue lesions are composed of solid tissue. If a cyst is observed, and its size is 2 cm or more, its liquid content can be easily evacuated under ultrasound control (a puncture can be performed). If the nodule is of a soft-tissue nature and all ultrasound characteristics are benign, then its growth rate and possible changes in structure can be monitored by ultrasound in periods of 6-12 months, and if we have even the slightest degree of suspicion that the nodule may be malignant, then we can perform a “core biopsy” under ultrasound control – a biopsy with a thick needle and perform a mammographic examination. In certain situations, it is necessary to get more information, and then we refer the patient to a breast examination using magnetic resonance imaging.

• How is a breast ultrasound examination performed?

  The examination is simple, quick and has no proven harmful effect. It is necessary to take off your clothes and lie on the bed for examination. If necessary, the patient can be placed in a lateral or semi-lateral position with her arms raised above her head. At the same time as the breasts are examined, both armpits must be examined. If a suspicious change is detected, then as part of the examination, an ultrasound examination of the loco-regional lymph nodes of the neck and the area above and below the collarbone is performed.

• How often is the examination performed?

  As a standard, the examination is performed for one year, and if a mammographic examination is also performed, ultrasound can be an additional method of examination if necessary. For ladies who do screening, we alternately examine the breasts by mammography and ultrasound, for one year. If benign changes are observed, the ultrasound can be performed for a year, but also for 6 months if there is a reason for it. When changes in malignant characteristics are diagnosed, then their biopsy can be performed under ultrasound control, the obtained tissue sample is sent for pathohistological analysis, which establishes a definitive diagnosis.

• When to start breast ultrasound?

  There is no clear limit when it is necessary to start breast examinations. We advise you to do it regularly, every year from the age of 25, regardless of whether you have breast problems or not. An ultrasound examination of the breasts is advised before starting hormone therapy, either as part of treatment, introduction of contraception or as part of preparation for in vitro fertilization. Examinations, in the case of longer hormone therapy, can be performed for 6 months, given that there are no proven harmful effects, and you can benefit from the examination.

  When problems appear – painful and sensitive breasts, when a lump is noticed in the breast or armpit or you notice any change in the skin, its appearance or color, do not wait, but come in for an examination IMMEDIATELY. In those situations, after the ultrasound, a mammographic examination will be performed if there is a reason. For the first 10 years after surgery, patients treated for breast cancer undergo regular, annual mammographic breast examinations, and if necessary, an ultrasound examination is indicated depending on the size and structure of their breasts.

• When to start breast ultrasound?

  There is no clear limit when it is necessary to start breast examinations. We advise you to do it regularly, every year from the age of 25, regardless of whether you have breast problems or not. An ultrasound examination of the breasts is advised before starting hormone therapy, either as part of treatment, introduction of contraception or as part of preparation for in vitro fertilization. Examinations, in the case of longer hormone therapy, can be performed for 6 months, given that there are no proven harmful effects, and you can benefit from the examination.

  When problems appear – painful and sensitive breasts, when a lump is noticed in the breast or armpit or you notice any change in the skin, its appearance or color, do not wait, but come in for an examination IMMEDIATELY. In those situations, after the ultrasound, a mammographic examination will be performed if there is a reason. For the first 10 years after surgery, patients treated for breast cancer undergo regular, annual mammographic breast examinations, and if necessary, an ultrasound examination is indicated depending on the size and structure of their breasts.

Breast biopsy

• Who performs a breast biopsy and how is it performed?

  The biopsy is performed by a radiologist under ultrasound control. The intervention is performed under local anesthesia (similar to the dentist), lasts about twenty minutes and does not require hospital treatment.

• Is the biopsy painful?

  No, a biopsy is not considered a painful procedure because it is performed under local anesthesia.

• How long does recovery take after a biopsy?

  On the day of the biopsy, rest is advised – avoiding lifting heavy loads and doing heavy physical work. You can return to your daily activities the very next day.

• Doctor's notification about your health condition and therapy?

  Yes. Before performing the biopsy, it is important to tell the radiologist basic information about your health and especially if you are taking medications that affect circulation or blood platelets (eg Aspirin, Cardiopyrin, Brufen, Naproxen, Voltaren, Diclofenac or Clopridogel/Plavix).

• When is the pathohistological finding obtained?

  The findings and recommendations for further procedures are obtained within 5 to 7 days after the biopsy.

• What are the next steps after receiving the findings?

  • If the finding is benign: you receive a recommendation for further follow-up and control examinations.

  • If the change requires removal: it is advised to see a surgeon to remove the change.

  • If the change requires further treatment: you are referred to the oncology committee to determine therapy.

  • If your radiologist or surgeon requires a breast biopsy under ultrasound control, you must contact the radiologist who performs the intervention!

Breast puncture

• Are breast cysts a rare occurrence?

  No, breast cysts can often be seen by ultrasound, even when the patient does not have any subjective complaints.

• When is a breast cyst puncture necessary?

  If a cyst of 2 cm or larger is detected and if the patient feels severe breast pain, a puncture can be performed during the ultrasound examination – evacuation of the liquid contents from the cyst.

• What is the purpose of breast cyst puncture?

  Puncture has two goals:

  Relieving the patient from pain.

  Obtaining content for cytological or bacteriological analysis.

  Analyzes can reveal signs of inflammation (when treatment with antibiotics is necessary) or the presence of malignant cells (when the change must be surgically removed). In most cases, the contents of the cyst have a characteristic appearance and color and do not require laboratory analysis.

• How is the puncture of the content from the breast performed?

  Puncture is performed using a syringe and a needle, with which the liquid content of the cyst is completely or partially removed. This causes the cyst to completely or partially collapse. The procedure is performed under ultrasound control, takes only a few minutes, is simple and usually minimally painful or painless.

• Is special preparation required for puncture?

  No, the puncture does not require special preparation, nor subsequent rest or special behavior after the procedure.

• What are the benefits of cyst puncture?

  Evacuating the contents reduces the size of the cyst and the tension it causes, which relieves the patient of pain and discomfort.

• Can the puncture be repeated?

  Yes, the puncture can be repeated several times and does not cause any additional discomfort.

Ultrasound examination of the thyroid gland

• Early detected malignancy (cancer) is curable in a high percentage of cases. how and why to examine the thyroid gland?

  The striatal gland is a small gland located on the front of the neck. It secretes hormones that act on all the cells of our body.

  Increased hormone secretion is called hyperthyroidism, and decreased secretion is called hypothyroidism. The most common disease of this gland today is chronic autoimmune inflammation – autoimmune thyroiditis or Hashimoto’s thyroiditis, which is manifested by fatigue, drowsiness, sluggishness, weakness, weight gain, thermoregulation disorder, frequent mood swings…

  Diseases of this gland are diagnosed using an ultrasound examination with mandatory correlation of the findings with the values ​​of hormone levels in the blood secreted by the gland and with the determination of the level of produced antibodies. The thyroid gland should be examined if you experience any general symptom that you have not had before, that lasts longer and does not improve after a period of physical and mental rest.

  Also, we advise you to examine the gland if there is a relative in the family with the disease of this gland, and the association of carcinoma of this gland with carcinomas of other glandular organs (primarily breast) has been proven.

  Ultrasound examination is simple, painless, without harmful effects, lasts a short time and does not require special preparation, and can detect small-sized cancers when the success of treatment is good and the percentage of cure is high.

• Cancer (carcinoma) of the thyroid gland

  Thyroid malignancy is constantly increasing in developed countries. It is more common in women, according to its nature it can be: follicular, papillary, medullary and anaplastic.

  The diagnosis is usually made after an ultrasound examination. While the tumor is small, it does not cause any symptoms, but during its growth, it spreads to the surrounding lymph nodes of the neck. Then general complaints can occur: weakness, fatigue, lassitude, pain in the neck area.

  If it is not treated, this malignancy spreads further, i.e. it metastasizes to the bones and lungs, when the success of the treatment is limited. Carcinoma is usually discovered by chance, by detecting a nodule in the gland during an ultrasound examination.

  Ultrasound is the most accurate method for examination and for fine needle aspiration (FNA), and the obtained punctate is proven pathocytologically. The treatment of this malignancy is surgical removal of the entire gland and the use of radioactive iodine if necessary.

• Goiter (goiter)

  Goiter (goiter) is an increase in the volume of the thyroid gland. Enlargement can be diffuse (enlargement of the entire gland) or nodular (appearance of one or more nodules/knots in the gland). This condition can also be observed by observing the patient (inspection) when an increase, thickening and some kind of asymmetry in the front part of the neck is noticed.

  Nodules in the thyroid gland are most often benign (cysts, adenomas, degenerated adenomas…) However, in a smaller percentage they can also represent malignant nodules/tumors. The disease takes a long time to develop, it is mostly painless, and the enlargement of the gland is not given much importance.

  As the disease progresses, pain, difficulty swallowing, difficulty swallowing and breathing problems may occur.

  The diagnosis is established by a puncture during an ultrasound examination, and the obtained content is sent for cytological analysis. Depending on the stage when the disease is diagnosed, the treatment plan follows.

Lymph node biopsy

• What is a core biopsy (coarse needle biopsy) of a lymph node?

  A core biopsy or “coarse needle biopsy” is a procedure to take a sample of tissue from a suspicious or enlarged lymph node. Although the name may sound alarming, the needle used is only 1.5–2 mm thick.

• How is the procedure performed and is it painful?

  The biopsy is performed by a radiologist under ultrasound control. The procedure is performed under local anesthesia (like at the dentist), lasts about 20 minutes and does not require hospitalization. The intervention is painless, and the next day the patient returns to daily activities.

• Is special preparation required before biopsy?

  Before the intervention, it is important to inform the radiologist about your medical condition and the therapy you are using, especially if you are taking drugs that affect circulation or blood platelets (eg Aspirin, Cardiopyrin, Brufen, Naproxen, Voltaren, Diclofenac or Clopridogel/Plavix).

• What happens to the sample after the biopsy and when do the results arrive?

  The obtained sample is sent for pathohistological analysis, based on which pathologists make a final diagnosis. The findings and recommendations for further procedures are usually received within 5-7 days.

• What are the next steps after receiving the findings?

  Depending on the results, you may receive a recommendation to see a surgeon to remove the lymph node, an internist-hematologist if a different type of treatment is needed, or instructions for further follow-up through a control ultrasound examination.

Ultrasound examination of lymph nodes

• What is an ultrasound examination of the lymph nodes and how reliable is it?

  Ultrasound examination is a highly reliable method for the analysis of superficially located lymph nodes. This method evaluates the shape, margins, internal structure, vascularization and measures the size of the lymph node.

• Which regions of the body are examined by ultrasound of the lymph nodes?

  The examination includes the superficially located lymph nodes of the neck, the area above and below the collarbone, the armpits and the groin (supra- and infraclavicular regions, axillae and inguinal region). During every routine breast examination, both armpits must be examined.

• When is an ultrasound examination of the lymph nodes recommended?

  The examination is recommended for patients who have undergone breast surgery for cancer, as well as those who are being treated for melanoma, lymphoma or other cancers, as part of monitoring therapy and the course of the disease. Also, it is indicated for a suddenly enlarged and painful node, when an inflammatory process is suspected.

• Is ultrasound examination of lymph nodes harmful?

  No, the scan is completely safe and can be repeated multiple times. If necessary, a puncture or biopsy of a suspicious lymph node can be performed under ultrasound control. The resulting content is then sent for cytological or microbiological analysis.

• How is an ultrasound examination of the lymph nodes performed?

  The patient removes clothing from the area to be examined and lies on the examination bed. The procedure is simple, takes about 15 minutes, does not require special preparation and is not unpleasant. A report of the findings is received immediately, along with instructions on the eventual need for a puncture or biopsy.

Ultrasound examination of the stomach (abdomen)

• What can be seen with an ultrasound examination of the abdomen?

  Ultrasound examination of the abdomen is a simple, painless and completely safe method that can be used to examine the liver, gall bladder, spleen, pancreas, kidneys and blood vessels of the abdominal region. The examination assesses the size and structure of the organs, as well as possible pathological changes.

• What does the examination itself look like?

  During the examination, the patient lies on his back and follows the doctor’s instructions – sometimes it is necessary to turn on his side or hold his breath for a better view of certain organs. The examination is fast, comfortable and does not cause pain.

• What kind of preparation is needed for an abdominal ultrasound?

  For the examination of the abdomen, it is necessary to be without food and drink (except water) for at least 4 hours before the examination and not to drink coffee during that period.
  For the kidney and bladder examination, fasting is not required, but the bladder must be full – it is advised not to urinate before the examination and to drink about 1-1.5 liters of liquid 2 hours before. Regular therapy should be continued and the medicines prescribed by the doctor should be taken.

• Does the ultrasound examination of the abdomen have contraindications?

  No, the examination is completely safe, does not radiate and has no proven harm. It can be repeated several times, and it is also safe for children and pregnant women.

• When are patients most often referred for abdominal ultrasound?

  The reasons can be different, but the most common are:

  • abdominal pain
  • kidney infections
  • suspicion of a tumor or monitoring the effect of therapy
  • hernia detection
  • the presence of fluid in the abdominal cavity
  • swelling of abdominal organs
  • the presence of stones in the gallbladder or kidneys
  • organ injuries are suspected
  • elevated body temperature of unknown origin
  • dilation of the aorta