Biopsies and 3-D mammography: more accuracy for better outcomes

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3-D Mammography – Dr. Gerald McCullough

The technology used in diagnostic imaging is constantly changing and improving, and TCHC remains at the front of these advancements.

A little over a year ago, we were one of the first in the region to get the capability to perform 3-D mammography. For years, we’ve done 2-D mammography, where the image of a breast is Happy breast cancer survivors supporting each othercompressed into one flat image. With 3-D mammography, we can take a picture of a breast and split it into dozens of 1 mm slices, like a loaf of bread.

This separates each image so you can look at it one slice at a time. If I see a nodule, I can scroll straight to it and see whether or not it has characteristics that are suspicious.

The biggest thing about 3-D mammography is increased accuracy. Sometimes we biopsy areas that are normal because they didn’t look normal, but 3-D allows us a better look at slight changes in the breast so we can reduce the number of false positive biopsies.

When you come in for a mammogram, there are two kinds you might receive. Screening mammograms test a healthy population for disease. It’s been shown that by screening for breast cancer, you increase survival, you increase detection and you promote better health. Diagnostic mammograms are performed if the doctor or the patient feels a lump or if we suspect that something’s not right.A Mammogram image showing left and right breasts.

No matter which type you receive, everyone who gets a mammogram at TCHC gets both a 2-D and 3-D. They are done with the same machine and in the same visit and take five to 10 minutes. The use of this technology, along with regular screening, is very important because you can get a clearer picture of the breast, intervene earlier and have better outcomes.

There may come a day when 3-D mammography becomes standard across the board. The great part is that it is already standard at TCHC so that we can give you more accurate results and peace of mind.

Stereotactic Breast Biopsy – Dr. David Kloss

Sometimes technology comes along and it is a flop (think 3-D TV viewing with those stupid, awkward goggles or think Google glasses).

But once in a while, the engineers get it right, and that new piece of technology REALLY delivers a radically new product or a dramatically better result. Stereotactic breast biopsy is one of those new technologies that REALLY delivered a radically new and improved result!

Nurse with a young woman having a mammogram. Dr. McCullough has described how helpful the 3-D mammography is at picking up very small, subtle changes in the breast. Eight out of 10 times, these little areas are NOT cancerous. But patients and doctors like to know for sure that these mammographic spots are benign (not cancerous).

Fifteen years ago, a small area in the breast that needed a biopsy to prove it was benign required a big, expensive operation; this resulted in a large scar, pain and time away from work.

For the last 18 months, the specialists at TCHC have been using the latest in computer technology combined with the newest mammogram machine to biopsy these tiny little areas. Rather than a trip through same-day surgery with a large scar, these biopsies are completed through a 3 mm (1/5 of an inch) incision under local anesthesia. The ENTIRE biopsy takes 15 minutes. The patients can drive themselves home!

Most often, these biopsies are benign and then the patient has the satisfaction of knowing that everything is OK! In the less common event that the biopsy returns suspicious or cancerous cells, I can sit down and talk to the patient and family members to discuss the current options of surgical management. This usually includes a “lumpectomy” (otherwise known as breast conserving therapy), sentinel lymph node biopsy (another minimally invasive biopsy technique) and then followed by radiation therapy.

With the help of this new, minimally invasive technology, the doctors at TCHC can deliver quicker, more effective care to you. We still deliver good ol’ fashioned hometown care, but with this new technology, the patient is even BETTER cared for!



About Dr. McCullough: Dr. McCullough is a radiologist at Wadena Clinic. He graduated from the University of Minnesota School of Medicine in Minneapolis and completed his residency at the University of Minnesota. In his spare time, he enjoys fishing and deer hunting.

About Dr. Kloss: Dr. Kloss is a board-certified general surgeon at Tri-County Health Care. In his free time, Dr. Kloss is an avid marathon runner. His race résumé includes the Marine Corps Marathon in Washington, D.C., as well as marathons in Dublin, Ireland; Paris, France; and Pittsburgh. He also ran the Twin Cities Marathon for the Leukemia and Lymphoma Society and the New York City marathon for the American Cancer Society. Dr. Kloss also earned Ironman status, having completed the Madison, Wisconsin, Ironman race in 2014.

Two New Tools in the Fight Against Breast Cancer

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By: Shannon Brauch, RN, TCHC Breast Navigator

3D Mammography

ret9992-4x6When it comes to breast health, every woman deserves the very best care possible. With the addition of 3D Mammography and Minimally Invasive Breast Biopsies at Tri-County Health Care, that is exactly what they will get.

A revolutionary tool in the early detection of breast cancer, 3D Mammography is the new standard in breast cancer screening today, with Tri-County’s new Genius 3D technology providing a 41% increase in the detection of invasive breast cancers compared to 2D alone, as well as up to a 40% reduction in anxiety producing false-positive recalls. The result is greater accuracy in diagnosis and ideally, reduced stress on the patient.

Who should have a Mammogram?

It’s recommended that all women 40 years of age and older receive an annual mammogram.

With 3D mammography, do I still need an annual screening?

Yes. All women are at risk for breast cancer, regardless of symptoms or family history. Mammograms often can detect potential problems before they can be felt. Early detection greatly increases treatment options and the likelihood of successful recovery.

Is 3D Mammography safe?

3D mammography is quite safe. Radiation exposure to the breast is very low. In fact, the radiation dose for a combined 2D/3D mammography exam is well below the acceptable limits defined by the FDA, and is only a fraction of the level of radiation you receive from natural sources.

Minimally Invasive Breast Biopsiesret9856-4x6

One of the only systems in the immediate region to offer minimally invasive breast biopsies, Tri-County Health Care is committed to providing female patients with care and technology required for the early detection and treatment of breast cancer.

A minimally invasive breast biopsy (or Stereotactic Breast Biopsy) is a procedure that uses mammography to precisely identify and biopsy an abnormality within the breast. It is normally done when the radiologist sees a suspicious abnormality on a mammogram that can’t be felt in a physical exam. This procedure will help determine whether or not you have breast cancer or any other concerning abnormalities in your breast.

Utilizing 3D Mammography as a guide, stereotactic breast biopsies use mammographic images to locate and target the area of concern and to help guide the biopsy needle to a precise location. This technique helps ensure the area that is biopsied is the exact area where the abnormality was seen on the mammogram.

Benefits of Minimally Invasive Breast Biopsies

A stereotactic breast biopsy is less invasive than a surgical biopsy, requires less recovery time and causes minimal scaring. Women who undergo the procedure can be in and out of the hospital the same day and able to sleep in their own bed that night.

Why is a Minimally Invasive Breast Biopsy Performed?

A breast biopsy is typically done if your doctor becomes concerned following a mammogram or breast ultrasound. It is used to investigate irregularities (such as a lump) in the breast.

Shannon Brauch, RN

Shannon Brauch, RN

About the Author: Shannon Brauch, RN, is the TCHC Breast Navigator. In her role she paves the path for women with breast health concerns and helps patients and their families navigate through the health care system. To learn more click here:



*Article was originally printed in Healthy Times Summer 2016.

Breast Health Navigator Eases Patient’s Concerns

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By: Shannon Brauch, RN, Women’s Health Coordinator

It wasn’t that long ago that patients with questions or concerns related to their breast health would rely heavily on their family and their own research to compliment what their doctor was telling them about an abnormal mammogram or other breast concerns.

When faced with a possible breast cancer diagnosis, women’s heads fill immediately with questions and concerns or frightful statistics they find when surfing the web. I have witnessed women whose minds were going 100 miles per hour. It’s these women who have found it nice to have someone else “be in charge” and guide them through this overwhelming process.


My role as a breast navigator is to try to pave the path for a woman who have breast health concerns. I help with referrals and scheduling appointments. I also work with our medical team to try to help women understand what their diagnosis really means. And, despite the fact that one in eight women will be diagnosed with breast cancer during her lifetime, there is some good news—98% of women will survive if their breast cancer is found early. More woman are getting regular mammograms, cancer is being detected earlier and breast navigation is gaining in popularity because it fills so many gaps in the current American health care system.

The original concept of patient navigation was pioneered in 1990 by Harold P. Freeman, MD, a surgical oncologist at Harlem Hospital, for the purpose of eliminating barriers to timely cancer screening, diagnosis, treatment and supportive care. Since Dr. Freeman’s groundbreaking work in Harlem, the concept of navigation or advocacy has grown far beyond cancer and now covers almost anything being done to help patients and families find their way through the maze of our health care system.

The role of the Breast Health Navigator has evolved to meet the changing demands of breast health care. The complexity of breast health treatment and the growing demand for out-patient services requires a trained nurse case manager with the ability to increase patient outcomes and patient satisfaction while containing costs. The Breast Health Navigator serves as a consistent coordinator throughout the continuum of care assessing the physical, educational, psychological and social needs of the patient. And, if the patient is diagnosed with breast cancer, I work seamlessly with our surgical team and I am always available as a resource to the oncology team when needed.

As a Breast Navigator at Tri-County Health Care, I feel privileged to be able to support and guide our patients, and their loved ones, through their journey. The support and guidance starts with our initial conversation and continues we me as the point of contact each step of the journey. I like to think of myself as a proactive patient representative who provides support, education and guidance through complex health care issues and treatment as they relate to breast health, and sometimes the diagnosis of breast cancer. I like to think of myself as a communication link between the patient and other care providers.

During our first conversation, I like to share with my patients that I value open communication and reassure them that I will be with them through every step of the journey. It’s important that my patients know that I will visit with them, occasionally on the phone and sometimes in person, before, during or after appointments, testing and surgery.

breast cancer awareness

Breast health concerns are a priority for women and at Tri-County Health Care we value the experience of our patients and believes it’s important to develop individualized treatment plans for our patients. This individualized approach assures that patients receive timely, quality care and I work diligently to remove barriers that stand between the patient and effective, comprehensive care. Part advocate, part teacher, part problem solver, part advisor, part friend, the nurse navigator provides one-on-one emotional support and services to help ease the burden for breast health patients and their loved ones.

As their trusted breast navigator, I believe it is important to be intricately involved with all areas of care related to my patient’s health. I work closely with our Tri-County Health Care surgeons, Dr. VanBruggen and Dr. Kloss and their nurses to schedule consultations, biopsies and follow-up appointments. When it’s the wish of the patients, I will go with the patient to their breast biopsy and offer support as needed.

The benefit of working with a nurse navigator is that there is never any pressure or rush put on the patients during their visits and if they forget to ask a question during the appointment, they can always call the breast navigator later when they think of it.

As a registered nurse, I am qualified and honored to provide not only information that helps patients navigate through their journey, from diagnosis to recovery and beyond, I also provide emotional support. By helping women through this process, I believe we provide hope.

If you or someone you know would like more information about the breast navigation program at Tri-County Health Car or about breast cancer screenings, diagnosis, treatment or follow-up care, please call me at 218-632-8182 or 218-639-4517.

Shannon, Brian and their beautiful three children.

Shannon, Brian and their beautiful three children.

About the Author:

Shannon is a lifetime resident of Wadena. Her husband Brian and her have three beautiful children Mason 9, McKenna 6 and Aubrey 3. They’ll be welcoming their fourth child in December. Shannon is currently the Women’s Health Coordinator and Breast Navigator at Tri-County Health Care. In her free time, she enjoys spending time with her family and friends and doing anything outdoors.