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StaceyVitielloMD
(Physician
- Radiology
(Verified)
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| Communities: Breast Cancer | Thank You's: 0 |
| Member Since: Jan. 2012 | Questions: 0 |
| Answers: 8 |
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Professional Statement
Dr. Vitiello completed her Fellowship in Breast Imaging at Yale University Medical Center, where she received the Yale Department of Radiology Fellow of the Year Award in 2000. She served as Chief Resident during her residency in Diagnostic Radiology at Beth Israel Medical Center in Manhattan. Dr. Vitiello has lectured to a wide variety of audiences on topics related to the early detection of breast cancer, and has authored a chapter on Breast Ultrasound for a well-known text, Roses’ Breast Cancer. She is a member of many professional societies, including the Society of Breast Imaging and the American Society of Breast Diseases.
Her years of clinical experience have honed her expertise in breast MRI, mammography, breast ultrasound, and minimally-invasive needle biopsies, which she now brings to Montclair Breast Center. Experiences with her patients and their families have resulted in her passionate advocacy for high-quality, individualized screening for all women. She is currently building a website and blog, “What Smart Women Need to Know About Breast Cancer” to share crucial information with a wider audience, and to give women the tools they need to navigate an often confusing, contradictory and impersonal “healthcare system.”
Her years of clinical experience have honed her expertise in breast MRI, mammography, breast ultrasound, and minimally-invasive needle biopsies, which she now brings to Montclair Breast Center. Experiences with her patients and their families have resulted in her passionate advocacy for high-quality, individualized screening for all women. She is currently building a website and blog, “What Smart Women Need to Know About Breast Cancer” to share crucial information with a wider audience, and to give women the tools they need to navigate an often confusing, contradictory and impersonal “healthcare system.”
Professional Info
Credential:
MD
Primary specialty:
Radiology
Medical school:
UMDNJ - Robert Wood Johnson Medical School
Residency:
Beth Israel Medical Center
Fellowship:
Yale University Medical Center
Areas of expertise:
Breast imaging - mammograms, breast ultrasound, breast MRIs, nuclear medicine exams
Practice name:
Montclair Breast Center
Practice address:
37 N. Fullerton Ave.
Montclair, NJ
07042
Practice phone number:
(973) 509-1818
Webpage:
http://staceyvitiellomd.com
Twitter
https://twitter.com/staceyvitmd
Personal Bio (My story)
Dr. Vitiello grew up in Harrington Park, NJ and attended high school at Northern Valley Regional High School in Old Tappan. She then completed her undergraduate studies at Georgetown University, graduating with honors, and returned to New Jersey to attend medical school at UMDNJ- Robert Wood Johnson Medical School. Dr. Vitiello and her husband are raising their two daughters, ages 7 and 10, in the city of Hoboken.
StaceyVitielloMD Activities
If the target for biopsy is microcalcifications, the adequacy of the specimen can be confirmed by doing a modified mammogram on the obtained specimens, to make sure that calcifications are within the tissue being sent to the pathologist. For masses and other types of biopsied lesions, it’s a bit trickier. For all biopsies, the amount of tissue collected can be visually assessed by the doctor performing the biopsy. For ultrasound-guided biopsies, the needle can be seen in real-time on the screen, and the doctor can see the biopsy needle going through the sampled lesion. For an MRI-guided biopsy, the MRI images taken with the biopsy needle in position are important for confirmation of appropriate tissue sampling. Knowing that there is always room for sampling error by the needle, most radiologists recommend six-month follow-up imaging of the biopsied breast, to confirm that the area biopsied has not changed in any significant way. In addition, when the radiologist receives the pathology report from the biopsy, he/she decides if this result from the pathologist is “concordant” with the imaging findings. If the pathology is not an acceptable answer for the radiologist’s findings (discordant), the radiologist will recommend that the lesion be taken out surgically to confirm benignity.
If the target for biopsy is microcalcifications, the adequacy of the specimen can be confirmed by doing a modified mammogram on the obtained specimens, to make sure that calcifications are within the tissue being sent to the pathologist. For masses and other types of biopsied lesions, it’s a bit trickier. For all biopsies, the amount of tissue collected can be visually assessed by the doctor performing the biopsy. For ultrasound-guided biopsies, the needle can be seen in real-time on the screen, and the doctor can see the biopsy needle going through the sampled lesion. For an MRI-guided biopsy, the MRI images taken with the biopsy needle in position are important for confirmation of appropriate tissue sampling. Knowing that there is always room for sampling error by the needle, most radiologists recommend six-month follow-up imaging of the biopsied breast, to confirm that the area biopsied has not changed in any significant way. In addition, when the radiologist receives the pathology report from the biopsy, he/she decides if this result from the pathologist is “concordant” with the imaging findings. If the pathology is not an acceptable answer for the radiologist’s findings (discordant), the radiologist will recommend that the lesion be taken out surgically to confirm benignity.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Biopsy, Breast Cancer Screening, Breast Biopsy, Breast Cancer Diagnosis
1
Answer |
3 months ago
Over the past 20 years, the standard of care for sampling suspicious lesions in the breast has evolved from open surgical biopsies to the modern standard of minimally-invasive needle biopsy. Over many years, studies have confirmed that needle biopsies are as accurate as surgical biopsies in diagnosing breast cancer, and the needle has advantages: no operating room visit, less invasive, minimal if any scarring, no stitches, fewer complications, less expensive, quicker to perform. In addition, if cancer is diagnosed with a needle biopsy, the patient will have a greater chance of having just one surgery. (If the cancer is diagnosed on a surgical biopsy, the patient usually has to return to the operating room a second time to get all of the cancer out, and to sample the lymph nodes under the arm.) Although most biopsies can be performed with a needle, approximately 10% of biopsies must be performed surgically. The reasons include: living in a region where there are no specialists trained to perform the needle biopsy; the location of the lesion might be in a part of the breast that the needle cannot safely reach; patient inability to cooperate with positioning for the needle biopsy; medical conditions that make direct control of bleeding in the operating room necessary; a breast that is too small or large to allow for the biopsy to be performed with a needle; the presence of an implant, which might not allow for a needle biopsy without a high risk of rupturing the implant.
Over the past 20 years, the standard of care for sampling suspicious lesions in the breast has evolved from open surgical biopsies to the modern standard of minimally-invasive needle biopsy. Over many years, studies have confirmed that needle biopsies are as accurate as surgical biopsies in diagnosing breast cancer, and the needle has advantages: no operating room visit, less invasive, minimal if any scarring, no stitches, fewer complications, less expensive, quicker to perform. In addition, if cancer is diagnosed with a needle biopsy, the patient will have a greater chance of having just one surgery. (If the cancer is diagnosed on a surgical biopsy, the patient usually has to return to the operating room a second time to get all of the cancer out, and to sample the lymph nodes under the arm.) Although most biopsies can be performed with a needle, approximately 10% of biopsies must be performed surgically. The reasons include: living in a region where there are no specialists trained to perform the needle biopsy; the location of the lesion might be in a part of the breast that the needle cannot safely reach; patient inability to cooperate with positioning for the needle biopsy; medical conditions that make direct control of bleeding in the operating room necessary; a breast that is too small or large to allow for the biopsy to be performed with a needle; the presence of an implant, which might not allow for a needle biopsy without a high risk of rupturing the implant.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Biopsy, Breast Cancer, Minimally-invasive Needle Biopsy, Breast Biopsy, Needle Biopsy
1
Answer |
3 months ago
For stereotactic biopsies and MRI-guided biopsies, I use a vacuum-assisted device.
For ultrasound-guided biopsies, I have found both core needles and vacuum devices to be equally successful in my experience, although the scientific literature reports fewer false-negatives with the vacuum-assisted devices. I prefer to use the smaller, less expensive, less scary core needle when possible. If a lesion is very small or subtle on the sonogram, I tend to use the vacuum-assisted device to obtain larger specimens and ensure adequate sampling. For stereotactic biopsies and MRI-guided biopsies, I use a vacuum-assisted device.
For ultrasound-guided biopsies, I have found both core needles and vacuum devices to be equally successful in my experience, although the scientific literature reports fewer false-negatives with the vacuum-assisted devices. I prefer to use the smaller, less expensive, less scary core needle when possible. If a lesion is very small or subtle on the sonogram, I tend to use the vacuum-assisted device to obtain larger specimens and ensure adequate sampling.
For ultrasound-guided biopsies, I have found both core needles and vacuum devices to be equally successful in my experience, although the scientific literature reports fewer false-negatives with the vacuum-assisted devices. I prefer to use the smaller, less expensive, less scary core needle when possible. If a lesion is very small or subtle on the sonogram, I tend to use the vacuum-assisted device to obtain larger specimens and ensure adequate sampling. For stereotactic biopsies and MRI-guided biopsies, I use a vacuum-assisted device.
For ultrasound-guided biopsies, I have found both core needles and vacuum devices to be equally successful in my experience, although the scientific literature reports fewer false-negatives with the vacuum-assisted devices. I prefer to use the smaller, less expensive, less scary core needle when possible. If a lesion is very small or subtle on the sonogram, I tend to use the vacuum-assisted device to obtain larger specimens and ensure adequate sampling.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Biopsy, Breast Tissue Sample, Breast Biopsy, Vacuum Assisted Device, Core Needle
2
Answers |
3 months ago
When you schedule your mammogram, try to avoid any times in the month when you know your breasts are bound to be more tender. No need to suffer if you don’t have to. You might also consider taking a dose of Ibuprofen or Tylenol about an hour before your appointment time. On the morning of your mammogram, do not put on deodorant, creams or powder. These things can potentially cause artifacts on the films, and result in you being called back for more pictures. In terms of your outfit on the day of your mammogram, it’s better to choose two pieces (top with pants or a skirt) rather than a dress, since you’ll be asked to undress from the waist up. Finally, if you’ve had breast imaging studies in the past at a different facility, get copies of the films and reports to either bring with you on the day of your test, or have them sent in advance. Having prior films for comparison makes the reading more accurate, and you’ll be less likely to get called back for additional pictures.
I tell patients to schedule the mammo just at the end of menses or shortly thereafter so it doesn't hurt so much. Try a morning appt and do not use deodorant, lotion, or powder as it sometimes can show up as calcifications [which are really on the skin but the radiologist can't tell]. This could result in a call back and unnecessarily upset you. Bring your deodorant with you and put it on after your mammo. And lastly don't assume that "no news is good news". If you haven't gotten a letter in a couple of weeks, call the doctor who ordered the mammo to get results. Human error happens.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Preparing For Mammogram, Breast Cancer Screening, Breast Cancer, Mammogram, Breast Imaging
3
Answers |
3 months ago
If you follow the news reports about breast cancer risk, it seems that recommendations change practically every day. However, there are a few lifestyle factors that I advise my patients to consider, since I believe there is enough scientific evidence to support them.
1. Exercise (brisk walking) 30 minutes per day at least 5 days per week led to a 20% decreased risk of breast cancer in the longstanding Women’s Health Initiative study.
2. Keep Body Mass Index (BMI) under 25. Being overweight increases the risk of breast cancer after menopause by 25%. Limiting red meat also seems to be useful.
3. Quit smoking. Many years of smoking increases breast cancer risk up to 30%. Secondhand smoke also seems to be a risk factor for non-smokers to develop pre-menopausal breast cancer.
4. Limit alcohol. 2-5 drinks per day leads to a 1 ½ times risk of breast cancer compared to non-drinkers. A recent small study suggested that red wine might be an exception, but more data is needed on this to know for sure.
5. Avoid exogenous hormones if you can. At the current time, we don’t know if there is a “safe” level or type. Many of the suggestions for lowering risk for breast cancer are the same recommendations I would give to lower the risk for most chronic illness. I like to speak in terms of creating the optimal healing environment in the body.
- Engage daily in moderate physical activity
- Avoid alcohol, transfats and processed foods
- Use stress reductions techniques often
- Have a positive mental outlook
- Detoxify your living environment, use less synthetic chemicals in your day to day life. Use products that are healthier for your body and the environment.
1. Exercise (brisk walking) 30 minutes per day at least 5 days per week led to a 20% decreased risk of breast cancer in the longstanding Women’s Health Initiative study.
2. Keep Body Mass Index (BMI) under 25. Being overweight increases the risk of breast cancer after menopause by 25%. Limiting red meat also seems to be useful.
3. Quit smoking. Many years of smoking increases breast cancer risk up to 30%. Secondhand smoke also seems to be a risk factor for non-smokers to develop pre-menopausal breast cancer.
4. Limit alcohol. 2-5 drinks per day leads to a 1 ½ times risk of breast cancer compared to non-drinkers. A recent small study suggested that red wine might be an exception, but more data is needed on this to know for sure.
5. Avoid exogenous hormones if you can. At the current time, we don’t know if there is a “safe” level or type. Many of the suggestions for lowering risk for breast cancer are the same recommendations I would give to lower the risk for most chronic illness. I like to speak in terms of creating the optimal healing environment in the body.
- Engage daily in moderate physical activity
- Avoid alcohol, transfats and processed foods
- Use stress reductions techniques often
- Have a positive mental outlook
- Detoxify your living environment, use less synthetic chemicals in your day to day life. Use products that are healthier for your body and the environment.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Reduce Breast Cancer Risk, Breast Cancer, Breast Cancer Risk, Reduce Cancer Risk, Cancer
3
Answers |
3 months ago
We use Breast Specific Gamma Imaging (BSGI), which is a molecular breast imaging test, at my practice in certain circumstances. This is a nuclear medicine study where a radioactive substance is injected into an IV catheter in the patient’s arm, and images of the breasts are obtained with the patient in a seated position. The test looks for spots in the breast that become “hot”, or that take up the radiotracer more avidly than the surrounding tissue. Although not all hot spots will be cancerous, they do need to be checked with further tests. If the BSGI is negative, there is a very high likelihood that no cancer is present in the breast.
At my practice, we use MRI (in addition to mammography) to screen patients at high risk for breast cancer, to further evaluate questionable mammographic, sonographic, or clinical findings, and to fully evaluate both breasts in patients newly diagnosed with breast cancer. Sometimes a patient cannot have an MRI, and in those circumstances we will usually recommend a BSGI test instead. Patients unable to have an MRI (with contrast) include: claustrophobic patients; those with pacemakers or other implanted devices that are not MRI-compatible; patients with metal aneurysm clips in their brain, or with metal fragments in their eyes; severe kidney disease; patients whose bodies are too large for the MRI unit; allergy to Gadolinium contrast dye. We use Breast Specific Gamma Imaging (BSGI), which is a molecular breast imaging test, at my practice in certain circumstances. This is a nuclear medicine study where a radioactive substance is injected into an IV catheter in the patient’s arm, and images of the breasts are obtained with the patient in a seated position. The test looks for spots in the breast that become “hot”, or that take up the radiotracer more avidly than the surrounding tissue. Although not all hot spots will be cancerous, they do need to be checked with further tests. If the BSGI is negative, there is a very high likelihood that no cancer is present in the breast.
At my practice, we use MRI (in addition to mammography) to screen patients at high risk for breast cancer, to further evaluate questionable mammographic, sonographic, or clinical findings, and to fully evaluate both breasts in patients newly diagnosed with breast cancer. Sometimes a patient cannot have an MRI, and in those circumstances we will usually recommend a BSGI test instead. Patients unable to have an MRI (with contrast) include: claustrophobic patients; those with pacemakers or other implanted devices that are not MRI-compatible; patients with metal aneurysm clips in their brain, or with metal fragments in their eyes; severe kidney disease; patients whose bodies are too large for the MRI unit; allergy to Gadolinium contrast dye.
At my practice, we use MRI (in addition to mammography) to screen patients at high risk for breast cancer, to further evaluate questionable mammographic, sonographic, or clinical findings, and to fully evaluate both breasts in patients newly diagnosed with breast cancer. Sometimes a patient cannot have an MRI, and in those circumstances we will usually recommend a BSGI test instead. Patients unable to have an MRI (with contrast) include: claustrophobic patients; those with pacemakers or other implanted devices that are not MRI-compatible; patients with metal aneurysm clips in their brain, or with metal fragments in their eyes; severe kidney disease; patients whose bodies are too large for the MRI unit; allergy to Gadolinium contrast dye. We use Breast Specific Gamma Imaging (BSGI), which is a molecular breast imaging test, at my practice in certain circumstances. This is a nuclear medicine study where a radioactive substance is injected into an IV catheter in the patient’s arm, and images of the breasts are obtained with the patient in a seated position. The test looks for spots in the breast that become “hot”, or that take up the radiotracer more avidly than the surrounding tissue. Although not all hot spots will be cancerous, they do need to be checked with further tests. If the BSGI is negative, there is a very high likelihood that no cancer is present in the breast.
At my practice, we use MRI (in addition to mammography) to screen patients at high risk for breast cancer, to further evaluate questionable mammographic, sonographic, or clinical findings, and to fully evaluate both breasts in patients newly diagnosed with breast cancer. Sometimes a patient cannot have an MRI, and in those circumstances we will usually recommend a BSGI test instead. Patients unable to have an MRI (with contrast) include: claustrophobic patients; those with pacemakers or other implanted devices that are not MRI-compatible; patients with metal aneurysm clips in their brain, or with metal fragments in their eyes; severe kidney disease; patients whose bodies are too large for the MRI unit; allergy to Gadolinium contrast dye.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Breast Cancer, Breast Imaging, Molecular Breast Imaging, Breast Cancer Detection
1
Answer |
3 months ago
We look for microcalcifications, masses, and architectural distortion on mammography; solid masses on ultrasound; and enhancing masses or lesions that “light up” with contrast on MRI. No imaging feature is 100% indicative of malignancy, and very often tissue sampling is needed to arrive at a diagnosis.
We look for microcalcifications, masses, and architectural distortion on mammography; solid masses on ultrasound; and enhancing masses or lesions that “light up” with contrast on MRI. No imaging feature is 100% indicative of malignancy, and very often tissue sampling is needed to arrive at a diagnosis.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Breast Imaging, Breast Cancer Detection
1
Answer |
3 months ago
A short-term follow-up MRI is usually recommended if the radiologist saw something on the original MRI that he/she thought was most likely benign (not cancer), but wants to be more certain. If the finding doesn’t change over time, the radiologist can more confidently call it benign.
A “clogged milk duct” generally refers to a duct in the breast that looks dilated, and may have some debris within it. It is usually a benign finding, but if the radiologist is not sure why the duct is blocked, he/she may choose to either biopsy it or follow it depending on how it looks on the MRI. A short-term follow-up MRI is usually recommended if the radiologist saw something on the original MRI that he/she thought was most likely benign (not cancer), but wants to be more certain. If the finding doesn’t change over time, the radiologist can more confidently call it benign.
A “clogged milk duct” generally refers to a duct in the breast that looks dilated, and may have some debris within it. It is usually a benign finding, but if the radiologist is not sure why the duct is blocked, he/she may choose to either biopsy it or follow it depending on how it looks on the MRI.
A “clogged milk duct” generally refers to a duct in the breast that looks dilated, and may have some debris within it. It is usually a benign finding, but if the radiologist is not sure why the duct is blocked, he/she may choose to either biopsy it or follow it depending on how it looks on the MRI. A short-term follow-up MRI is usually recommended if the radiologist saw something on the original MRI that he/she thought was most likely benign (not cancer), but wants to be more certain. If the finding doesn’t change over time, the radiologist can more confidently call it benign.
A “clogged milk duct” generally refers to a duct in the breast that looks dilated, and may have some debris within it. It is usually a benign finding, but if the radiologist is not sure why the duct is blocked, he/she may choose to either biopsy it or follow it depending on how it looks on the MRI.
New answer by StaceyVitielloMD (Physician - Radiology (Verified)) in topic(s) Breast Cancer Screening, Clogged Milk Duct, MRI (Magnetic Resonance Imaging), Breast Imaging
1
Answer |
3 months ago
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