Diagnostic Procedures for Breast Cancer

How is breast cancer diagnosed?

It is important to remember that a lump or other changes in the breast, or an abnormal area on a mammogram, may be caused by cancer or by other, less serious problems.

To determine the cause of any signs or symptoms, your physician will perform a careful physical examination that includes:

• personal and family medical history
• current overall health status
• one or more of these breast examinations:
  
  
  • palpation - carefully feeling the lump and the tissue around it - its size, its texture, and whether it moves easily. Benign (noncancerous) lumps often feel different from cancerous ones.
  • nipple discharge examination - fluid may be collected from spontaneous nipple discharge and then sent to the lab to look for cancer cells. Most nipple secretions are not cancer, as an injury, infection, or benign tumor may cause discharge.

For women who are at high risk for breast cancer, a procedure called ductal lavage may be used. Ductal lavage is a procedure that collects cells from inside the milk ductal system - the location where most breast cancers begin.

In addition to a physical examination by your physician, an imaging test will be performed. Imaging tests may include one or more of the following:

• diagnostic mammography - a diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.
  
  

• ultrasonography - high-frequency sound waves, not heard by humans. The sound waves enter the breast and bounce back. The pattern of their echoes produces a picture called a sonogram, which is displayed on a screen. This examination is often used along with mammography.

• scintigraphy - a breast scan is a specialized radiology procedure used to assess the breasts when other examinations have been inconclusive. A breast scan is a type of nuclear radiology procedure. This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the breasts. The radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is absorbed by certain types of body tissues.

Based on these exams, your physician may decide that no futher tests are needed and no treatment is necessary. In such cases, your physician may want to check you regularly to watch for any changes.

Often, however, the physician must remove fluid or tissue from the breast to be sent to the lab to look for cancer cells. The procedure, called biopsy, may be performed using a needle to acquire a tissue sample or a surgical method.

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A breast biopsy is a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery to determine if cancer or any abnormal cells are present.

Biopsies may be performed under local or general anesthesia. There are several types of breast biopsy procedures. The type of biopsy performed will depend upon the location and size of the breast lump or abnormality.

Types of breast biopsy procedures include, but are not limited to, the following:

• fine needle biopsy aspiration - a very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help differentiate a cyst from a lump.
  
• core needle biopsy - a large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.
  
• surgical biopsy (also called an open biopsy) - a surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are two types of surgical biopsies. During an incisional biopsy, a small part of the lump is removed; whereas during an excisional biopsy, the entire lump is removed.

In some cases, if the breast lump is very small and deep and is difficult to locate, the wire localization technique may be used during surgery. With this technique, a special wire is placed into the lump under x-ray guidance. The surgeon follows this wire to help locate the breast lump.

There are special instruments and techniques that may be used to guide the needles and to assist with biopsy procedures. These include, but are not limited to, the following:

• stereotactic biopsy - stereotactic biopsy locates the exact location of a breast lump or suspicious area by using a computer and mammography to create a three-dimensional (3D) picture of the breast. A sample of tissue is removed with a needle.

• Mammotome® breast biopsy system (also called vacuum-assisted biopsy) - a type of tube is inserted into the breast lump or mass. The breast tissue is gently suctioned into the tube, and a rotating knife removes the tissue. In 1999, the US Food and Drug Administration (FDA) approved the use of the hand-held Mammotome device.

• ultrasound-guided biopsy - a technique that uses a computer and a transducer that sends out ultrasonic sound waves to create images of the breast lump or mass. This technique helps to guide the needle biopsy.

• sentinel lymph node biopsy - a procedure that is used to determine if cancer cells have spread to other parts of the body. This procedure involves injecting a dye and/or radioactive substance near the tumor. This injection helps to locate the lymph node closest to the tumor (sentinel node) - the one that is most likely to have cancer cells present if the cancer has spread. The surgeon removes the lymph node that absorbs the dye and radioactive substance and sends it to the pathologist to examine it closely for the presence of cancer cells.

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Breast Care at the
Breast Imaging Center at Rush

The Rush Breast Imaging Center was designed around womens needs. The center has been designed based on what women told us they wanted. Our facility is designed to put women at ease.

For more information, visit the Rush Breast Imaging Center home page.

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