How is breast cancer diagnosed?
The tests and procedures used in the breast cancer diagnosis include:
- Breast examination for any lumps or other abnormalities
- Breast ultrasound
- Biopsy (Remove a sample of breast cells for testing)
- Breast MRI
Your doctor will examine the breasts and lymph nodes in armpit, for any lumps or other abnormalities. During the examination, the individual may need to sit or stand in different positions with their arms such as above their head or by their sides.
Annual mammograms are recommended for women who are 45 years of age and older but screenings can start as early as 40. A mammogram is an X-ray which takes only images of the breasts which help doctors locate abnormalities such as masses in your breasts that may signify cancer. Keep in mind that an abnormality on your mammogram does not automatically mean you have breast cancer; however further tests might be required to confirm the presence of cancer.
An ultrasound is a procedure that makes use of sound waves to produce images of the interior body. When a mass is detected in the mammogram your doctor can recommend an ultrasound to identify the mass. Your doctor may also advice an ultrasound if your breast features a visible lump. Ultrasounds help physicians decide whether a lump is a fluid or a solid. A fluid-filled mass would indicate a non-cancerous cyst. Some masses may be a fluid-solid mixture that is usually benign but may require short-term follow-up imaging or even a sample depending on what the ultrasound image looks like. A breast ultrasound is performed by placing the gel on the breasts and use a head held probe to create an image of breast tissue.
A biopsy extracts a tissue sample from a lump or mass to determine if it is malignant or benign. A breast biopsy can be done in many ways, depending on the tumor size. If the tumor is small and not very suspicious, the needle biopsy can be performed by a surgeon or radiologist. The doctor who performs this procedure inserts the needle into the breast and extracts a slice of tissue as the sample. Based on the doctor’s recommendation, this can be achieved with or without guidance on the imaging. In certain circumstances you may need a surgical biopsy that removes all or part of the lumps. The surgeon can remove any enlarged lymph nodes if any around the breast tissue.
For tissue evaluation, these biopsies are used as the gold standard procedure such as:
- Fine-needle aspiration biopsy: This type of biopsy is when the lump in the breast is solid. The doctor inserts a thin needle and retracts a tiny piece of tissue for further examination by a pathologist. In certain cases, the doctor may recommend to examine a suspected cystic lump in order to ensure that a cyst has no cancer
- Core needle biopsy: This procedure involves the use of a larger needle and tube to extract a tissue sample up to the size of a pen. The needle is guided by sensation, mammography or ultrasound. If the finding is best seen by mammogram in a woman, then a mammogram-guided biopsy is done. This is also known as stereotactic breast biopsy
- Surgical breast biopsy: A surgeon removes parst (incisional biopsy) or all (excisional biopsy, wide local excision, or lumpectomy) of a lump for assessment under a microscope in this type of biopsy. If the lump is small or hard to locate by touch, a procedure called wire localization may be used by the surgeon to map a route to the mass prior to the surgery. A wire can be inserted by ultrasound guidance or mammogram guidance
- Sentinel node biopsy: A sentinel node biopsy of the is a biopsy of a lymph node in which cancer most likely spreads first. In breast cancer, the axilla or armpit area from the lymph nodes are typically preferred for a sentinel node biopsy. This test is used to help assess the existence of cancer in cancer-affected lymph nodes on the side of the breast
- Image-guided breast biopsy: A doctor uses an imaging tool such as an ultrasound, mammogram, or MRI for an image-guided biopsy to create a real time image of a suspicious region that cannot be easily seen or felt through the skin. Your doctor will use this image to help direct a needle to spot the area where abnormal cells are collected
Analysis of these biopsies may help your doctor determine the breast cancer grade, the characteristics of the tumor and how your cancer will respond to certain treatments.
Breast MRI scan
Because of its higher risk for false positive results, an MRI scan is not typical used as a screening tool for breast cancer. But if you have breast cancer risk factors, your doctor may recommend MRI screenings with your annual mammograms as a precaution. This test uses a magnet and radio waves to get an image of the interior region of your breast.
Tests to Stage Breast Cancer
After you are diagnosed with breast cancer, the next step is to identify the stage of the disease. The doctor decides the best possible treatment based on the grade of cancer you have. Staging depends on the tumor size and its spread to other parts of the body beyond the breast. Cancer cells which spread to lymph nodes can travel to various parts of the body. Your doctor can recommend for complete blood profile during the staging process and conduct a mammogram of your other breast to test for signs of a tumor.
Your doctor can also use any of the following tests to assess the severity of the cancer and also to assist with the diagnosis including:
- Bone scan: Metastasized cancer can spread to the bones. A bone scan allows the doctor to test for signs of cancerous cells in the bones.
- CT scan: This is another type of X-ray to create detailed images of your organs. Your doctor may use a CT scan to see if cancer has spread outside the breast to other organs, such as chest, lung, or stomach area.
- MRI scan: Although this imaging test is not a standard screening method for breast cancer, it is useful in staging of the disease. An MRI produces digital images of different parts of the body. This will help the doctor decide whether the spinal cord, brain and other organs have been spread by the cancer cells.
- PET scan: A PET scan is a unique test that is performed by your doctor injecting a dye into your vein. As the dye travels through the body, 3-D images of the interior body are produced through a special camera. This helps the doctor to identify the location of tumors.