BREAST CANCER:

 diagnosis

If a woman has a breast abnormality, Saint John’s physicians will use diagnostic procedures to help determine the need for a biopsy.  Any of the following tests may be used:

Ultrasound

Ultrasound uses sound waves to create an image of the breast on a computer screen and then those images are analyzed by the physician.  Based on the ultrasound, a doctor may be able to tell whether a lump is a cyst or a solid mass.

Biopsy

A biopsy — a small sample of tissue removed for analysis in the laboratory — is the only test that can tell if cancer is present. Biopsies can provide important information about an unusual breast change and help determine whether surgery is needed and if so, the type of surgery required.

Types of biopsies include:

• Fine-needle aspiration biopsy. The doctor uses a thin, hollow needle to withdraw cells from the lump. He or she then analyzes the specimen under the microscope to look for abnormal cells.

• Core needle biopsy. A radiologist or surgeon uses a hollow needle to remove tissue samples from a breast lump.  The advantage of a core needle biopsy is that it removes more tissue for analysis.
  

• Stereotactic biopsy. This technique is used to sample and evaluate an area of concern, such as microcalcification, that can be seen on a mammogram but that cannot be seen on an ultrasound. During the procedure, a radiologist takes a core needle biopsy, using a mammogram as a guide. Stereotactic biopsy usually takes about an hour and is performed using local anesthesia.

• Wire localization. A woman’s doctor may recommend this technique when a lump is seen on a mammogram but cannot be evaluated with a stereotactic biopsy. Using a woman’s mammogram as a guide, a thin wire is placed in the breast and the tip guided to the lump. Wire localization is usually performed right before a surgical biopsy and is a way to guide the surgeon to the area of concern.

• Surgical biopsy. This remains one of the most accurate methods for determining whether a breast change is cancerous; however, this procedure is the most invasive of the biopsy techniques . During this procedure, the surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is large, only a sample will be taken (incisional biopsy). The biopsy is generally performed on an outpatient basis in a clinic or hospital.
  

Malignant cells removed in a biopsy can be tested for the presence of hormone receptors. If the cancer cells have receptors for estrogen or progesterone or both, a doctor may recommend treatment with a drug such as tamoxifen, which prevents estrogen from binding to these sites.