Diagnosis
If a woman has any symptoms of breast cancer, she should see a doctor as soon as possible. The doctor will conduct a physical exam and examine the breasts, nipples and lymph nodes. If the doctor suspects breast cancer, he or she may recommend additional diagnostic tests.
Imaging Tests
Here are some imaging tests used to help diagnose breast cancer:
Mammogram
A mammogram is an X-ray of the breast. Doctors use mammograms to screen for breast cancer in women with no symptoms, and to help diagnose the disease in women with breast lumps or other signs and symptoms.
Ultrasound
Ultrasound bounce sound waves off your internal organs and tissues in order to create echoes that form a picture.
Click Image to Enlarge.
Click Image to Enlarge.
Magnetic resonance imaging (MRI) mammography
Magnetic resonance imaging (MRI) uses radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer to show "slices" of the body. MRI scans are very useful for examining the soft tissues of the body.
Additional Tests
After diagnosis, the doctor may perform the following tests to evaluate the size of the tumor, and whether it has spread to lymph nodes or other organs. These tests will help the doctor determine the stage of the cancer and the best treatment plan.
Chest X-Ray
The doctor may order a chest X-ray to see whether the breast cancer has spread to the lungs. The doctor may also recommend that patients have a chest X-ray before surgery to make sure their hearts and lungs are healthy enough for the operation.
Mammogram
The doctor may order more detailed mammograms to get more thorough, precise views of the breasts.
Click Image to Enlarge.
Click Image to Enlarge.
Magnetic resonance imaging (MRI)
MRI scans of the breasts can be performed to get a better sense of how much cancer is in the breast. MRI scans can also be used to look for cancer metastases. A metastasis is a tumor that has spread to another part of the body. MRI scans are helpful in looking at the brain and spinal cord, and some organs in the abdomen.
Click Image to Enlarge.
Bone Scan
The doctor may order a bone scan to see if cancer has spread to the bones. A bone scan provides a picture of all of the bones in the body and allows doctors to detect small areas of cancer cells not visible on standard X-rays.
Click Image to Enlarge.
Computed tomography (CT) scan
The doctor may order a CT scan to find areas of cancer spread throughout the body. A CT scan takes many pictures as it rotates around the body. It produces detailed cross-sectional images of the body and allows doctors to study specific areas.
Ultrasound
Ultrasounds can also be used to search for cancer that may have spread. Doctors commonly use abdominal ultrasounds to look for tumors in the liver or other abdominal organs, and to see if cancer is present in the lymph nodes.
Click Image to Enlarge.
Positron emission tomography (PET) / Computed tomography (CT) scan
A CT scan produces detailed cross-sectional images of the body and allows doctors to study specific areas. A PET scan is a specialized test in which a mildly radioactive sugar is given through an IV catheter, and a scan is performed that detects areas of elevated radioactivity. Growing cancer cells will absorb higher amounts of the radioactive sugar than normal cells, which allows the cancer to be detected by the scan. An integrated PET-CT scan combines images from a PET scan and a CT scan to produce a more thorough image than either test alone. Both scans are performed at the same time using only one machine.
Click Image to Enlarge.
Digital Breast Tomosynthesis (DBT)
Digital breast tomosynthesis (DBT) is a new type of breast cancer screening examination that produces clearer and more detailed images of the breasts than standard mammograms.
In a standard mammography, the breast is compressed between two plates and low-dose X-ray images are taken from two angles: from the top and from the side. However, mammograms may occasionally produce false positive results or fail to detect a tumor. Dense breast tissue located near a tumor can reduce visibility of the tumor, causing it to be hidden on the mammogram.
In digital breast tomosynthesis, the breast is compressed between two plates and the machine rotates around the breast, taking images from multiple angles. These image are then processed by a computer and used to construct 3-dimensional images of the breast. These images are clearer and more detailed than those produced by a standard mammogram, and can improve the visibility and detection of tumors, and reduce the risk of falsely identifying a tumor.
Biopsy
The doctor performs a biopsy when mammograms and other diagnostic tests detect a breast abnormality that might be cancer. During a biopsy, a tissue sample is removed from the breast. The sample is sent to a laboratory where a pathologist examines it under a microscope. A biopsy is the only sure way to tell if cancer is present. Here are the types of biopsy the doctor may recommend:
Fine needle aspiration biopsy
A thin, hollow needle attached to a syringe is used to extract a tissue sample from a suspicious area.
Core needle biopsy
A larger needle is used to remove a small cylinder of tissue from the breast.
Vacuum-assisted biopsy
The doctor makes a small incision in the breast and inserts a hollow needle into the abnormal breast tissue. This needle is attached to a suction device that sucks a cylinder of tissue into the needle and cuts it from the breast with a rotating knife.
Surgical biopsy
The doctor uses a surgical knife to remove an area of abnormal breast tissue. This type of biopsy is performed when a prior needle biopsy shows suspicious findings and more tissue is needed for a definitive diagnosis. A surgical biopsy is also performed in situations where a core needle biopsy is not technically feasible. Whenever possible, a core needle biopsy is performed prior to surgical excision.
Image Guided Biopsy
If a breast abnormality cannot be seen or felt, but is only detectable by mammogram, ultrasound or MRI, the biopsy can be performed under direct imaging guidance. For example, if an abnormality can be detected by ultrasound, the biopsy can be performed by using the ultrasound device to guide the biopsy needle to the abnormality and to confirm that the correct area has been sampled.
Ultrasound Guided Biopsy
An ultrasound guided biopsy is performed for abnormalities that are seen on ultrasound. Breast cysts and solid masses are common abnormalities that can be sampled under ultrasound guidance. In an ultrasound guided biopsy, the doctor uses the ultrasound machine to locate the abnormality and collect a biopsy sample.
Stereotactic Biopsy
A stereotactic biopsy is performed for abnormalities that are seen only on mammogram. Calcifications are a type of abnormality that typically requires a stereotactic biopsy. In a stereotactic biopsy, the doctor uses a mammogram machine to locate the tumor and collect a biopsy sample. The patient lies down on a table and the breast is compressed with a paddle. The doctor then takes X-rays of the breast with the mammogram machine to locate the exact position of the tumor and determine the correct angle of entry for the needle. Once the needle is inserted, the doctor takes more X-rays to ensure the needle is in the correct position, and uses the needle to collect tissue samples from the breast.
Additional tests are performed if cancer is found to study the cancer cells themselves.
These tests reveal:
• How fast the cancer may grow
• How likely it is that the cancer may spread
• How effective certain treatments may work
• How likely the cancer is to come back
Estrogen and Progesterone Receptor Test
A test to measure the amount of estrogen and progesterone (hormones) receptors in the cancer tissue. If there are receptors for estrogen and/or progesterone present on the cancer cells, the cancer is called estrogen and/or progesterone receptor positive. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
Human Epidermal Growth Factor Type 2 Test (HER2/neu)
A laboratory test to measure how many copies of the HER2/neu genes, are present, and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target HER2/neu protein, such as trastuzumab and pertuzumab.
Mulitgene Tests
Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).
There are many types of multigene tests. The following multigene tests have been studied in clinical trials:
- Oncotype DX
Oncotype DX is a genomic test for breast cancer that evaluates the patient’s risk of recurrence and likely response to chemotherapy. Oncotype DX is recommended for patients with early-stage disease whose tumor cells are estrogen receptor positive and HER2/neu negative. The test analyzes the activity of 21 genes that have been identified as biomarkers for breast cancer. Based on the results of the test, the patient receives a Recurrence Score between 0 and 100. A low score means the patient has a low risk of recurrence and may not benefit from chemotherapy. A high score means the patient has a high risk of recurrence and would likely benefit from chemotherapy treatment.
Extensive research effort has been put on the development of additional molecular tests that can be used to predict the clinical course of the disease or response to different therapy options. Many of these are being tested in clinical trials.
- MammaPrint
This test helps predict whether Stage I or Stage II breast cancer that is node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.
