Diagnosis of Breast Disease
The use of these three tests means an accurate diagnosis can be made promptly. For women with an unusual lump that can be biopsied, there is good evidence that triple assessment gives a more accurate diagnosis than just using one or two tests.
However, some patients will only need a physical examination and imaging. A biopsy is only carried out if there is an abnormal area found through physical examination or imaging.
When the three tests give the same result, it is nearly always possible to give a definitive diagnosis, whether positive (cancer) or negative (not cancer – a benign condition or nothing abnormal), so appropriate treatment can be discussed as soon as possible.
All three tests should usually be carried out at the same visit to the breast unit to save you making several trips to hospital for the different tests.
Physical examination
This is an examination of your breasts, your armpits (axillae), the area around your collarbone, and your neck, carried out by a hospital doctor or specialist nurse.
Your breasts are examined to find any abnormalities, including lumps or other signs or symptoms of breast cancer. The other areas are examined to check for enlarged lymph nodes, which can be a sign of breast cancer.
Lymph nodes are glands found in your armpit and other areas of your body that are part of your immune system.
Breast imaging
This involves imaging the inside of your breasts using either a mammogram (an x-ray that uses very low doses of radiation) or an ultrasound examination (which uses sound waves). Some people may have both.
The best method of imaging for you will depend on your age and physical characteristics: If you are 40 or over, you should be given two-view mammography, which is mammography carried out at two angles for each breast. Additional views may also be required.
You may also have an ultrasound examination if your doctors think that this will provide useful extra information. Occasionally (for example for some patients with breast implants) a magnetic resonance imaging (MRI) investigation may be helpful, although this type of imaging is not routine for diagnostic assessment.
An MRI is a scan using radio waves and a magnetic field to create images of the body. If you are under 40 (or pregnant or breastfeeding), you are likely to have an ultrasound examination rather than a mammogram.
This is because breast tissue in younger women and those who are pregnant or breastfeeding is often denser, making the mammogram more difficult to interpret.
Any abnormalities are therefore usually picked up better by ultrasound than mammogram. However, you may need both types of imaging and it is possible for younger, pregnant or breastfeeding women to have a mammogram.
Biopsy
One of two techniques can be used to take a sample of cells (a biopsy) from the lump or area of abnormality in your breast and/or armpit: a core biopsy or Fine Needle Aspiration (FNA). A pathologist will examine the sample in the laboratory to determine whether or not it contains cancer cells.
A core biopsy or FNA can be used, although core biopsy is now more common. Either technique can be performed in an outpatient clinic, and you can go home afterwards. You should have a biopsy on the same day as your other tests. Both procedures use a needle and the results are usually available within a week. For a core biopsy, more than one sample is usually taken.
A local anaesthetic is always given beforehand. Although the biopsy itself should not be painful, the local anaesthetic injection may briefly cause discomfort. Some bruising can occur at the biopsy site, but the wound is too small to need stitches and should heal quickly.
For FNA, a thin needle is used to take a sample of cells from the breast lump or abnormal area in your breast and/or armpit. FNA can be painful for some women. The test tends to be more painful if the needle has to be inserted relatively deep into your breast or when the needle has to be moved around within the breast.
You may be offered a local anaesthetic before FNA to reduce any pain. However, because having a local anaesthetic can itself cause discomfort, many women choose not to have this injection.