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Tests - If Cancer is Suspected

If something unusual is found on your mammogram, or if you or your doctor find a lump, other tests to determine whether you have cancer need to be done.

Your doctor may suggest imaging tests such as a diagnostic mammogram and/or a breast ultrasound. These tests can sometimes determine whether a lump is benign.

A ductogram is a test that can be helpful in determining the cause of a nipple discharge. During a ductogram, a small tube is inserted into the milk duct of the nipple. Dye is injected to allow x-ray technicians to visualize the inside of the duct.

A fine needle aspiration (FNA) may be used to remove fluid or cells from the affected area of the breast. This test can be done in your physician's examining room. If the lump is a cyst, draining the fluid will make it disappear. If the lump is solid, then a sample of cells is tested for cellular changes. A negative result from a FNA may not be reliable. If the lump feels worrisome, then one of the more definitive biopsy techniques below will be needed.

A biopsy is a procedure in which cells from the breast are removed for laboratory study. It is the only way to determine if you have breast cancer. In this way, doctors determine what type of cancer you have and whether the cancer is invasive. There are several kinds of biopsies. These techniques give the pathologist a chance to assess the tissue structure and can differentiate between localized (in situ) and infiltrating (invasive) cancer.

A biopsy is performed either in the radiology department or on an outpatient basis in the hospital depending on which of the following procedures is used:

  • Ultrasound guided core needle biopsy - A procedure where tissue is removed through a needle guided by ultrasound.
  • Stereotactic core needle biopsy - A procedure where tissue is removed through a needle guided by stereotactic mammography.
  • An open biopsy is performed in the operating room of a hospital. The lump/mass is removed as well as the surrounding tissue. A preliminary diagnosis is usually given at this point using quick section analysis.

Laboratory Analysis

The biopsy sample is processed in the laboratory and the tissue is examined under a microsope.

If the tissue is cancerous, then the biopsy sample is given a grade. This grade helps predict the prognosis or outcome. Cancers that closely resemble normal breast tissue tend to grow and spread more slowly. In general, a lower grade number corresponds with a slower-growing cancer. A higher number indicates a faster-growing cancer. Our treatment section outlines the treatment of each stage.

The biopsy sample can also be used to see whether it has receptors for certain hormones such as estrogen and progesterone. These cancers are referred to as ER-positive or PR-positive. Cancers with hormone receptors tend to have a better outlook than those without and are more likely to respond to hormonal therapy.

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