Up to 15% of screening mammograms will require more testing. Sometimes, additional testing reveals a simple cyst. Other times it may be more serious. That’s why the latest imaging technology and procedures are important to minimize delayed or missed diagnoses. The experts at St. Joseph Hospital Comprehensive Breast Center have many sophisticated options to diagnose new cancers, as well as monitor and stage existing cancers. These options include minimally invasive procedures, which are used whenever possible to eliminate needless surgeries.
After a breast exam, a mammogram or an ultrasound, your doctor may determine that a biopsy is needed to make a diagnosis. A breast biopsy removes a sample of breast tissue that is examined under a microscope to determine whether the lump is cancerous (malignant) or not (benign).
If your doctor decides you need a biopsy, you may be referred to a surgeon or another specialist who has experience performing breast biopsies. There are several different types, and the one recommended for you will depend on what was learned from earlier breast exams.
This procedure involves inserting a thin needle into the breast to remove cells from a lump. These cells are then examined under a microscope. Local anesthesia may be given. This test may be done to determine whether a lump is solid or is a fluid-filled cyst. A cyst will collapse and disappear after the fluid is removed. If the lump is not a cyst, another type of biopsy may be done.
A core needle biopsy uses a larger needle than a fine needle aspiration, with a special tip. The patient lies on her back on a table. Under a local anesthesia, ultrasound guides the needle into the lump to remove a tissue sample that will be sent to a pathologist to check for cancer. A "post mammogram" is taken after the biopsy.
For masses that are visible using ultrasound, an ultrasound-guided breast biopsy is a highly accurate method to guide a biopsy needle into a suspicious area and remove tissue for further examination by a pathologist. This procedure uses high frequency sound waves instead of radiation. This type of biopsy is especially useful for abnormalities that show up on a mammogram or ultrasound, but can’t be felt by self-exam.
This biopsy is used to evaluate a lump that is seen on a mammogram, but cannot be felt during a breast examination. During the procedure, the patient lies on a specially designed table with an opening for the breast with their breast on a platform. If a table is used, the table is raised so that the radiologist and technologist can work underneath. A special type of X-ray precisely locates the part of the breast from where the biopsy sample is to be taken. Using local anesthesia, a needle is placed into the breast lump to extract cells that will be sent to a pathologist to check for cancer.
Performed under local anesthesia, this procedure involves placing a fine needle with a very thin wire into the breast at the site of a suspicious area found during a mammogram or breast ultrasound. The wire is as thin as a human hair. A second mammogram is done to make sure the needle is in the right place. Then, the lump or abnormal tissue is removed with a longwire. The tissue is reviewed by a pathologist to check for cancer cells.
In an open biopsy, the surgeon makes an incision and removes a sample of the suspicious lump or the entire lump. This is usually done on an outpatient basis, with local or general anesthetic. The tissue is then examined by a pathologist. If cancer is found, additional surgery may be necessary.
Doctors at St. Joseph Hospital Comprehensive Breast Center also use noninvasive tests to diagnose, monitor and stage breast cancers. With the latest technology in their skilled hands, our experts can customize treatment and reduce the need for more invasive tests in some cases.
Positron emission tomography (PET scan) is one of the newest forms of imaging tests. Most often, this technology is used in patients with confirmed breast cancer to evaluate the spread of disease and ensure that the most appropriate form of treatment is selected. A PET scan may be combined with computed tomography (CT) to provide both an anatomical and functional view of the suspect cells. With all this information, doctors can better differentiate between healthy and cancerous cells, even when the cancer is too small to detect by conventional imaging. This is particularly important when looking to see if cancer has spread ("metastasized") from the breast to other parts of the body.
Lymphatic Mapping and SLN is a new, minimally invasive method to determine whether or not a cancer has spread to the lymph nodes. A radioactive dye is injected and a special gamma-camera image is taken of the lymph nodes. The SLN (Sentinel Lymph Node) is usually the first node to which a cancer spreads. If this node is cancer-free, the patient will not have to undergo surgery to biopsy or remove additional lymph nodes.