Types of Cancer > Breast Cancer > Diagnosis

Breast Cancer Diagnosis

In some cases, women find a lump during self-exams or a physician discovers a lump during a clinical exam. The widespread use of mammography, however, is increasingly detecting evidence of a breast problem when no palpable lump exists.

To determine if cancer is present, a doctor will perform a biopsy to remove cells from the suspicious area. A pathologist will examine the tissue for the existence of cancer cells.

Biopsy samples are also examined for the presence of receptors for hormones such as estrogen and progesterone. If these hormones exist, they are referred to as ER-positive or PR-positive. Cancers with these receptors are more likely to respond to hormone therapy.

Biopsy
There are several types of biopsies.

• Fine Needle Aspiration Biopsy
  In a fine-needle aspiration, a needle is inserted through the skin into a lump to get a sample of fluid. If the lump is solid, small pieces of tissue are removed. A physician may use ultrasound or magnetic resonance imaging to guide the needle into the lump.
  
  
• Stereotactic Core Needle Biopsy
  This outpatient procedure, which involves only a puncture wound, may spare some women from having a surgical biopsy. During a stereotactic core needle biopsy, a physician uses ultrasound or magnetic resonance imaging to guide a needle into the breast to collect slivers of tissue from a suspicious area that can be seen on a mammogram, but is too small to be felt. Physicians may rely on digital mammography, which is used to produce an image of the breast in five seconds (rather than five minutes) to refine the contrast of the image so lesions can be seen more clearly.
  
  
• MRI Guided Biopsy
  Greenwich Hospital is one of the few cancer centers in the area to offer women magnetic resonance imaging (MRI) guided biopsy. MRI can detect suspicious areas that are not visible with mammography or ultrasound.
  
  
• Needle Localization
  Mammographic and/or ultrasound-guided needles mark the location of non-palpable breast abnormalities prior to surgery, enabling surgeons to precisely locate the abnormality during the operation. Needle localization is performed by an interventional radiologist.
  
  
• Surgical Biopsy
  Some women may need surgery to remove all or part of the lump for examination under the microscope to look for cancer cells.

Imaging Tests
Additional imaging tests may be used to determine the spread of the cancer and help make decisions about treatment. These tests include chest x-ray, bone scan, computed tomography, magnetic resonance imaging, and positron emission tomography. For a complete list of imaging procedures available at Greenwich Hospital, visit the Radiology Department section of this web site.