Mammography and Full-field digital mammography (FFDM) A mammography is one of the most common medical techniques used to screen and diagnose breast cancer, to examine any breast problems and for normal medical routine check-ups. The advantage of this technique is that it can determine the nature of the abnormal mass tissue. The standard mammography technique uses an x-ray to produce an image of the breast on a large sheet of photographic film. The full field digital mammography allows the image to be recorded, viewed and stored on a computer. This advanced mammography allows a better visualization of the mass or lump. Full field digital mammography is not widely available and costs more than a standard mammography. See our picture here:

Breast ultrasound or sonography
Ultrasound is a technique that uses high-frequency sound waves to outline a specific part of the body. The sound waves are transmitted into the targeted area and echoed back by a special device and transformed into an image format by a computer.

This technique has become a valuable tool, when used together with mammography, to diagnose breast cancer in the last few years because it is widely available and is less expensive than other cancer diagnosis options. The ultrasound technique is usually used after a mammogram has located a specific area of concern. It's main advantage is distinguishing between cysts and solid masses and between benign and malignant tumors.

Ductogram or galactogram
This technique involves inserting a plastic tube in the opening of the duct at the nipple and injecting a certain amount of contrast substance. The contrast substance will help outline the shape of the duct and will locate any mass inside the duct on an x-ray image. This technique is used to determine the cause of bloody nipple discharge.

Computer-aided detection and diagnosis (CAD)
This technique is used by a radiologist to detect suspicious abnormalities on mammograms as a result of a standard mammography. This technique involves a computer device that scans the mammogram film, locating tumors or lesions that the doctor could not identify. The advantage of this technique is that it helps to diagnose breast cancer while it's in the earliest stages.

Scintimammography
This technique involves the administration of a radioactive tracer in the vein that will attach to the cancer cells and make them detectable by a special camera. This technique is new and is used in experimental trials.

Magnetic resonance imaging (MRI)
MRI is an advanced technique that uses radiowaves, strong magnets and a contrast substance to outline the image of a certain part of the body. The cancer cells absorb a high amount of the contrast substance and reveal the shape and pattern of the abnormal tissue mass. This technique is used to better examine and evaluate the mass and lumps revealed by the mammography or in the routine screening process of those women that have a high risk for developing breast cancer.

Nipple discharge examination
This type of test is performed only when the patient is displaying spontaneous nipple discharge. The secretion eliminated by the nipple is collected and examined under microscope in order to identify the type of cells it contains. If the secretion is clear, green colored or milky, the presence of cancer is very unlikely. If the secretion is red or red-brown, it means that it contains blood and might possibly be caused by a malignant tumor. But a similar type of secretion can be caused by an internal breast infection, injury, or benign tumors. Even if the secretion has no evidence of cancer cells, a cancer diagnosis is not completely excluded and other types of investigation are recommended.

Ductal lavage and nipple aspiration
The ductal lavage is an experimental test developed in order to help those women that do not have symptoms of breast cancer, but face a high risk of developing breast cancer, to obtain a better picture and a deep understanding of their cancer risk. This procedure is performed under local anesthesia. A small amount of anesthetic cream (that numbs the skin) is applied around the nipple and a catheter is used to withdraw a tiny amount of liquid from the milk ducts. This ductal fluid is collected with the help of a saline liquid that is inserted into the duct through the catheter.

Nipple aspiration is another cancer test used to detect the breast cancer risk and involves a simple procedure performed to collect abnormal cells from the duct. This procedure is not an intrusive technique. It uses two small cups that are placed on the breast. This device warms the breast, gently compresses them and performs a slight suction in order to bring duct fluids to the surface of the breast skin for collection and later examination.

Biopsies
A Biopsy is the next step after the previous investigations (mammography, ultrasound and physical examination) find abnormal mass tissues suspected of being cancerous. The role of a biopsy is to remove a certain amount of tissue sample for microscopic investigation. There are several types of biopsies: (1) fine needle aspiration biopsy, (2) core (large needle) biopsy, and (3) surgical biopsy. The decision as to which biopsy type is necessary depends on the characteristics of the suspected cancerous mass (lesion's level of suspicion, the mass/lump size and location, the presence of other symptoms of lesions).

(1) Fine needle aspiration biopsy (FNAB) : This procedure involves using a thin needle attached to a syringe to remove a cell sample from the breast lump or mass. This procedure is easily performed when the lump is located at the surface of the breast tissue. When the tumor is deep within the breast, this procedure will be performed under ultrasound. Another method used in these circumstances is a stereotactic needle biopsy. This procedure is performed with the help of a computer device that analyses two mammograms taken from 2 angles to indicate the precise location of the tumor. Fine needle aspiration biopsy can sometimes miss the tumor and withdrawn cells from a nearby area.

(2) Stereotactic core needle biopsy: This procedure is performed under local anesthesia and involves removing a small cylinder of tumor tissue. There are two new sterotactic methods that remove more tissue than a core biopsy: mammotome or vacuum-assisted biopsy and advanced breast biopsy instrument (ABBI).

The mammotome procedure involves taking a consistent sample of tumor tissue (twice as much tissue that is removed through a core biopsy) using a cylinder inserted into the breast tissue. This cylinder contains a special rotating knife that removes the tissue sample when inserted into the breast tissue .

(3) Surgical biopsy : This is a procedure where the whole tumor or a part of the tumor is removed for a detailed lab examination. There are two types of this procedure: incisional biopsies, when a small piece of a big tumors is removed for examination and excisional biopsies, when the whole tumor with the surrounding margin of normal-appearing breast tissue is removed completely for a detailed lab examination.

These biopsies are performed under local anesthesia. Sometimes, if the lump is hard to locate by touch or the surrounding area looks suspicious, these biopsies are is used in conjunction with another procedure called wire localization. Wire localization is performed under imaging techniques used to help the doctor guide the needle in the target area. A thin wire is inserted into the tissue through the center of the needle and is used to locate the area that needs to be removed.

Chest X-rays:
This type of x-ray is used to determine if the cancer has spread.

Bone Scan:
This method is performed only when there is a suspicion that the cancer has spread to the bones. The procedure uses a radioactive substance that once injected, will be absorbed by the problematic bone tissue and can be visualized on the image scan.

Computed Tomography (CT):
The CT scan is an advanced x-ray procedure that produces a more detailed cross-sectional image of the body. The CT scan procedure involves two phases: in the first phase, a set of pictures will be taken and in the second phase the patient will receive an intravenous injection (IV) of a radiocontrast agent in order to better outline the structure of the body and a second set of pictures will be taken.

Positron Emission Tomography (PET):
This technique uses an injectable glucose substance that contains a radioactive atom. Cancer cells absorb a high level of this substance, making them easier to be detected by a special camera device. This technique is used when there is suspicion that the cancer has spread to other areas of the body.