The next step is a detailed physical examination of (1) the breasts in
order to locate any lump or suspicious mass and to identify the texture,
size and relationship of this lump/mass with the nearby tissue areas and
chest muscles, (2) the nipple in order to notice any modification of the
it's appearance and shape, and (3) the general look and appearance of
the breast's skin.
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
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
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
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.
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
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.
This type of x-ray is used to determine if the cancer has spread.
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.