If a woman is suspected to have breast cancer, some investigations are required to confirm the diagnosis of the disease. They help in distinguishing between benign breast disease (fibrosis, simple cyst, papilloma, mild hyperplasia, or lobular carcinoma in situ) and the breast cancer.
Further, they can help in determining the extent of locoregional invasion and the spread of disease to distant body parts, which in turn help in selecting an appropriate treatment option.
Breast Cancer Investigation Methods:
- Mammogram: It uses low dose X-rays to examine the breasts. In this test, a special machine has used that consist of two plates to compress and flatten the breast to be examined. Thereafter, an X-ray image of the breast is taken. This test can provide information about the cancerous changes within the breast tissue which generally appears as a lump/mass, microcalcifications, or other changes. Any abnormality observed during this test warrants detailed investigations to establish the diagnosis of breast cancer. Mammograms are not very sensitive in case of dense breast tissue.
- Breast ultrasound: In this technique, a transducer is used to direct very high-frequency sound waves towards the breast tissue to be examined. The sound waves are reflected off the internal structures depending on their ability to reflect these waves. The reflected sound waves are collected by a special detector (fixed near the transducer) to produce a real-time image of the internal tissues on a computer screen. This test can distinguish between fluid-filled cysts (mostly benign) and solid tumor masses. This technique can also be used to guide a needle to collect biopsy samples.
- Breast Biopsy: Biopsy sample is generally collected from the suspected areas observed during the mammography or the breast ultrasound. Depending on the size and location of the suspicious area, a fine needle biopsy, a core needle biopsy, or a surgical biopsy technique is utilized. Sometimes, a biopsy sample from lymph nodes under the arms may also be collected. The collected biopsy samples are examined in a laboratory and can provide information about the type of cancer, grade of cancer, and the presence of specific defective genes or proteins in the cancer cells.
- Imaging Tests: These tests are generally employed after the establishment of the pathological diagnosis. They help to detect the spread of disease to distant body parts and assess the stage of the disease so that an appropriate treatment option can be selected. Alternatively, these tests are employed after treatment to evaluate the treatment efficacy and to detect disease response, progression, or recurrence.
- Computed tomography (CT) scan: In this technique, detailed cross-sectional images of body organs are generated using x-rays, with or without a contrast medium. It can help diagnose the spread of disease to nearby/distant lymph nodes and other organs, and may also be used to guide a biopsy needle into the affected area.
- Magnetic resonance imaging (MRI) scan: This technique provides detailed images of tissues inside the body using radio waves, a strong magnetic field, and gadolinium contrast. It can accurately diagnose the extent of invasion and spread of disease to nearby/distant body parts.
- Positron emission tomography (PET) scan: This technique uses a radioactive substance (e.g.fluorodeoxyglucose [FDG]) that is given intravenously prior to the procedure. Cancer cells absorb larger amounts of the radioactive substance than normal cells. The areas of higher radioactivity indicate cancerous tissue on the PET scan. Thus, this technique can diagnose the spread of disease to distant body parts. It is usually combined with a CT scan (PET/CT).
- Bone Scan: In this test, a radioactive material is injected into the vein of the patient, which gets accumulated in the areas of bones affected by the disease, which are then detected with the help of radioactivity detectors. In this way, it may help to detect the spread of cancer to bones.
- Chest X-ray: This is relatively less-sensitive imaging technique that can reveal the spread of cancer to lungs or pleura. Spread to lungs or pleura may appear as nodul(s), pleural effusion, etc.
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Watch this video to better understand the INVESTIGATIONS for diagnosing and staging breast cancer.
In this video, CancerBro will explain the process of how breast cancer is diagnosed.
Imaging for breast cancer requires local imaging of the breast, and in some cases, whole body imaging called as systemic imaging.
Mammography is done in all the cases of breast cancer. In some cases, mammography may be inadequate, when ultrasound or MRI of the breast may be required.
In advanced disease or symptoms related to distant organ involvement, systemic imaging may be required, such as whole-body CT scan, bone scan, MRI brain or PET CT.
Mammography imaging of the breast is reported as a score called BIRADS score.
BIRADS 1 means absolutely normal breast, with 0% chances of malignancy.
BIRADS 2 means the presence of benign findings, with 0% chances of malignancy.
BIRADS 3 means the presence of findings that are probably benign, with less than 2% chances of malignancy. Needle testing of breast is not required in BIRADS 1, 2 or 3.
BIRADS 4 means suspicious for malignancy, with 2-95% chances of malignancy. Needle testing should be considered in this.
BIRADS 5 means highly suggestive of malignancy, with more than 95% chances of malignancy. Needle testing should be done in this.
Needle testing of breast may be done by FNAC or biopsy, but biopsy is preferred as it is more accurate, and provides sufficient tissue for ER, PR and HER-2 testing.
So first we did a local imaging when we had a suspicious mass in breast. Then we did a needle testing to confirm that it is cancer.
Once the diagnosis of breast cancer is confirmed, we have to do the systemic imaging depending upon clinical presentation, to stage the disease, whether it is localized, locally advanced or metastatic.
This completes the diagnostic work-up for breast cancer.