The Breast Cancer ProgramDiagnosis Printer Friendly Page

If the abnormal area found on the mammogram is most likely benign, the patient will be asked to return at six months for another mammogram. The radiologist will look for any changes in the area. If none are found, the patient will return every six months for another year or two; if after that period there are no changes, the patient will resume a normal screening schedule.

Sometimes it is difficult to see or adequately evaluate masses through mammography. In those cases, ultrasound imaging may be used. Ultrasound is a technique that uses high-frequency sound waves that are bounced off tissues and internal organs. Their echoes produce a picture called a sonogram. These sonograms are helpful in differentiating between solid tumors and fluid-filled cysts.

Other imaging techniques that may be utilized when dealing with hard-to-identify masses include specialized MRI (magnetic resonance imaging) equipment, such as the breast MRI system at University Hospital and PET (positron emission tomography) scans, also available at University Hospital.

If the abnormal area found on the mammogram is highly suspicious with a likelihood of cancer, the next step will be to obtain a biopsy, which is the removal of cells or tissue from the breast.
Depending upon the technique used, biopsies are performed by breast surgeons or radiologists.

In order to perform the biopsy, the physician must be able to identify the location of the lump/mass in the breast. When the lump cannot be felt, different imaging techniques can be used to help locate it.

Ultrasound Guided Biopsy – an ultrasound examination of the breast is performed at the time of the biopsy to locate the mass.

Needle Localized Biopsy – very thin needles or guide wires are placed with the help of mammography around the abnormal tissue so it can be surgically removed.

Stereotactic Biopsy – images from a three-dimensional scanning device are processed by a computer program to provide a precise location of the tumor.

Depending upon the individual case, biopsies can be performed in different ways:

Fine-Needle Aspiration (FNA) – a fine needle is used to withdraw fluid and/or cells from a breast lump. If the fluid appears to contain cells, it is sent to the lab where a pathologist looks at it under the microscope. If the fluid is clear, it may not need to be sent to the lab.

Core Biopsy (Needle Biopsy) – A thick needle is used to withdraw cells from the lump. The cells are examined in the lab by a pathologist.

Mammotome Biopsy - A large needle is placed in the lump guided by ultrasound or stereotactic imaging. The mammotome device is then used to vacuum out tissue from the affected area.

Surgical Biopsy – These procedures are performed in the operating room. There are two types: excisional biopsies involve the removal of the entire mass for evaluation by a pathologist. Incisional biopsies remove only part of the mass for evaluation.

Staging

To appropriately develop an individualized treatment plan for a woman with breast cancer, her physician needs to know the stage of her disease; that is the size of the tumor and whether it has spread. When breast cancer does spread, it often first appears in the lymph nodes under the arm. Sometimes, the full extent of the cancer cannot be known until after surgery is performed to remove the tumor and lymph nodes.

Stage 0 – Carcinoma in situ
At this stage, the cancerous cells have not spread beyond the tissue in which they originally developed. The presence of these cells increase the risk of eventually developing invasive breast cancer.

Stage I – early stage invasive cancer
Tumor is no larger than two centimeters across (less than ¾ inch) and cells have not spread beyond the breast.

Stage II – invasive cancer
The tumor is larger (2 -5 centimeters, or ¾ inch to 2 inches across) and may or may not have spread to the lymph nodes under the arm.

Stage III – locally advanced cancer
The tumor is large, but the cancer cells have not spread beyond the breast and nearby lymph nodes.

Stage IV – distant Metastatic cancer
The cancer has spread to other parts of the body.

Recurrent Cancer
This refers to cancer that comes back after treatment. It may be localized to the breast and nearby lymph nodes or it may spread to other parts of the body.

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