Breast Cancer Screening (PDQ®)—Patient Version - National Cancer Institute Certain genetic syndromes , such as Li-Fraumeni or Cowden syndrome . MRIs find breast cancer more often than mammograms do, but it is common for MRI results to appear abnormal even when there isn't any cancer. Other screening tests are being studied in clinical trials. Thermography Thermography is a procedure in which a special camera that senses heat is used to record the temperature of the skin that covers the breasts. A computer makes a map of the breast showing the changes in temperature. Tumors can cause temperature changes that may show up on the thermogram. There have been no clinical trials of thermography to find out how well it detects breast cancer or if having the procedure decreases the risk of dying from breast cancer. Tissue sampling Breast tissue sampling is taking cells from breast tissue to check under a microscope . Abnormal cells in breast fluid have been linked to an increased risk of breast cancer in some studies. Scientists are studying whether breast tissue sampling can be used to find breast cancer at an early stage or predict the risk of developing breast cancer.

Three ways of taking tissue samples are being studied: Fine-needle aspiration : A thin needle is inserted into the breast tissue around the areola (darkened area around the nipple ) to take out a sample of cells and fluid. Nipple aspiration : The use of gentle suction to collect fluid through the nipple. This is done with a device similar to the breast pumps used by women who are breast-feeding. Ductal lavage : A hair-size catheter (tube) is inserted into the nipple and a small amount of salt water is released into the duct. The water picks up breast cells and is removed. Screening clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI website . Risks of Breast Cancer Screening Key Points Women who have had previous breast biopsies. Women with a family history of breast cancer. Women who take hormones, such as estrogen and progestin . The skill of the radiologist also can affect the chance of a false-positive result. Anxiety from additional testing may result from false positive results. False-positive results from screening mammograms are usually followed by more testing that can lead to anxiety .

In one study, women who had a false-positive screening mammogram followed by more testing reported feeling anxiety 3 months later, even though cancer was not diagnosed. However, several studies show that women who feel anxiety after false-positive test results are more likely to schedule regular breast screening exams in the future. Mammograms expose the breast to radiation. Being exposed to radiation is a risk factor for breast cancer. The risk of breast cancer from radiation exposure is higher in women who received radiation before age 30 and at high doses . For women older than 40 years, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure. There may be pain or discomfort during a mammogram. During a mammogram , the breast is placed between 2 plates that are pressed together. Pressing the breast helps to get a better x-ray of the breast. Some women have pain or discomfort during a mammogram. The risks and benefits of screening for breast cancer may be different in different age groups. The benefits of breast cancer screening may vary among age groups: In women who are expected to live 5 years or fewer, finding and treating early stage breast cancer may reduce their quality of life without helping them live longer.

As with other women, in women older than 65 years, the results of a screening test may lead to more diagnostic tests and anxiety while waiting for the test results. Also, the breast cancers found are usually not life-threatening. It has not been shown that women with an average risk of developing breast cancer benefit from starting screening mammography before age 40. Women who have had radiation treatment to the chest, especially at a young age, are advised to have routine breast cancer screening. Yearly MRI screening may begin 8 years after treatment or by age 25 years, whichever is later. The benefits and risks of mammograms and MRIs for these women have not been studied. There is no information on the benefits or risks of breast cancer screening in men. No matter how old you are, if you have risk factors for breast cancer you should ask for medical advice about when to begin having breast cancer screening tests and how often to have them. Talk to your doctor about your risk of breast cancer and your need for screening tests. Talk to your doctor or other health care provider about your risk of breast cancer, whether a screening test is right for you, and the benefits and harms of the screening test.

You should take part in the decision about whether you want to have a screening test, based on what is best for you. (See the PDQ summary on Cancer Screening Overview for more information.) About This PDQ Summary About PDQ Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish . PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH. Purpose of This Summary This PDQ cancer information summary has current information about breast cancer screening. It is meant to inform and help patients, families, and caregivers.

It does not give formal guidelines or recommendations for making decisions about health care. Reviewers and Updates Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board . Clinical Trial Information A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials are listed in PDQ and can be found online at NCI's website . Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237). Permission to Use This Summary PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].” The best way to cite this PDQ summary is: PDQ® Screening and Prevention Editorial Board. PDQ Breast Cancer Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: . Accessed <MM/DD/YYYY>. [PMID: 26389160] Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only.

If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online . Visuals Online is a collection of more than 2,000 scientific images. Disclaimer The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page. Contact Us More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us . Updated: January 22, 2016 Most text on the National Cancer Institute website may be reproduced or reused freely. The National Cancer Institute should be credited as the source. Please note that blog posts that are written by individuals from outside the government may be owned by the writer, and graphics may be owned by their creator. In such cases, it is necessary to contact the writer, artist, or publisher to obtain permission for reuse. We welcome your comments on this post.

All comments must follow our comment policy . Want to use this content on your website or other digital platform? Our syndication services page shows you how. National Cancer Institute A quick guide to what's on this page What a mammogram is A mammogram is an X-ray of the breast. It can help to find breast cancer early as part of a breast cancer screening programme. How you have a mammogram A radiographer helps you to position one breast at a time between 2 flat plates on the X-ray machine. The plates press your breast firmly between them for a few moments to take the X-ray. You have 2 X-rays of each breast. The compression of the breast helps to give a clear picture. Having a mammogram can be uncomfortable. Some people find it painful. But the discomfort only lasts for the short time that your breast is compressed. After the mammogram Two specialists look at your mammogram to see if there are any signs of cancer. Around 96 out of 100 women (96%) in the UK screening programme have a normal result. Some women have an unclear result and may need to have the mammogram again.

Screening can find very early changes in the lining of the breast ducts called ductal carcinoma in situ (DCIS). If you have any areas of DCIS, you usually have surgery to remove them. If screening finds a cancer it is usually at an early stage when there is a good chance of successful treatment. Your GP will then refer you to a specialist breast clinic for further tests and treatment. How a mammogram feels Some women worry about whether a mammogram will hurt. For most women it is just a bit uncomfortable. Some women do feel some pain, but it is usually only for a few moments while you are having the X-rays taken. Some women may have discomfort or soreness for a few days afterwards. A Cochrane review reported that having good information before the test and having control over your breast compression during your mammogram reduces pain. Taking aspirin or paracetamol before the procedure didn't help. If you would like to, you can read this review on pain in mammography in the Cochrane Library . It is written for researchers and specialists and so is not written in plain English. After the mammogram To check for any signs of cancer, 2 people called film readers or image readers look at your mammogram.

The film readers are radiologists or radiographers . You should get your results within 14 days. The radiographer will tell you when to expect yours. Around 96 out of 100 women in the breast screening programme have a normal result (96%). If the X-ray is not clear enough or shows any abnormal areas, the clinic staff will call you back for more tests. You may need to have the X-rays taken again. What a mammogram can show Well developed breast cancers nearly always show up clearly on mammograms. But no screening test is perfect and unfortunately there will always be some cancers that are missed or do not show up. With early stage breast cancer, there may be no lump, but your mammogram may show small areas of calcium in patterns within the breast tissue. These areas of calcium are called calcification. But calcification also sometimes develops because of non cancerous changes in the breast. The skill and experience of the technicians and doctors helps them to read the different patterns and decide which might be related to cancer and so need further tests. Some cancers do not show clear signs on a mammogram. So always tell your doctor if you find any lump or changes in your breast, even if you recently had a mammogram.

If screening finds cell changes - DCIS Your screening mammogram may show changes in the lining of the breast ducts called ductal carcinoma in situ (DCIS). This means that there are breast cancer cells there. But they are all inside the tubes that carry milk within the breast (the ducts). This means that they can't spread. In some women DCIS may spread into the surrounding breast tissue after some years, to become an invasive ductal breast cancer . Your doctor will usually recommend that you have any areas of DCIS removed with surgery. There is very little risk of low grade or intermediate grade DCIS coming back once it has been removed. But if you have high grade DCIS you may need more treatment after surgery. You can read about treatments on our page about DCIS . If screening finds a cancer If screening shows that you have cancer, it is likely to have been found early. This means you have a good chance of successful treatment.

Breast Cancer Tests: Screening, Diagnosis, & Monitoring | Breastcancer.org Home → Symptoms & Diagnosis → Screening and Testing → Breast Cancer Tests: Screening, Diagnosis, and Monitoring Breast Cancer Tests: Screening, Diagnosis, and Monitoring Save as Favorite Sign in to receive recommendations ( Learn more ) Whether you’ve never had breast cancer and want to increase your odds of early detection, you’ve recently been diagnosed, or you are in the midst of treatment and follow-up, you know that breast cancer and medical tests go hand in hand. Most breast-cancer-related tests fall into one or more of the following categories: Screening tests: Screening tests (such as yearly mammograms) are given routinely to people who appear to be healthy and are not suspected of having breast cancer. Their purpose is to find breast cancer early, before any symptoms can develop and the cancer usually is easier to treat. Diagnostic tests: Diagnostic tests (such as biopsy) are given to people who are suspected of having breast cancer, either because of symptoms they may be experiencing or a screening test result. These tests are used to determine whether or not breast cancer is present and, if so, whether or not it has traveled outside the breast.

Diagnostic tests also are used to gather more information about the cancer to guide decisions about treatment. Monitoring tests: Once breast cancer is diagnosed, many tests are used during and after treatment to monitor how well therapies are working. Monitoring tests also may be used to check for any signs of recurrence. On the following pages, you can read more about the many tests you may have at different points in the process of screening, diagnosis, and treatment. The tests are covered in alphabetical order. Urokinase Plasminogen Activator Protein Inhibitor Test If you're waiting for test results, or have questions about what your results may show, connect with others for support and answers in the Breastcancer.org Discussion Board forum Waiting for Test Results . If you've been diagnosed with breast cancer and are waiting for test results about your diagnosis, connect with others in the Breastcancer.org Discussion Board forum Diagnosed and Waiting for Test Results . Expert Quote "A screening test tries to find a disease before there are any symptoms. With breast cancer, there's a misconception that if you feel fine, don't have a lump, and have no family history of breast cancer, you're okay.

The truth is that three-quarters of the women in whom we find breast cancer have no risk factors. So screening is important for everyone." -- Susan Greenstein Orel, M.D. Screening and diagnosis: Mammogram, clinical breast exam, and other tests | womenshealth.gov Screening and diagnosis: Mammogram, clinical breast exam, and other tests Subscribe to Breast Cancer email updates. Enter email address Home > Breast Cancer > Screening and diagnosis: Mammogram, clinical breast exam, and other tests Breast Cancer More information on screening and diagnosis: Mammogram, clinical breast exam, and other tests Breast cancer screening Breast cancer screening looks for signs of cancer before a woman has symptoms. Screening can help find breast cancer early, when the chance of successful treatment is best. Two tests are commonly used to screen for breast cancer: Mammogram. A low-dose x-ray exam of the breasts to look for changes that are not normal. Check the womenshealth.gov screening charts (PDF, 132KB) to see when you should get a mammogram. Clinical breast exam (CBE). The doctor looks at and feels the breasts and under the arms for lumps or anything else that seems unusual. Ask your doctor if you need a CBE.

Related information Some women have not gotten regular mammograms in the past because of cost and lack of insurance. But insurance companies are now required to cover mammograms every 1 to 2 years for women over 40 at no cost to the patient because of the Affordable Care Act . Depending on factors such as family history and your general health, your doctor may recommend a mammogram before age 40 or more often. Learn more about mammograms and what to expect . Steps to breast self-exam (from Susan G. Komen for the Cure) Regular screening is the best way to find breast cancer early in most women. If you are at higher risk of breast cancer, your doctor might want to use other tests too, such as a different type of mammogram or magnetic resonance imaging (MRI). It is important to let your doctor know if you find any changes in your breast, such as a lump or dimpling or puckering of the skin. Although research results do not support an official recommendation that all women conduct breast self-exams, knowing your body is key to pointing out any concerns to your doctor. Return to top Diagnosing breast cancer Screening tests look for signs of cancer.

If a screening mammogram or CBE shows a breast change that could be cancer, additional tests are needed to learn more. These tests might include: Diagnostic mammogram. This type of mammogram uses x-rays to take more detailed images of areas that look abnormal on a screening mammogram. Ultrasound exam. Sound waves help your doctor see if a lump is solid (could be cancer) or filled with fluid (a fluid-filled sac that is not cancer). Magnetic resonance imaging (MRI). Radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the breast. MRI may be used if enlarged lymph nodes or lumps are found during a clinical breast exam that are not seen on a mammogram or ultrasound. Breast biopsy. Fluid or tissue is removed from the breast and checked for cancer cells. There are many types of biopsy. A biopsy is the only test to find out if cells are cancer. Not all women who have abnormal screening test results need to have a biopsy. Sometimes, doctors can rule out cancer based on the results of follow-up tests without biopsy. Finding out about "abnormal" breast changes can be scary. Talk to your doctor about what tests you might need and what the test results mean.

If you learn that you have cancer, your doctor will help you move forward and begin treatment. More information on Screening and diagnosis: Mammogram, clinical breast exam, and other tests Read more from womenshealth.gov Breast Cancer Fact Sheet - This fact sheet provides information on why women should be concerned about breast cancer and gives resources for more information. Mammograms Fact Sheet - This fact sheet discusses the different types of mammograms available, explains how often a woman should get them, and gives facts about their safety and effectiveness. Explore other publications and websites A Woman's Guide to Breast Care (Copyright © Breast Cancer Network of Strength) - This pamphlet explains how to perform a breast self-exam. BRCA1 and BRCA2: Cancer Risk and Genetic Testing - This fact sheet answers some frequently asked questions about genetic testing for breast cancer genes. It also provides information on how to interpret results of genetic testing, risk factors for developing breast cancer, and laws built to protect against genetic discrimination. For Women Facing a Breast Biopsy (Copyright © American Cancer Society) - This Web page explains the range of procedures that may be needed to determine a breast cancer diagnosis.

It describes the different benign and malignant conditions that are possible, what to do if your biopsy comes up positive, and where you can go for emotional support. Having a Breast Biopsy: A Guide for Women and Their Families - This guide talks about the different kinds of breast biopsies. It covers the research about how well different kinds of biopsies work to find cancer and possible side effects. The guide provides a list of talking points a woman can raise with her doctor or nurse. Mammograms - This fact sheet explains how screening mammograms differ from diagnostic mammograms. It also explains the benefits and limitations of screening mammography, as well as recommendations for when a woman should begin and how frequently she should have screening mammograms. Mammograms and Other Breast Imaging Procedures (Copyright © American Cancer Society) - This internet site describes the process of a mammogram, gives tips on how to find a good screening facility, when you should start having screenings, and what to do on the day of the mammogram. National Breast and Cervical Cancer Early Detection Program - This website provides information on breast and cervical cancer, screenings, and common barriers to screening, and explains how this program can help women achieve better outcomes.

Preventive Services: Breast Cancer Screening (Mammograms) - This fact sheet discusses Medicare's coverage policy on breast cancer screening. It explains how often mammograms are covered, who is eligible, and what factors increase risk for breast cancer. Understanding Breast Changes: A Health Guide for Women - This booklet explains normal, age-related breast changes you may experience throughout your life and how they differ from changes that indicate breast cancer. It also discusses mammograms and maintaining your breast health. Connect with other organizations Mammogram examples and Ultrasound breast pictures By Steven Halls Examples of Mammogram image studies A mammogram (a combination of X-ray images of the breast) is a routine part of a breast cancer screening program. ‘Breast palpation‘ programs (physically checking for lumps) are generally agreed to be insufficient. Breast self examination programs are also unreliable, as a lesion can develop for years before it becomes palpable. Of course, when a ‘bump‘ or ‘lump‘ of some kind has been found on a clinical exam by a family physician, the patient will immediately be referred for a mammogram. Women with higher than average risk factors and older women should generally have them performed more frequently.

Normally, the X-ray component of a mammogram is all that is required for breast cancer screening purposes. An ultrasound is typically a ‘second look‘ type of application. It is not a good idea to have an ultrasound and not a mammogram , and it is probably best to follow the advice of the screening physicians. I just want to let you know that I have created a newer version of this page, with more up-to-date information on Mammogram Screening Images . However, it isn’t nearly as long as this one. This page is still really useful. Information about the lesion as seen on mammograms and ultrasounds On a mammogram, a lesion will usually appear as ‘brighter‘ than the surrounding tissue. This is because things that are denser than fat will stop more x-ray photons, hence they appear brighter. Ultrasounds are a little harder to figure out. The darkest images on a sonograph are cysts containing liquid. Solids are less definitive. With ultrasound the radiologist will probably be trying to get a sense of the internal texture of the suspected breast lesion and surrounding area.

Solid lesions can be a little brighter or darker than the surrounding tissue, and the way to evaluate them on ultrasound is to look closely at the margins or the ‘outer edges‘ of the nodule . Examples of breast cancer screening mammography interpretation Even with ill-defined borders and spiculated margins, other factors make breast cancer an unlikely diagnosis The X-ray image below shows a suspected mass of about 1 cm in diameter. Some architectural distortion is also apparent. An ultrasound image of the same lesion suggest that the lesion is solid. The mass appears to be hypoechoic with ill-defined, spiculated, and microlobulated margins. It is not possible to rule out malignancy here because posterior acoustic shadowing is not present. When a lesion is homogeneous, good ‘through-transmission‘ of the ultrasound beam is possible, and malignant breast cancer lesions are typically not so homogeneous. Asymmetric breast density often has benign causes The X-ray image below shows a lesion with ‘asymmetric density‘. That indicates that the lesion likely contains a variety of elements, which may or may not indicate breast cancer. On the sonogram below, the asymmetric density observed in the X-ray appears to be fat tissue.

This is due to the fact that although its a little darker-appearing on ultrasound than other fat, it has internal texture resembling a fat lobule. There is an apparent ‘capsule‘, which is the thin bright line around the outside of the dark oval area. (A capsule is a fibrous covering that surrounds some things like lipomas). This suggests the lesion might be harmtoma or fibroadenolipoma , but as there is no apparent capsule on the X-ray, this is less likely. Usually in a post-traumatic or post-operative hematoma there would be a collection of solid and liquid components, and that does not appear to be the case here. The site requires further investigation, perhaps by ‘spot films‘ with compression, (which gives a more detailed view of the lesion itself and not the surrounding breast tissue). Likely diagnosis might be fibroglandular dysplasia or other fibrocystic changes. Scar tissue can often appear suspicious The image below contains a lesion with irregular, spiculated margins. There does not appear to be a ‘central‘ mass to this lesion, which right makes it less likely to be breast cancer. However, something this suspicious would likely be biopsied to find out exactly what is going on.

It is more likely to be either a post-surgical scar, or possibly a ‘radial scar‘. In actual fact this particular image was taken from a woman who had breast surgery, so a post-surgical scar is the most probable diagnosis. A closer look via magnification of the same lesion reveals a central radio-transparency likely caused by fat necrosis , and there is no central mass. The spiculations around the lesion are likely a ‘desmoplastic‘ reaction to the surgery. (‘desmoplasia’ refers to the growth of fibrous and connective tissues. This is common following surgery, and is often simply referred to as ‘scar tissue’). Male Breast Ultrasound: Gynecomastia versus breast cancer Male breast cancer is very rare, but a condition called “gynecomastia“, which is the development of abnormally large breasts in men, is quite common. Gynecomastia is usually caused by excessive growth of fibroglandular breast tissue in men in their 60s, or as the result of hormonal imbalances. But, it may be caused by breast cancer as well, so a full mammographic investigation is always warranted.

In the mammogram below, one can see the increased density of the fibroglandular tissues behind the nipple. It appears to be developing in a concentric pattern. The contour of the dense area is ‘concave-outward‘, and interspersed with fat. There are no well-formed masses and no suspicious microcalcifications . It certainly would appear to be gynecomastia from natural or hormonal causes, and not breast cancer. In the sonogram of the same breast one notes that the density appears hypoechoic, and with ill-defined margins. The “amount” of tissue appears to be thicker than average in a male, but the only way to know if anything abnormal is going on in the sonogram would be to compare it with an ultrasound of the other breast, and see if the densities are about the same. Lactating adenomas are often mistaken for a breast cancer tumor in pregnant women Breast cancer is very uncommon in younger women. So, if a young woman who was pregnant came in for screening of a palpable lump on her breast, it is far more likely that the lesion is a fibroadenoma of some kind.

One common variation of fibroadenoma in pregnant women is a ‘ lactating adenoma ‘, which is essentially a tubular adenoma occuring in pregnant women and thus featuring accumulation of milk secretions in addition to hyperplasia. Breast X-rays are not normally given to pregnant women. Given that breast cancer is very unlikely and lactating adenoma is quite likely, ultrasound and possibly a fine needle aspiration biopsy would typically be utilized for diagnostic investigations. The main concern with a lactating adenoma from the perspective of breast cancer is that the condition can occur simultaneously with breast carcinoma. However, on their own they are of absolutely no increased risk for subsequent breast cancer development. In the ultrasound image of lactating adenoma below, one notes a hypoechoic, non-cystic mass in an ovoid shape. It has a long axis running parallel to the skin, posterior acoustic enhancement, and well-defined margins Mammograms of lactating ademonas (not generally given to pregnant women) will tend to show an oval well-circumscribed mass with radiolucent (somewhat transparent) central areas (radiolucent features will appear darker on an X-ray).

Ultrasounds of lactating adenomas tend to reveal the heterogeneous echotexture of the tumor, with central hyperechogenic areas. The radiolucent (X-ray) and hyperechogenic (ultrasound) areas will indicate the fat content of the milk secretions in the tumor. Since lactating adenomas occur in pregnant and breastfeeding women, this tends to simplify diagnosis. An abscess, for example, would be unlikely in the absence of erythema (redness often due to inflammation) or skin edema (a ‘bulge’ caused by the build up of fluids). Lactating adenomas also tend to be only slightly painful, unlike an abscess. But, to exclude any possibility of malignancy a fine needle biopsy is usually performed anyways. Fine needle biopsy is actually preferred over a core biopsy in suspected lactating adenomas, because milk secretions can ‘find their own paths‘ through various tissues and confuse the issue. In the cytologic image of lactating adenoma below, there are many more ducts than would normally occur (hyperplasia). The ducts are dilated and contain milk secretions.

The proliferation of new ducts distinguishes the lesion from a simple galactocele , which is just an accumulation of milk that cannot escape through normal channels. Lactating adenomas, like fibroadenomas, are somewhat prone to infarction (tissue death from compromised blood supply), and this can lead to some strange and misleading features, possibly suggestive of malignant breast cancer . Some of these features may include things like structural heteroechogenicity, microlobulated margins, pronounced hypoechogenicity, posterior acoustic shadowing, and irregularly shaped masses. A fine needle aspiration is warranted given any unexpected or unusual element such as this. Interpreting breast cancer screening mammograms improves with experience It takes years of radiological experience to gain facility in interpreting mammograms. However, anything abnormal, and especially features which show unusual density, odd shapes, and irregular border, will be referred for biopsy. Interpretation accuracy improves over the first three years of practice, and continues to be refined over the course of a radiologist’s career. For some reason, the rate of ‘abnormal findings‘ on mammograms is slightly higher in North America than in Europe. Let’s do some Q&A about Mammography… How are mammograms done?

During a mammogram, your breasts are compressed between two firm surfaces to spread out the breast tissue. Then, an x-ray captures black and white images of your breasts that are displayed on a computer screen and examined by a doctor who looks for signs of cancer. How can mammograms be used? A mammogram can be used either for screening or for diagnostic purposes. How often should you have a mammogram? It all depends on your age and your risk of breast cancer. How do I know when I should begin screening mammography? Some general guidelines for when to begin screening mammography include women with an average risk of breast cancer and woman with a high risk of breast cancer. What are the risks? Some known risks and limitations of mammograms include the following: Mammograms expose you to low-dose radiation, they aren’t always accurate, they can be difficult to interpret in younger women, having a mammogram may lead to additional testing, screening mammography can’t detect all cancers, and not all of the tumors are found by mammography can be cured. How do I prepare for my mammogram appointment?

Choose a certified mammogram facility, schedule the test for a time when your breasts are least likely to be tender, bring your prior mammogram images, don’t use deodorant before your mammogram, and consider an over-the-counter pain medication if you find that having a mammogram is uncomfortable. What can a radiologist possibly find on my mammogram imaging? Possible findings include calcium deposits, masses or lumps, distorted tissues, dense areas appearing in only one breast or one specific area on the mammogram, and new dense area that has appeared since your last mammogram. References Sickles A, Periodic Mammographic Follow-up of Probably Benign Lesions, Radiology 1991; 179:463-468. Hagan-Absert, Sandra, Textbook of Diagnostic Ultrasonography, Mosby, (c)2001. Yang, Wei Tse., Whitman,Gary J., . Yuen,Edmund H. Y., Tse, Gary M. K., and Stelling, Carol B. .Sonographic Features of Primary Breast Cancer in Men. AJR 2001; 176:413-416 Berg WA. Letters.

AJR; 181:1427, Nov. 2003. Kopans DB. Negative Mammographic and US Findings Do Not Help Exclude Breast Cancer. Radiology Volume 222, N 3: 857- 858, March 2002. Paquette D, Snider J, Bouchard F, Olivotto H, for the Canadian Breast Cancer Screening Initiative. Performance of screening mammography in organized programs in Canada in 1996, CMAJ 2000;163(9):1133-8 Sickles EA , Wolverton DE, Dee KE. Performance Parameters for Screening and Diagnostic Mammography: Specialist and general Radiologists. Radiology 2002; 224: 861-869. Sabate, J.M., Clotet, M., Torrubia, S., Gomez, A., Guerrero, R., de Las Heras, P., Lerma, E.

Radiologic Evaluation of Breast Disorders Related to Pregnancy and Lactation; RadioGraphics, (October 2007)27, S101-S124. Elmore JG, Nakano CY, Koepsell TD, Desnick LM, D’Orsi CJ, Ransohoff DF.International variation in screening mammography interpretations in community-based programs. J Natl Cancer Inst. 2003 Sep 17;95(18):1384-93. Miglioretti DL, Gard CC, Carney PA, Onega TL, Buist DS, Sickles EA, Kerlikowske K, Rosenberg RD, Yankaskas BC, Geller BM, Elmore JG. When radiologists perform best: the learning curve in screening mammogram interpretation.Radiology. 2009 Dec;253(3):632-40. Feldman J, Smith RA, Giusti R, DeBuono B, Fulton JP, Scott HD.Peer review of mammography interpretations in a breast cancer screening program. Am J Public Health. 1995 Jun;85(6):837-9.

Sickles, EA., Successful methods to reduce false-positive mammography interpretations. Radiologic Clinics of North America Volume 38, Issue 4, Pages 693-700 Birdwell RL, Ikeda DM, O’Shaughnessy KF, Sickles EA. Mammographic characteristics of 115 missed cancers later detected with screening mammography and the potential utility of computer-aided detection. Radiology. Apr 2001;219(1):192-202 van Engeland, S., Karssemeijer, N., Matching Breast Lesions in Multiple Mammographic Views. Lecture Notes in Computer Science, 2001, Volume 2208/2001, 1172-1173, Wang, J., Shih, TTF., Hsu, JCY, Li, YW.

The evaluation of false negative mammography from malignant and benign breast lesions.(March 2000_Volume 24, Issue 2, Pages 96-103 ABOUT X-RAYS ABOUT X-RAYS Contrast X-ray Exam Description: X-ray, or radiography, is the oldest and most common form of medical imaging. An X-ray machine produces a controlled beam of radiation, which is used to create an image of the inside of your body. This beam is directed at the area being examined. After passing through the body, the beam falls on a piece of film or a special plate where it casts a type of shadow. Different tissues in the body block or absorb the radiation differently. Dense tissue, such as bone, blocks most of the radiation and appears white on the film. Soft tissue, such as muscle, blocks less radiation and appears darker on the film. Often multiple images are taken from different angles so a more complete view of the area is available. The images obtained during X-ray exams may be viewed on film or put through a process called “digitizing” so that they can be viewed on a computer screen. Sometimes an X-ray exam includes contrast.

For a contrast study, you will receive a drug called a contrast agent, which will highlight or contrast parts of the body so they show more clearly on the X-ray image. Example of Uses: X-ray exams can be used to view, monitor, or diagnose bone fractures abdominal pain cancer Preparation for an X-ray exam: For most X-ray exams, there is no special preparation needed. You will be asked to wear a hospital gown and remove all jewelry and metal objects before the test. For contrast X-ray exams, you will be given a dose of contrast agent by mouth, as an enema, or as an injection or by catheter (thin tube) into a specific area of the body. Your physician will provide any specific instructions necessary for your contrast study. During the Exam: You will be asked to either lie on an exam table or stand next to the X-ray machine. The room may be cool in order to keep the equipment from overheating. The technologist, or person performing the exam, may use pillows or sandbags to help you hold the proper position. You will be asked to hold very still, without breathing for a few seconds. The technologist will step behind a radiation barrier and activate the X-ray machine.

Often multiple images or views are taken from different angles, so the technologist will reposition you for another view and the process will be repeated. You will not feel the radiation. A mammogram is an X-ray exam of the breast. A special machine designed specifically to examine breast tissue is used. It takes a different form of X-ray and uses lower doses of radiation than a usual X-ray. Because these X-rays do not go through breast tissue as easily, the mammogram machine has two plates that compress the breast to spread the tissue apart. A more accurate image is obtained with less radiation this way. Time Required: 5 to 60 minutes Noise During Exam: Minimal clicking or buzzing noises. Space During Exam: You will either lie on an exam table or stand next to the X-ray machine with ample space around you. Benefits: X-ray exams are fast and easy. The equipment used is relatively inexpensive and widely available. Risks: X-ray exams exposure patients to radiation. The amount of radiation exposure is variable depending upon the X-ray type (for example, of the brain, lungs, or abdomen) and the X-ray machine type (for example, different models and manufacturers). Because the radiation exposure is variable, the risks are also variable.

Please speak to your radiologist, or your physician who refers you for the X-ray exam, for specific details on radiation exposure and possible risks. Women should inform their doctor if they are or may be pregnant or nursing prior to any radiological imaging. Your doctor may recommend another type of test to reduce the possible risk of exposing your baby to radiation. There is a rare risk of a major allergic reaction to the contrast agent. Results: X-rays are recorded on film or recorded digitally. A radiologist, who is a physician with specialized training in X-ray and other imaging tests, will analyze and interpret the results of your X-ray and then send a report to your personal physician. For non-emergency situations, it usually takes a day or so to interpret, report, and deliver the results. Contact your personal physician for information on the results of your exam. For further info: Diagnosis - Breast cancer - Mayo Clinic Breast cancer Core needle biopsy Core needle biopsy A core needle biopsy uses a long, hollow tube to extract a core of tissue. Here, a biopsy of a suspicious breast lump is being done. The core is sent to a laboratory for testing. Breast MRI Breast MRI During a breast MRI, you lie on your stomach on a padded scanning table.

Your breasts fit into a hollow depression in the table, which contains coils that detect magnetic signals. The table slides into the large opening of the MRI machine. Tests and procedures used to diagnose breast cancer include: Breast exam. Your doctor will check both of your breasts and lymph nodes in the armpit, feeling for any lumps or other abnormalities. Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality. Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst. Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous.

A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options. Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. Other tests and procedures may be used depending on your situation. Staging breast cancer Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and the best treatment options. Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery. Tests and procedures used to stage breast cancer may include: Blood tests, such as a complete blood count Mammogram of the other breast to look for signs of cancer Breast MRI Computerized tomography (CT) scan Positron emission tomography (PET) scan Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing.

Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body. AskMayoExpert. Breast cancer. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015. Breast cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. Accessed May 3, 2016. Townsend CM Jr, et al. Diseases of the breast. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. Accessed May 3, 2016. Leading new cancer cases and deaths — 2016 estimates. American Cancer Society. Accessed May 4, 2016. SEER stat fact sheet: Female breast cancer. National Cancer Institute. Accessed May 4, 2016. AskMayoExpert. Breast reconstruction. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.

What you need to know about breast cancer. National Cancer Institute. Accessed May 9, 2016. Hormone therapy for breast cancer. National Cancer Institute. Accessed May 9, 2016. Cancer‐related fatigue. Fort Washington, Pa.: National Comprehensive Cancer Network. Accessed May 3, 2016. Palliative care. Fort Washington, Pa.: National Comprehensive Cancer Network. Accessed May 3, 2016. Faslodex (prescribing information). Wilmington, Del.: AstraZeneca; 2016. Accessed May 9, 2016. Herceptin (prescribing information). South San Francisco, Calif.: Genentech Inc.; 2016. Accessed May 9, 2016. Perjeta (prescribing information). South San Francisco, Calif.: Genentech Inc.; 2016. Accessed May 9, 2016. Kadcyla (prescribing information). South San Francisco, Calif.: Genentech Inc.; 2016. Accessed May 9, 2016.

Tykerb (prescribing information). Research Triangle Park, N.C.: GlaxoSmithKline; 2015. Accessed May 9, 2016. McDermott AM, et al. Surgeon and breast unit volume-outcome relationships in breast cancer surgery and treatment. Annals of Surgery. 2013;258:808. Ibrance (prescribing information). New York, N.Y.: Pfizer; 2016. Accessed May 6, 2016. Afinitor (prescribing information). East Hanover, N.J.: Novartis; 2016. Accessed May 6, 2016. AskMayoExpert. Tamoxifen and CYP2D6. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. Breast SPOREs. National Cancer Institute. Accessed May 3, 2016. Cook AJ. Allscripts EPSi. Mayo Clinic, Rochester, Minn. May 3, 2016. Toledo E, et al.

Mediterranean diet and invasive breast cancer risk among women at high cardiovascular risk in the PREDIMED trial. JAMA Internal Medicine. 2015;175:1752. Breast cancer prevention — Patient version (PDQ). National Cancer Institute. Accessed May 9, 2016. Related Mammography | Mammogram | Breast Cancer | MedlinePlus Patient Handouts Summary A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if you have a lump or other sign of breast cancer. Screening mammography is the type of mammogram that checks you when you have no symptoms. It can help reduce the number of deaths from breast cancer among women ages 40 to 70. But it can also have drawbacks. Mammograms can sometimes find something that looks abnormal but isn't cancer. This leads to further testing and can cause you anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes you to radiation. You should talk to your doctor about the benefits and drawbacks of mammograms.

Together, you can decide when to start and how often to have a mammogram. Mammograms are also recommended for younger women who have symptoms of breast cancer or who have a high risk of the disease. When you have a mammogram, you stand in front of an x-ray machine. The person who takes the x-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture. You should get a written report of your mammogram results within 30 days. NIH: National Cancer Institute Breast Ultrasound What are the limitations of Ultrasound Imaging of the Breast? What is Ultrasound Imaging of the Breast? Ultrasound is safe and painless, and produces pictures of the inside of the body using sound waves. Ultrasound imaging, also called ultrasound scanning or sonography , involves the use of a small transducer (probe) and ultrasound gel placed directly on the skin. High-frequency sound waves are transmitted from the probe through the gel into the body. The transducer collects the sounds that bounce back and a computer then uses those sound waves to create an image.

Ultrasound examinations do not use ionizing radiation (as used in x-rays ), thus there is no radiation exposure to the patient. Because ultrasound images are captured in real-time, they can show the structure and movement of the body's internal organs, as well as blood flowing through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Doppler ultrasound is a special ultrasound technique that allows the physician to see and evaluate blood flow through arteries and veins in the abdomen, arms, legs, neck and/or brain (in infants and children) or within various body organs such as the liver or kidneys. Ultrasound imaging of the breast produces a picture of the internal structures of the breast. During a breast ultrasound examination the sonographer or physician performing the test may use Doppler techniques to evaluate blood flow or lack of flow in any breast mass. In some cases this may provide additional information as to the cause of the mass. What are some common uses of the procedure?

Determining the Nature of a Breast Abnormality The primary use of breast ultrasound today is to help diagnose breast abnormalities detected by a physician during a physical exam (such as a lump or bloody or spontaneous clear nipple discharge) and to characterize potential abnormalities seen on mammography or breast magnetic resonance imaging (MRI). Ultrasound imaging can help to determine if an abnormality is solid (which may be a non-cancerous lump of tissue or a cancerous tumor) or fluid-filled (such as a benign cyst ) or both cystic and solid. Doppler ultrasound is used to assess blood supply in breast lesions . Supplemental Breast Cancer Screening Mammography is the only screening tool for breast cancer that is known to reduce deaths due to breast cancer through early detection. Even so, mammograms do not detect all breast cancers. Some breast lesions and abnormalities are not visible or are difficult to interpret on mammograms. In breasts that are dense, meaning there is a lot of ducts, glands, fibrous tissue and less fat, many cancers can be hard to see on mammography. Many studies have shown that ultrasound and magnetic resonance imaging (MRI) can help supplement mammography by detecting breast cancers that may not be visible with mammography.

MRI is more sensitive than ultrasound in depicting breast cancer, but MRI may not be available to all women. If screening MRI is performed, then screening ultrasound is not needed, though ultrasound may be used to characterize and biopsy abnormalities seen on MRI. When ultrasound is used for screening, abnormalities not visible with mammography may be identified, including some that may require biopsy. Many of the abnormalities found with screening breast ultrasound are not cancer (false positives), but breast US allows for a full examination. See the Breast Cancer Screening page for more information. Ultrasound can be offered as a screening tool for women who: are at high risk for breast cancer and unable to undergo an MRI examination. are pregnant or should not be exposed to x-rays (which is necessary for a mammogram). have increased breast density — when the breasts have a lot of glandular and connective tissue and not much fatty tissue (see the Dense Breasts page for more information). Ultrasound-guided Breast Biopsy When an ultrasound examination reveals a suspicious breast abnormality, a physician may choose to perform an ultrasound-guided biopsy . Because ultrasound provides real-time images, it is often used to guide biopsy procedures.

An ultrasound exam will usually need to be performed before the biopsy in order to plan the procedure and to determine if this method of biopsy can be used. For more information on this procedure, please refer to the Ultrasound-guided Breast Biopsy page. top of page How should I prepare? You will be asked to undress from the waist up and to wear a gown during the examination. top of page What does the equipment look like? Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. Some exams may use different transducers (with different capabilities) during a single exam. The transducer sends out inaudible, high—frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines. The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor.

The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area within the patient that is being examined to the transducer (the device used to examine the patient), as well as the type of body structure and composition of body tissue through which the sound travels. A small amount of gel is put on the skin to allow the sound waves to best travel from the transducer to the examined area within the body and then back again. Ultrasound is an excellent modality for some areas of the body while other areas, especially the lungs, are poorly suited for ultrasound. top of page How does the procedure work? Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency (whether the object is solid or filled with fluid). In medicine, ultrasound is used to detect changes in appearance, size or contour of organs, tissues, and vessels or to detect abnormal masses, such as tumors.

In an ultrasound examination, a transducer both sends the sound waves and receives the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images. Short video loops of the images may also be saved. Doppler ultrasound, a special application of ultrasound, measures the direction and speed of blood cells as they move through vessels. The movement of blood cells causes a change in pitch of the reflected sound waves (called the Doppler effect). A computer collects and processes the sounds and creates graphs or color pictures that represent the flow of blood through the blood vessels. top of page How is the procedure performed? You will lie on your back on the examining table and may be asked to raise your arm above your head.

After you are positioned on the examination table, the radiologist (a physician specifically trained to supervise and interpret radiology examinations) or sonographer will apply a warm water-based gel to the area of the body being studied. The gel will help the transducer make secure contact with the body and eliminate air pockets between the transducer and the skin that can block the sound waves from passing into your body. The transducer is placed on the body and moved back and forth over the area of interest until the desired images are captured. There is usually no discomfort from pressure as the transducer is pressed against the area being examined. However, if scanning is performed over an area of tenderness, you may feel pressure or minor pain from the transducer. Doppler sonography is performed using the same transducer. Once the imaging is complete, the clear ultrasound gel will be wiped off your skin. Any portions that are not wiped off will dry to a powder. The ultrasound gel does not stain or discolor clothing. What will I experience during and after the procedure? Ultrasound examinations are painless and easily tolerated by most patients. Breast ultrasound is usually completed within 30 minutes.

If a Doppler ultrasound study is performed, you may actually hear pulse-like sounds that change in pitch as the blood flow is monitored and measured. You may be asked to change positions during the exam. When the examination is complete, you may be asked to dress and wait while the ultrasound images are reviewed. After an ultrasound examination, you should be able to resume your normal activities immediately. top of page Who interprets the results and how do I get them? A radiologist, a physician specifically trained to supervise and interpret radiology examinations, will analyze the images and send a signed report to your primary care physician, or to the physician or other healthcare provider who requested the exam. Usually, the referring physician or health care provider will share the results with you. In some cases, the radiologist may discuss results with you at the conclusion of your examination. Follow-up examinations may be necessary, and your doctor will explain the exact reason why another exam is requested. Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up examination may also be necessary so that any change in a known abnormality can be monitored over time.

Follow-up examinations are sometimes the best way to see if treatment is working or if a finding is stable or changed over time. What are the benefits vs. risks? Benefits Most ultrasound scanning is noninvasive (no needles or injections). Occasionally, an ultrasound exam may be temporarily uncomfortable, but it should not be painful. Ultrasound is widely available, easy-to-use and less expensive than other imaging methods. Ultrasound imaging is extremely safe and does not use any ionizing radiation. Ultrasound scanning gives a clear picture of soft tissues that do not show up well on x-ray images. Ultrasound provides real-time imaging, making it a good tool for guiding minimally invasive procedures such as needle biopsies and fluid aspiration. Ultrasound imaging can help detect lesions in women with dense breasts. Ultrasound may help detect and classify a breast lesion that cannot be interpreted adequately through mammography alone. Using ultrasound, physicians are able to determine that many areas of clinical concern are due to normal tissue (such as fat lobules ) or benign cysts. For most women 30 years of age and older, a mammogram will be used together with ultrasound.

For women under age 30, ultrasound alone is often sufficient to determine whether an area of concern needs a biopsy or not. Risks For standard diagnostic ultrasound , there are no known harmful effects on humans. Interpretation of a breast ultrasound examination may lead to additional procedures such as follow-up ultrasound and/or aspiration or biopsy. Many of the areas thought to be of concern turn out to be non-cancerous. What are the limitations of Ultrasound Imaging of the Breast? Ultrasound is one of the tools used in breast imaging, but it does not replace annual mammography. Many cancers are not visible on ultrasound. Many calcifications seen on mammography cannot be seen on ultrasound. Some early breast cancers only show up as calcifications on mammography. MRI findings that are due to cancer are not always seen with ultrasound. Biopsy may be recommended to determine if a suspicious abnormality is cancer or not. Most suspicious findings on ultrasound that require biopsy are not cancers. Many facilities do not offer ultrasound screening, and the procedure may not be covered by some insurance plans. It is important to choose a facility with expertise in breast ultrasound, preferably one where the radiologists specialize in breast imaging.

Ultrasound depends on the abnormality being recognized at the time of the scan as it is a "real-time" examination. This requires experience and good equipment. One measure of a facility's expertise in breast ultrasound can be found in its ACR accreditation status. Check the facilities in your area by searching the ACR-accredited facilities database . Biopsy Biopsy Save as Favorite Sign in to receive recommendations ( Learn more ) Imaging studies such as mammogram and MRI, often along with physical exams of the breast, can lead doctors to suspect that a person has breast cancer. However, the only way to know for sure is to take a sample of tissue from the suspicious area and examine it under a microscope. A biopsy is a small operation done to remove tissue from an area of concern in the body. If your doctor feels anything suspicious in your breast, or sees something suspicious on an imaging study, he or she will order a biopsy. The tissue sample is examined by a pathologist (a doctor who specializes in diagnosing disease) to see whether or not cancer cells are present. If cancer is present, the pathologist can then look at the cancer’s characteristics. The biopsy will result in a report that lays out all of the pathologist’s findings.

Biopsy is usually a simple procedure. In the United States, only about 20% of women who have biopsies turn out to have cancer. By contrast, in Sweden, where cost accounting is much stricter and only the most suspicious lesions are biopsied, 80% of biopsies turn out to be cancerous (malignant). Biopsy techniques Different techniques can be used to perform biopsy, and it’s likely that your surgeon will try to use the least invasive procedure possible — the one that involves the smallest incision and the least amount of scarring. However, the choice of procedure really depends on your individual situation. Biopsy can be done by placing a needle through the skin into the breast to remove the tissue sample. Or, it can involve a minor surgical procedure, in which the surgeon cuts through the skin to remove some or all of the suspicious tissue. Fine needle aspiration biopsy Fine needle aspiration (FNA) is the least invasive method of biopsy and it usually leaves no scar. You will be lying down for this procedure. First, an injection of local anesthesia is given to numb the breast. The surgeon or radiologist uses a thin needle with a hollow center to remove a sample of cells from the suspicious area.

In most cases, he or she can feel the lump and guide the needle to the right place. In cases where the lump cannot be felt, the surgeon or radiologist may need to use imaging studies to guide the needle to the right location. This is called ultrasound-guided biopsy when ultrasound is used, or stereotactic needle biopsy when mammogram is used. With ultrasound-guided biopsy, the doctor will watch the needle on the ultrasound monitor to guide it to the area of concern. With stereotactic mammography, mammograms are taken from different angles to pinpoint the location of the breast mass. The doctor then inserts the hollow needle to remove the cell sample. Core needle biopsy Core needle biopsy uses a larger hollow needle than fine needle aspiration does. If you have this type of biopsy, you’ll be lying down. After numbing the breast with local anesthesia, the surgeon or radiologist uses the hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area. In most cases, the needle is inserted about 3 to 6 times so that the doctor can get enough samples. Usually core needle biopsy does not leave a scar.

If the lesion cannot be felt through the skin, the surgeon or radiologist can use an image-guided technique such as ultrasound-guided biopsy or stereotactic needle biopsy. A small metal clip may be inserted into the breast to mark the site of biopsy in case the tissue proves to be cancerous and additional surgery is required. This clip is left inside the breast and is not harmful to the body. If the biopsy leads to more surgery, the clip will be removed at that time. In addition to offering quick results without significant discomfort and scarring, both fine needle aspiration and core needle biopsy give you the opportunity to discuss treatment options with your doctor before having any surgery. In some cases, needle biopsy can be performed right in the doctor’s office, unless your doctor needs the help of imaging equipment to guide the biopsy. However, needle biopsy has a higher risk of a “false negative” result — a result suggesting that cancer is not present when it really is. This is likely because needle biopsy removes a smaller amount of tissue than surgical biopsy does and may not pick up the cancer cells. Your doctor may recommend a surgical biopsy in follow up to, or instead of, a needle biopsy. Together you can decide what is best for your situation.

Vacuum-assisted breast biopsy Vacuum-assisted breast biopsy, also known by the brand names Mammotome or MIBB (which stands for Minimally Invasive Breast Biopsy), is a newer way of performing breast biopsy. Unlike core needle biopsy, which involves several insertions of a needle through the skin, vacuum-assisted biopsy uses a special probe that only has to be inserted once. The procedure also is able to remove more tissue than core needle biopsy does. For vacuum-assisted breast biopsy, you’ll lie face down on an exam table with special round openings in it, where you place your breasts. First, an injection of local anesthesia is given to numb the breast. Guided by mammography (stereotactic-guided biopsy) or ultrasound, the surgeon or radiologist places the probe into the suspicious area of the breast. A vacuum then draws the tissue into the probe. A rotating cutting device removes a tissue sample and then carries it through the probe into a collection area. The surgeon or radiologist can then rotate the probe to take another sample from the suspicious lesion. This can be repeated 8 to 10 times so that the entire area of concern is thoroughly sampled.

In some cases, a small metal clip is placed into the biopsy site to mark the location, in case a future biopsy is needed. This clip is left inside the breast and causes no pain or harm. If the biopsy leads to more surgery, the clip will be removed at that time. Vacuum-assisted biopsy is becoming more common, but it is still a relatively new procedure. If you are having this form of biopsy, make sure that the surgeon or radiologist is experienced at using the equipment. Incisional biopsy Incisional biopsy is more like regular surgery. After using local anesthesia to numb the breast and giving you an injection to make you drowsy, the surgeon uses a scalpel to cut through the skin to remove a piece of the tissue for examination. As with needle biopsy, if the surgeon cannot feel the lump or suspicious area, he or she may need to use mammography or ultrasound to find the right spot. Your surgeon also may use a procedure called needle wire localization. Guided by either mammography or ultrasound, the surgeon inserts a small hollow needle through the breast skin into the abnormal area. A small wire is placed through the needle and into the area of concern. Then the needle is removed.

The doctor can use the wire as a guide in finding the right spot for biopsy. Your doctor may recommend incisional biopsy if a needle biopsy is inconclusive — that is, the results are unclear or not definite — or if the suspicious area is too large to sample easily with a needle. As with needle biopsy, there is some possibility that incisional biopsy can return a false negative result. However, you do get the results fairly quickly. Given that it is a surgical procedure, incisional biopsy is more invasive than needle biopsy, it leaves a scar, and it may require more time to recover. Excisional biopsy Excisional biopsy, the most involved form of biopsy, is surgery to remove the entire area of suspicious tissue from the breast. In addition to removing the suspected cancer, the surgeon generally will remove a small rim of normal tissue around it as well, called a margin. As with incisional biopsy, if the surgeon cannot feel the lump or suspicious area, he or she may need to use mammography or ultrasound to find the right spot. Your surgeon also may use needle wire localization to mark the right area for biopsy. Excisional biopsy is the surest way to establish a definite diagnosis without getting a false negative result.

Also, having the entire lump removed may provide you with some peace of mind. However, excisional biopsy is more like regular surgery, and it will leave a scar and require more time to recover. Like incisional biopsy, excisional biopsy is performed with local anesthesia. Before your biopsy Biopsies are not medical emergencies and can be scheduled at your convenience. But for peace of mind, most people want their biopsies done "yesterday." Medical guidelines say that about 90% of biopsies should be needle biopsies, the least invasive procedure. Still, research has shown that about 70% of breast biopsies are surgical biopsies. This means that many women who don't have cancer are having unnecessary surgery. It also means that women who are diagnosed with breast cancer have to have a second operation to remove the cancer.

Before proceeding with a biopsy, be sure to ask your doctor to: review the results of your mammogram and any other imaging studies with you show you the area in question explain the type of biopsy that's recommended for you and explain why that type of biopsy is recommended; if surgical biopsy is recommended ask if needle biopsy can be done discuss how and why the biopsy will be performed answer any of your questions arrange for you to sign required consent forms tell you when and how you can get the biopsy results A few days to a week after biopsy, your doctor should give you a pathology report that explains what was found in the tissue sample. See Your Diagnosis for more information. Last modified on October 7, 2015 at 6:57 AM

Question: What is the name given to a breast X-Ray
Answer: Mammogram