To help find the cause of any signs or symptoms of breast cancer, a physician or nurse practitioner does a careful physical exam and asks questions about personal and family medical history. In addition, he/she may do one or more of the following.

Clinical breast exam. A practitioner can tell a lot about a lump by carefully feeling it and the tissue around it. (Benign lumps often feel different from cancerous ones.) He/she can examine the size and texture of the lump and try to determine whether the lump moves easily. Other signs and symptoms that warrant further study include not only a lump but a thickening of the breast tissue, a change in the size or shape of the breast, nipple discharge, dimpling, puckering, or scaling of the skin or nipple or any change from the norm.

Mammography. A mammogram is the best tool available for finding breast cancer early, before symptoms appear. Mammograms can often detect a breast lump before it can be felt. Although mammograms are the best way to find breast abnormalities early, they do have some limitations. A mammogram may miss some cancers that are present (false negative) or may find things that turn out not to be cancer (false positive).For more detailed information about mammography click here.

Computer-Aided Detection. LewisGale Hospital at Montgomery uses the ImageChecker system in conjunction with all screening and diagnostic mammography exams. The first FDA-approved Computer Aided Detection (CAD) system for breast imaging, R2 assists radiologists during their review of mammograms by identifying abnormalities that may be indicative of cancer.

Ultrasound. Using high frequency sound waves, ultrasonography can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer).

If an area of the breast looks suspicious as a result of any of these diagnostic tests, your doctor may advise you to have a biopsy.

Biopsy

If a biopsy is requested fluid or tissue is removed from the breast to assist your physician in providing a diagnosis. He/she may refer you to a member of our Clinical Breast Care Team for one of the following:

Fine needle aspiration. A thin needle is used to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked by a lab.

Core Needle Biopsies

Free Hand Core. Core needle biopsies involve removing small samples of breast tissue using a hollow (core) needle. One method is a free hand procedure which is used for lumps that can be felt. The area biopsied is cleaned and injected with a local anesthetic where the needle will be inserted. Three to six separate samples of tissue are usually taken. The tissue removed is sent to the lab to be evaluated by the pathologist.

Ultrasound Guided Core. Ultrasound can be used as an imaging tool to locate the abnormality that cannot be felt. The radiologist locates the area with ultrasound and guides the biopsy needle to obtain the core samples.

Mammotome Stereotactic Core Biopsy. Stereotactic biopsy is a core biopsy using specialized equipment to take a series of mammography films to locate the biopsy area on a computer. The radiologist then calculates where the needle should be inserted. This biopsy procedure is used for areas that are identified in the breast by mammography, such as microcalcifications. The procedure is done as an outpatient in the hospital. Stereotactic procedures are done with the woman lying on her abdomen on a special table with her breast hanging through a hole in the table. The breast is injected with a local anesthetic and a small surgical slit is cut in the breast to allow the biopsy probe to pass into the breast. (No stitches are required after the procedure). The biopsy probe is connected to a vacuum line that pulls tissue into the sampling chamber. The physician can rotate the probe without removing it from the breast with each sampling. 8 -12 tissue samples are removed from the breast and sent to the lab for a pathologist to evaluate. A small sterile clip may be placed into the biopsy site to mark the area in case a future biopsy is needed. The procedure takes about 30 minutes to 1 hour.

Incisional Biopsy. An Incisional biopsy is the removal of a small piece of the suspicious area under either local anesthesia or general anesthesia. The sample of breast tissue is then sent to the lab to be evaluated by the pathologist.

Excisional Biopsy. Excisional Biopsy is the removal of an entire lump or suspicious area by a surgeon. The area surrounding the area, referred to as the margin may be removed at the same time. The size of the incision varies according to the size of the lump removed and the area is closed with several stitches.