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 Diagnosis
of Breast Cancer
The Breast Health Center is equipped with the best
technology to provide fast screening and accurate diagnosis
for patients with symptoms in the breasts, so as to
identify cancers at the earliest stage.
The following would explain some commonly used terms
in the diagnostic work up of breast diseases:
Mammography
One in eight women will be diagnosed with breast cancer
in their lifetime. The best way to prevent breast cancer
is to detect the disease as early as possible. The earlier
treatment can be offered, the better would be the chance
of survival.
Mammography is a special technique where the mammography
machine delivers low-dose X-ray to the breast. Many
small tumors can be detected on a mammogram before they
can be felt through self-exam or by your doctor.
In United States and most Western countries, all healthy
women are recommended to have a baseline mammogram at
the age of 40, and continue with mammograms every one
to two years thereafter.
Breast Ultrasound
The ultrasound transducer delivers high-frequency sound
waves to tissues, which are bounced off to produce a
picture. An ultrasound exam of the breast can provide
complementary information to a mammogram.
Whereas mammography is good at picking up small amounts
of calcium often found in breast cancer tissues, Breast
Ultrasound is better at telling whether a lump is solid
or filled with fluid (a "cyst"). That's why
the technique may sometimes reveal lumps that are difficult
to see on a mammogram.
Breast Ultrasound is also used in interventional radiography,
where the radiologist uses the imaging technique to
guide needles to obtain samples for a biopsy.
Breast MRI
Magnetic Resonance Imaging, or MRI, uses powerful magnetic
field and a computer to create pictures of areas inside
the body.
In younger women, routine mammography may not be appropriate
since their breast tissue may be too dense for the low
dose X-ray to go through.
For these patients, a Breast MRI may reveal subtle
cancers possibly undetectable by mammography.
Additionally, doctors may use breast MRI in patients
with proven cancer to detect additional lesions in the
same breast and find unsuspected tumors in the opposite
breast.
Since Breast MRI may reveal more information in patients
after breast surgery or radiation therapy, it is often
used to track response to chemotherapy, and look for
recurrences on follow-up.
Biopsy
After a breast exam, a mammogram or an ultrasound, your
doctor may determine that a biopsy is needed to come
to a definite conclusion.
A biopsy removes a sample of tissue to be examined
under the microscope to determine whether the lump is
cancerous (malignant) or not (benign). Because breast
cancer is a serious diagnosis, a biopsy is often recommended
after breast exam, a mammogram or a breast ultrasound
that have raised suspicions.
Traditionally in an open biopsy, the surgeon makes
an incision and removes a sample of the suspicious lump
or the entire lump to be examined by a pathologist.
If cancer is found, additional surgery may be performed.
The experts in the Breast Health Center, experienced
with minimally invasive procedures, have many sophisticated
options to help our patients in this regard to avoid
needless open surgeries.
Fine Needle Aspiration
During Fine Needle Aspiration or FNA, the surgeon inserts
a thin needle into the breast to obtain cell samples
from the breast to be examined under a microscope by
an experienced pathologist, or cytologist.
The needle is no different from the one used to draw
blood, so the procedure is more painful than receiving
an injection.
The procedure is best for breast lesions containing
fluid (cysts). Sometimes the cyst would completely disappear
after all the fluid is sucked out.
For solid lesions, however, FNA may not produce enough
cell samples to be examined for an accurate diagnosis.
Core Needle Biopsy
In Core Needle Biopsy the doctor uses a special hollow
"core" needle to obtain tissue from the breast
through the skin under local anesthesia. A cone of breast
tissue, about 1.6 mm thick and 20 mm long , would be
sampled out to be examined by the pathologist. Multiple
needle insertions may be necessary.
To ensure that the tissues obtained do come from the
suspicious area in the breast, a core needle biopsy
may be performed under Ultrasound Guidance in the Breast
Health Center as an Interventional Radiography procedure.
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