If abnormalities are found, what's next?

Unlike screening tests, diagnostic procedures help to further characterize breast abnormalities such as a breast lump or a spot on a mammogram or MRI. These tests help your doctor determine the need for a biopsy and also may be used to help guide a biopsy.

Types of Diagnostic Procedures

Ultrasound uses sound waves to create an image of your breast on a computer screen. By analyzing this image, your doctor may be able to tell whether a lump is a cyst or a solid mass. Cysts, which are sacs of fluid, usually aren't cancerous, although your doctor may recommend draining the cyst.

A biopsy — a small sample of tissue removed for analysis in the laboratory — is the only test that can tell if cancer is present. Biopsies can provide important information about an unusual breast change and help determine whether surgery is needed and if so, the type of surgery required. Types of biopsies include:

• Fine-needle aspiration biopsy. Your doctor uses a thin, hollow needle to withdraw tissue from the lump. He or she then sends the tissue to a lab for microscopic analysis. The procedure takes about 30 minutes and is similar to drawing blood.
• Core needle biopsy. A radiologist or surgeon uses a hollow needle to remove tissue samples from a breast lump. As many as 15 samples, each about the size of a grain of rice, may be taken then sent to a pathologist to be analyzed for malignant cells. The advantage of a core needle biopsy is that it removes more tissue for analysis. Sometimes your radiologist or surgeon may use ultrasound to help guide the placement of the needle.
• Stereotactic biopsy. This technique is used to sample and evaluate an area of concern, such as microcalcification, that can be seen on a mammogram but that cannot be felt or seen on an ultrasound. During the procedure, a radiologist takes a core needle biopsy, using your mammogram as a guide. Stereotactic biopsy usually takes about an hour and is performed using local anesthesia.
• Wire localization. Your doctor may recommend this technique when a worrisome lump is seen on a mammogram but can't be felt or evaluated with a stereotactic biopsy. Using your mammogram as a guide, a thin wire is placed in your breast and the tip guided to the lump. Wire localization is usually performed right before a surgical biopsy and is a way to guide the surgeon to the area to be removed and tested.
• Surgical biopsy. This remains one of the most accurate methods for determining whether a breast change is cancerous. During this procedure, your surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is large, only a sample will be taken (incisional biopsy). The surgical biopsy is generally performed on an outpatient basis in a clinic or hospital.


• Estrogen and progesterone receptor tests
  Malignant cells removed in a biopsy can be tested for the presence of hormone receptors. If the cancer cells have receptors for estrogen or progesterone or both, your doctor may recommend treatment with a drug such as tamoxifen, which prevents estrogen from binding to these sites.
• Staging tests
  Staging tests determine the size and location of your cancer and whether it has spread. They also help with treatment planning. Cancer is staged using the numbers 0 through IV.
  See complete explanations of breast cancer
• Genetic tests
  If you have a strong family history of breast cancer or other cancers, blood tests may help identify defective genes that are being passed through the family. But these tests are often inconclusive and should only be done in select cases after a thorough evaluation with a genetic counselor.
• The decision-making consultation
  If you are diagnosed with breast cancer, it is imperative that you effectively communicate with your doctors as you navigate through the series of complex decisions surrounding your treatment options.