Follow-up Tests to Diagnose Breast Changes

An ultrasound exam, an MRI, a biopsy, or other follow-up tests may be needed to learn more about a breast change.

"My doctor said my mammogram found something 'abnormal.' That scared me, so I went back for more testing. It turned out that I had a benign cyst. It wasn't cancer. That was a relief."

Ultrasound

An ultrasound exam uses sound waves to make a picture of breast tissue. This picture is called a sonogram. It helps radiologists to see if a lump or mass is solid or filled with fluid. A fluid-filled lump is called a cyst.

MRI

Magnetic resonance imaging, also called MRI, uses a powerful magnet, radio waves, and a computer to take detailed pictures of areas inside the breast. Sometimes breast lumps or large lymph nodes are found during a clinical breast exam or breast self-exam that were not seen on a mammogram or ultrasound. In these cases, an MRI can be used to learn more about these changes.

Breast biopsy

A breast biopsy is a procedure to remove a sample of breast cells or tissue, or an entire lump. A pathologist then looks at the sample under a microscope to check for signs of disease. A biopsy is the only way to find out if cells are cancer.

Biopsies are usually done in an office or a clinic on an outpatient basis. This means you will go home the same day as the procedure. Local anesthesia is used for some biopsies. This means you will be awake, but you won't feel pain in your breast during the procedure. General anesthesia is often used for a surgical biopsy. This means that you will be asleep and won't wake up during the procedure.

Common types of breast biopsies:

• Fine-needle aspiration biopsy
  A fine-needle aspiration biopsy is a simple procedure that takes only a few minutes. Your health care provider inserts a thin needle into the breast to take out fluid and cells.
• Core biopsy
  A core biopsy, also called a core needle biopsy, uses a needle to remove small pieces or cores of breast tissue. The samples are about the size of a grain of rice. You may have a bruise, but usually not a scar.
• Vacuum-assisted biopsy
  A vacuum-assisted biopsy uses a probe, connected to a vacuum device, to remove a small sample of breast tissue. The small cut made in the breast is much smaller than with surgical biopsy. This procedure causes very little scarring, and no stitches are needed.

Your doctor may use ultrasound or mammography during a breast biopsy to help locate the breast change.

• Surgical biopsy
  A surgical biopsy is an operation to remove part, or all, of a lump so it can be looked at under a microscope to check for signs of disease. Sometimes a doctor will do a surgical biopsy as the first step. Other times, a doctor may do a surgical biopsy if the results of a needle biopsy do not give enough information.

When only a sample of breast tissue is removed, it's called an incisional biopsy. When the entire lump or suspicious area is removed, it's called an excisional biopsy.

If the breast change cannot be felt, wire localization, also called needle localization, may be used to find the breast change. During wire localization, a thin, hollow needle is inserted into the breast. A mammogram is taken to make sure that the needle is in the right place. Then a fine wire is inserted through the hollow needle, to mark the area of tissue to be removed. Next, the needle is removed, and another mammogram is taken. You then go to the operating room where the surgeon removes the wire and surrounding breast tissue. The tissue is sent to the lab to be checked for signs of disease.

"My doctor found what felt like a lump during an exam. She said I should get a biopsy. I was afraid. But my doctor told me that it's always best to find out exactly what the problem is and take care of it early."

Questions to ask if a biopsy is recommended:

• Why is a biopsy needed? What will it tell us? ___________________________________________
• What type of biopsy will I have? How will the biopsy be done? ______________________________
• Where will the biopsy be done? How long will it take? ____________________________________
• Will it hurt? _____________________________________________________________________
• How much breast tissue will be removed?_____________________________________________
• Will I be awake? ________________________________________________________________
• What tests will be done on the breast tissue? __________________________________________
• When will I know the results?_______________________________________________________
• Will there be side effects? _________________________________________________________
• How should I care for the biopsy site? ________________________________________________
• Will I need to rest after the biopsy? __________________________________________________

Questions to ask about your biopsy results:

• What were the results of the biopsy? _________________________________________________
• What do the biopsy results mean? __________________________________________________
• What are the next steps? Do I need more tests? ________________________________________
• Who should I talk with next? ________________________________________________________
• Do I have an increased risk of breast cancer? __________________________________________
• Who can give me a second opinion on my biopsy results? ________________________________

For a printable checklist, please see page 19 of the Understanding Breast Changes: A Health Guide for Women pdf.