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Breast cancer investigations: Imaging:
X-rays - Mammography
Ultrasound (US)
MRI
MRI X-ray MRI MRI v. XRAY
lymphoscintigraphyLymphoscintigraphy
Bone scan
Bone density test
Other scans: brain scan, lung scan, liver scan
Breast self examination: Women should examine their breasts each month at about the same time in their menstrual cycle if they are pre-menopausal. They should be instructed in this professionally by their doctor or by a health professional at a screening clinic. If a professional is not available, there are several excellent web sites with instructions and diagrams.
Health professional examination: A woman should have a breast exam as part of her periodic (annual) check-up.
Biopsy is the removal of tissue for examination by a pathologist to make a diagnosis.
A needle biopsy involves taking a core of a lesion by inserting a hollow needle into the lesion.
When a woman has a lump diagnosed on mammography or other imaging she will often have a surgical open (excisional) biopsy. If the lesion is easily felt, i.e., palpable, it can be located by the surgeon by touch. If the lesion is small and not easily felt a radiologist will insert a wire with the tip in the lesion to guide the surgeon. This is usually done during an ultrasound examination done before surgery but can be done also with MR.
Sentinel Node. Lymph nodes are one of the first defences against infections. They are situated throughout the body. The lymph nodes that drain the breast are in the armpit (axilla), in the region of the collar bone (clavicle) and near the blood vessels inside the chest that feed the breast (internal mammary artery). They are linked by a network of vein-like vessels that carry lymph. Lymph is a milky fluid that has some ability to fight infection, but mostly it carry germs or other irritants to the lymph nodes to be dealt with by the body's immune system. The first node in the chain that drains the breast is called the sentinel node. There may be more than one sentinel node. The sentinel node is usually in the axilla where there are many nodes draining the breast and arm, often 16-21 nodes in all. When a breast cancer starts to spread (metastasize) it may do so through the lymphatic system. The first lymph gland that the cancer cells reach is the sentinel node. The sentinel node is detected by lymphoscintigraphy. The surgeon will remove the sentinel node for biopsy. If the cancer is already confirmed and the preliminary staging is already done, the surgeon will remove all nodes for biopsy for better staging as a guide to treatment. The main side effect of this is lymphedema (lymphoedema). This is a serious and long lasting condition with pain and swelling in the affected arm. Less serious is Axillary web syndrome which causes tender cords to appear in the axilla and arm. These cords usually go away without treatment, but physio may help. Because the drainage system of the arm is damaged by the surgery the arm may swell.
Mammography is the Xray examination of breasts. It is usually performed in the screening for or diagnosis of breast cancer. There are certain protocols for routine mammography. High risk women should have mammography annually. Others should follow the protocol of their health practitioner.
Digital V. Film Mammograms can be done on film or digitally. Both are effective in detecting breast cancer. Digital is better as it uses less radiation.
Digital is more effective in women under age 50 with denser breasts.
Ultrasound uses sound waves to obtain an image of the breast. No ionizing radiation is used. It is used after a lump is found by a woman or her doctor. An abnormal mammogram often is followed by a US exam. A mammogram may show suspicious changes such as calcification or "abnormal architecture" but not show a mass: US will help make a proper diagnosis.
Ultrasound may be used to place a wire in a suspicious lump to guide the surgeon when doing a biopsy.
MRI Magnetic resonance imaging. No radiation is involved in this technique. If a woman is at very high risk for breast cancer MRI may be done in addition to mammography.
MRI is used for women who have the gene for breast cancer, BRCA1 or BRCA2, or have a strong family history. It is now being suggested for any woman who has had breast cancer previously at her annual follow-up exam, and both breasts should be done. Some centres feel that MRI should be done on the other breast when a diagnosis is made on one breast. The mammogram may have missed a cancer in the second breast.
MRI may be used for pre-operative wire placement in areas where a biopsy is to be taken.
MRI v. MAMMOGRAPHY
MRI detects more breast cancers than mammography, but has more false positives. Up to 25% of MRIs reported positive are wrong. Therefore MRI is not done as a screening tool: too many women would be falsely diagnosed. They would have unnecessary follow-up investigations and would suffer the mental and financial stress associated with this.
MRI misses certain patterns of calcification which shows on mammography. These patterns may strongly suggest cancer.
MRI is better at detecting cancer in dense, non-fatty breasts.
MRI takes longer than mammography and costs more.
Lymphoscintigraphy of the breast involves injecting a radioactive chemical into the breast and following it as it is carried to the nearest lymph glands. The chemical may be injected around the lump (perilesional), into the skin over the lump (subdermal) or around the nipple (periareolar). Often the radiologist uses two of these methods, e.g., perilesional and periareolar.
All methods need local anaesthetic but the injections around the nipple are particularly painful. Insist on proper analgesia for periareolar injections- e.g., injection of local anaesthetic plus the use of analgesic cream.
The technician makes a mark over the sentinel node to guide the surgeon, who will use a hand held radioactivity detector to make sure the correct node is removed. In addition the surgeon may use blue dye which drains from the breast incision to the sentinel node. The surgeon then can see the dyed node as well as detect it by the hand held detector.
Bone Scan involves injecting a radioactive tracer into a vein. The tracer is attracted to bone which is "active", meaning that in the bone cells involved bone-turnover is happening. The body is laying down or removing calcium from that area. It takes an hour or two for this uptake to occur. In breast cancer patients the radiologist is looking for metastases in bone. The bone scan will also show other "active" conditions such as arthritis. The radiologist can tell the difference between metastases and arthritic joints.
Bone density test. This is a painless test using special Xrays which detect the mineral content of bone. Osteoporosis is the thinning of bone which occurs with age. Women who have estrogen sensitive cancer will be put on anti-estrogen drugs which may worsen the natural aging process on bones. They need a bone density test before starting the medication and at regular intervals afterwards to measure any increased loss of bone.
Other scans. The treating physician may order scans of internal organs such as liver, brain and lung if tests show that the cancer is likely to have spread. These are the most likely organs that would be involved in spread.
X-rays - Mammography
Ultrasound (US)
MRI
MRI X-ray MRI MRI v. XRAY
lymphoscintigraphyLymphoscintigraphy
Bone scan
Bone density test
Other scans: brain scan, lung scan, liver scan
Breast self examination: Women should examine their breasts each month at about the same time in their menstrual cycle if they are pre-menopausal. They should be instructed in this professionally by their doctor or by a health professional at a screening clinic. If a professional is not available, there are several excellent web sites with instructions and diagrams.
Health professional examination: A woman should have a breast exam as part of her periodic (annual) check-up.
Biopsy is the removal of tissue for examination by a pathologist to make a diagnosis.
A needle biopsy involves taking a core of a lesion by inserting a hollow needle into the lesion.
When a woman has a lump diagnosed on mammography or other imaging she will often have a surgical open (excisional) biopsy. If the lesion is easily felt, i.e., palpable, it can be located by the surgeon by touch. If the lesion is small and not easily felt a radiologist will insert a wire with the tip in the lesion to guide the surgeon. This is usually done during an ultrasound examination done before surgery but can be done also with MR.
Sentinel Node. Lymph nodes are one of the first defences against infections. They are situated throughout the body. The lymph nodes that drain the breast are in the armpit (axilla), in the region of the collar bone (clavicle) and near the blood vessels inside the chest that feed the breast (internal mammary artery). They are linked by a network of vein-like vessels that carry lymph. Lymph is a milky fluid that has some ability to fight infection, but mostly it carry germs or other irritants to the lymph nodes to be dealt with by the body's immune system. The first node in the chain that drains the breast is called the sentinel node. There may be more than one sentinel node. The sentinel node is usually in the axilla where there are many nodes draining the breast and arm, often 16-21 nodes in all. When a breast cancer starts to spread (metastasize) it may do so through the lymphatic system. The first lymph gland that the cancer cells reach is the sentinel node. The sentinel node is detected by lymphoscintigraphy. The surgeon will remove the sentinel node for biopsy. If the cancer is already confirmed and the preliminary staging is already done, the surgeon will remove all nodes for biopsy for better staging as a guide to treatment. The main side effect of this is lymphedema (lymphoedema). This is a serious and long lasting condition with pain and swelling in the affected arm. Less serious is Axillary web syndrome which causes tender cords to appear in the axilla and arm. These cords usually go away without treatment, but physio may help. Because the drainage system of the arm is damaged by the surgery the arm may swell.
Mammography is the Xray examination of breasts. It is usually performed in the screening for or diagnosis of breast cancer. There are certain protocols for routine mammography. High risk women should have mammography annually. Others should follow the protocol of their health practitioner.
Digital V. Film Mammograms can be done on film or digitally. Both are effective in detecting breast cancer. Digital is better as it uses less radiation.
Digital is more effective in women under age 50 with denser breasts.
Ultrasound uses sound waves to obtain an image of the breast. No ionizing radiation is used. It is used after a lump is found by a woman or her doctor. An abnormal mammogram often is followed by a US exam. A mammogram may show suspicious changes such as calcification or "abnormal architecture" but not show a mass: US will help make a proper diagnosis.
Ultrasound may be used to place a wire in a suspicious lump to guide the surgeon when doing a biopsy.
MRI Magnetic resonance imaging. No radiation is involved in this technique. If a woman is at very high risk for breast cancer MRI may be done in addition to mammography.
MRI is used for women who have the gene for breast cancer, BRCA1 or BRCA2, or have a strong family history. It is now being suggested for any woman who has had breast cancer previously at her annual follow-up exam, and both breasts should be done. Some centres feel that MRI should be done on the other breast when a diagnosis is made on one breast. The mammogram may have missed a cancer in the second breast.
MRI may be used for pre-operative wire placement in areas where a biopsy is to be taken.
MRI v. MAMMOGRAPHY
MRI detects more breast cancers than mammography, but has more false positives. Up to 25% of MRIs reported positive are wrong. Therefore MRI is not done as a screening tool: too many women would be falsely diagnosed. They would have unnecessary follow-up investigations and would suffer the mental and financial stress associated with this.
MRI misses certain patterns of calcification which shows on mammography. These patterns may strongly suggest cancer.
MRI is better at detecting cancer in dense, non-fatty breasts.
MRI takes longer than mammography and costs more.
Lymphoscintigraphy of the breast involves injecting a radioactive chemical into the breast and following it as it is carried to the nearest lymph glands. The chemical may be injected around the lump (perilesional), into the skin over the lump (subdermal) or around the nipple (periareolar). Often the radiologist uses two of these methods, e.g., perilesional and periareolar.
All methods need local anaesthetic but the injections around the nipple are particularly painful. Insist on proper analgesia for periareolar injections- e.g., injection of local anaesthetic plus the use of analgesic cream.
The technician makes a mark over the sentinel node to guide the surgeon, who will use a hand held radioactivity detector to make sure the correct node is removed. In addition the surgeon may use blue dye which drains from the breast incision to the sentinel node. The surgeon then can see the dyed node as well as detect it by the hand held detector.
Bone Scan involves injecting a radioactive tracer into a vein. The tracer is attracted to bone which is "active", meaning that in the bone cells involved bone-turnover is happening. The body is laying down or removing calcium from that area. It takes an hour or two for this uptake to occur. In breast cancer patients the radiologist is looking for metastases in bone. The bone scan will also show other "active" conditions such as arthritis. The radiologist can tell the difference between metastases and arthritic joints.
Bone density test. This is a painless test using special Xrays which detect the mineral content of bone. Osteoporosis is the thinning of bone which occurs with age. Women who have estrogen sensitive cancer will be put on anti-estrogen drugs which may worsen the natural aging process on bones. They need a bone density test before starting the medication and at regular intervals afterwards to measure any increased loss of bone.
Other scans. The treating physician may order scans of internal organs such as liver, brain and lung if tests show that the cancer is likely to have spread. These are the most likely organs that would be involved in spread.
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