Breast Cancer Diagnosis
1 AnswerThe development of intraductal approaches to diagnosis and treatment represents one of the most important advances in breast disease treatment. Intraductal endoscopic techniques allow surgeons to perform evaluations through the nipple using very fine micro-endoscopes without surgery and without general anesthesia. This minimally invasive approach has been proved highly successful in the detection of papillomas. An endoscopic papillomectomy can diagnose pathologic nipple discharge.
The lifetime risk of developing certain types of cancer is greatly increased for women and men who inherit a BRCA1 or BRCA2 mutation. Men and women can learn if they have the BRCA1 or BRCA2 gene mutation by getting evaluated.
Knowing about the presence of a BRCA1 or BRCA2 mutation can be lifesaving. There are many interventions that can increase the chance for early diagnosis and/or lower the chances for developing cancer.
Men and women with a BRCA1 or BRCA2 mutation may do the following:
- Choose to start screening for breast cancer at age 25
- Receive specialized breast screening that includes regular mammography and breast MRI
- Participate in screening studies that offer cutting-edge technologies
- Be screened for ovarian cancer
- Choose to have ovaries or healthy breast tissue removed to reduce risk of developing cancer
- Be candidates for other specialized types of enhanced screening
- Receive personalized medical recommendations for overall health
1 AnswerDigital breast tomosynthesis (DBT) has a few minor drawbacks:
- The approved indications for DBT state that it must be used as an adjunct to standard digital mammography. This means that the radiation dose for women having DBT is slightly higher than it would be with standard digital mammography. Even with the addition of DBT, however, the dose remains lower than the maximum allowed with older, analog mammography.
- Because DBT is a new platform, techniques for best use are still evolving.
- To date, no substantial trials of 3-D tomosynthesis have been performed in the U.S., though a large trial is currently being planned. A large-scale population-based study is ongoing in Europe. These trials are very hard to do and must involve many thousands of women to show a significant benefit in cancer detection of tomosynthesis over routine mammography.
1 AnswerThe digital breast tomosynthesis (DBT) system employs a digital X-ray that records a series of low-dose, high-resolution images of the breast while traversing a small (15°) arc around the compressed breast. As the projection angle changes, images are recorded at slightly different depths and thicknesses, from one surface of the breast to the other.
The compression time of approximately four seconds needed for DBT is similar to that used for standard two-dimensional digital mammography. Following the procedure, reconstruction algorithms are used to create a 3-D rendering of the interior breast architecture.
This rendering is presented to the breast imager as a stack of images of the breast that, in total, represent the area from one skin surface to the other. Each DBT image can be magnified or manipulated to better reveal minute detail. These processes can reduce the superimposition of overlapping tissue shadows seen in two-dimensional mammograms, allowing more accurate interpretations of breast changes.
Among the greatest advantages of DBT for radiologists is that it offers images with a clarity and degree of detail substantial enough to reduce some of the false-positives and false-negatives associated with 2-D mammographic imaging. In small series studies, researchers have reported reducing the false-positive callback rate by as much as 30 to 40%.
1 AnswerMale breast cancer is typically found through a clinical breast exam. If your doctor feels any lumps, a mammogram or ultrasound may then be used to look for any abnormalities within the breast. If you have nipple discharge, your doctor can examine the fluid to look for cancerous cells. A biopsy is used to make a definitive diagnosis of breast cancer, including the type and stage.
1 AnswerThe following lab tests are used to diagnose breast cancer:
- Oncotype DX: The Oncotype DX test (also called the 21-gene test) is used to determine if chemotherapy is likely to benefit women with early stage breast cancer. This lab test also helps doctors to know the likelihood of disease recurrence. With this information, you and your doctor can make more informed decisions about your breast cancer treatment.
- Tumor molecular profiling: For this lab test, a sample of the metastatic or recurrent breast tumor is removed, often as part of a biopsy or other surgery. Then, the sample is tested for a variety of enzymes, proteins and genes to identify which drug therapies are likely to be most effective. Examples of tests include HER2 tumor tests and hormone receptor tests.
1 AnswerDuring a biopsy, your doctor removes cells from the breast and a pathologist inspects the cells under a microscope to see if they are cancerous. Some common biopsies used to help doctors make a breast cancer diagnosis include the following: fine needle aspiration biopsy, which uses a small needle; core needle biopsy, which uses a larger needle; or surgical biopsy, in which all or part of a lump is removed and checked for cancer. Here are two other types of biopsy:
- Sentinell lymph node biopsy: Your doctor may first perform a sentinel lymph node biopsy to determine whether cancer has spread to the lymph glands under the arm. First, a radioactive substance and/or a dye is injected near the tumor site. Then, the first lymph nodes that pick up the dye are removed and reviewed by a pathologist to check for the presence of cancer cells.
- MRI-guided breast biopsy: A minimally invasive, image-guided procedure in which specially trained radiologists use MRI technology and targeting software to precisely locate and remove cells from a suspicious area in the breast for diagnosis and treatment planning.
1 AnswerBreast cancer doctors use advanced diagnostic tests and tools to accurately locate and stage the disease, and plan your individualized treatment. Throughout your breast cancer treatment, doctors use imaging and laboratory tests to track the size of the tumors, monitor your response to treatment and modify your treatment when needed. The following are common tests and exams used for diagnosing and treating breast cancer:
- Breast exam
- Other imaging tests: MRI or PET/CT scans, miraluma breast imaging and bone scans
- Lab tests: tumor tests & genetic tests
There are different types of breast cancer biopsies -- and the kind you get can affect your long-term care. In this video, Dr. Tom Ortmeier discusses the different ways a breast biopsy can be done.
1 AnswerHealthwise answeredRegular checkups - After you've been treated for breast cancer the first time, you will have regular checkups to be sure that the cancer has not returned. You and your doctor will talk about how often you will need checkups. Your checkups may include a physical exam, a clinical breast exam (CBE), or a mammogram. An MRI of the breast may also be used. Diagnostic tests - If your doctor thinks that breast cancer has come back or spread, you may have other tests, including:
- Blood tests, such as a complete blood count (CBC). These help find the cause of symptoms such as fatigue, weakness, fever, bruising or weight loss.
- Tissue tests, such as a biopsy.
- Imaging studies, such as abdominal ultrasound, bone scan, chest X-ray, CT scan, or MRI.
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