Diagnosis

Breast Examination is based on three pillars. The first is physical examination; the second is imaging and the third tissue examination. This is called triple diagnosis. In case of suspected abnormalities in the breast, each of the three studies should be conducted before a diagnosis can be established or excluded.

The physical examination consists of inspection of the breast and palpation of the breast. Both breasts have an extension of tissue that extends into the axilla, which is called Spense’s tail. Furthermore, there are lymph nodes in the axilla. Therefore the axilla has to be examined as well.

The most commonly used imaging technique is mammography. This is an X-ray of the breast, made in two directions. This is the examination that is used for population screening. Tissue can be obtained with a thick or fine needle. It can also be obtained surgically.

Below is an overview of the different techniques that can be used to establish the diagnosis. Click on the subject you want to learn more about.

Mammography

Mammografie apparaat

Mammography device

With the use of a special device, a breast X-ray is taken. The breast is compressed to ensure that it is pictured completely and to keep the radiation dose as low as possible. This investigation can be conducted in the context of screening (early detection of tumours), in case of a suspected malignancy or for persecution of already diagnosed tumours. This investigation can also be performed in men.


Ultrasound

Echo van de borst

Ultrasound

Imaging of the breast by the use of sound waves. Based on the difference of the echo of the sound waves from the different types of tissue, a distinction can be made between, for example, a cyst and a different type of lump. The ultrasound is usually performed as an addition to mammography. In young women, this investigation alone can also be useful, since the mammogram is less sensitive in these women.
In addition, ultrasound can also be used as guidance for biopsy of the tumour.


Chest X-ray

Thoraxfoto borstkas

Chest X-ray

A so-called chest x-ray is an x-ray of the chest. If there is a risk of, for example, metastases to the lungs, ribs or vertebrae, a chest X-ray can provide more information.







MRI-scan

MRI-scan van de borst

MRI-scan

Magnetic Resonance Imaging (MRI) of the chest is an imaging method of the breast for which strong magnetic waves are used. When the outcome of the ultrasound and mammogram are inconclusive, an MRI can be made. With this investigation, some tumours can be seen, which were not visible on ultrasound and mammogram. This investigation is not widely used because of its high costs.

If a suspect lesion has been demonstrated on the mammogram, additional information can be obtained with respect to the extension and possible multifocality of this lesion. Also for research purposes an additional MRI can be made.

Skeleton scan

Breast cancer has the ability to metastasize to the skeleton. In order to discover this, a nuclear scan can be made. This investigation can be performed in patients with a large tumour, when the tumour has spread to the lymph nodes, or when the patient has symptoms of pain in the bones.

To carry out this investigation a small amount of radioactive substance is injected into a vein. The skeleton assimilates this substance and in places where the skeleton has an unusual amount of blood vessels this substance accumulates. These places are called “hot spots”. These “hot spots” may indicate a new outbreak of cancer cells.

Pathology

Borstkankercellen

Pathology

When the nature of a lump is unclear on the mammogram or breast ultrasound, a biopsy can be performed. Subsequently, the pathologist will investigate the nature of the tissue by microscopic examination of the tissue. Based on the number, the type and the arrangement of the cells, the pathologist can make a decision about whether or not the lump is malignant.

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