Further tests for DCIS

If the area of micro-calcification shows signs of DCIS, you’ll have further tests. You will need to have samples of tissue removed from the micro-calcification (a biopsy) and examined under a microscope for DCIS or cancer cells. The biopsy is usually done at the breast screening unit before you’re referred to a breast surgeon. There are different types of biopsy, and the doctor or nurse will explain the procedure that you will have.

Occasionally some women with DCIS go to their doctor with symptoms, such as a lump in the breast or a discharge from the nipple. When this happens, tests such as an ultrasound scan| or a fine needle aspiration (FNA)| as well as a mammogram may be done.

 

Breast biopsy Back to top

There are different types of biopsy. They include:

• a needle biopsy with a mammogram to guide the needle to the correct place
• a vacuum-assisted biopsy, which provides more tissue for diagnosis
• a biopsy with wire guidance, which is a small operation carried out if the other techniques are not possible.

 

Needle biopsy with mammogram

Needle biopsy is sometimes called a core biopsy. You’ll have a mammogram to show where the micro-calcification is and to help the doctor to guide a needle into the exact area to be removed. When the needle is guided by a mammogram, it’s known as a stereotactic needle biopsy.

To begin, you‘ll be positioned on a mammography machine that has a special device attached. In most units the test is done while you’re sitting down, but in a few you will lie on your front. The radiographer will then take a picture of your breast from two different angles to work out the exact position of the abnormal area so that the needle can be put into the right place.

Before the biopsy your doctor will inject some local anaesthetic to numb the area. You may feel a little soreness or a sensation of pressure, but this should only last for a short time. You’ll have a few biopsies taken at the same time. Afterwards your breast may be bruised and feel a bit sore. You can take painkillers until it eases.

Vacuum-Assisted Biopsy (VAB)

A special vacuum-assisted technique, which provides more tissue for diagnosis, can be used.

First, the doctor will numb the area with an injection of local anaesthetic and a small cut is then made in the skin. A tiny instrument or probe is placed through the cut into the breast tissue and guided to the correct area using a mammogram. When the probe is in the correct position, a vacuum gently draws and collects a piece of breast tissue into a small collecting chamber. Several biopsies are taken in this way usually without having to remove and reinsert the probe.

Afterwards, the probe is taken out and the cut is covered with a small dressing, with no need for any stitches. The whole procedure takes about an hour.

You’ll be able to go home immediately afterwards. Side effects after a VAB biopsy are generally mild. You may have bruising and feel a bit sore for a few days afterwards.

Biopsy with wire guidance

If it isn’t possible to remove enough micro-calcification to make a diagnosis with a needle biopsy or a VAB, you may need a small operation. You’ll be referred to a specialist breast surgeon at the hospital to have this done under a local or general anaesthetic.

After you’ve had a mammogram to show where the micro-calcification is, your surgeon will inject some local anaesthetic into the area to make it numb. They will then gently insert a very fine wire, which is kept in place with a dressing, into the area of micro-calcification. The wire acts as a marker to show the surgeon the area that has to be biopsied. It’s removed after the biopsy is taken. Occasionally the wire is put in the day before the biopsy.

Another way this can be done is by injecting a tiny amount of a radioactive drug, which is harmless, into the area of micro-calcification. This shows up on a mammogram so that the surgeon can see the area that has to be biopsied.

Afterwards your breast may be bruised and feel sore. You may need to take painkillers until it eases. The bruising should go away within a couple of weeks.

Other tests Back to top

Ultrasound

Sound waves are used to build up a picture of the breast and show if a lump is solid (made of cells) or filled with fluid (a cyst).

You’ll be asked to take off your top and bra and lie down on a couch. An ultrasound specialist will put gel onto your breast and gently rub a small device over the area. This shows a picture of the inside of the breast on a screen. Ultrasound is painless and only takes a few minutes.

Fine needle aspiration (FNA)

This is a quick, simple procedure. Your doctor will inject some local anaesthetic into the area to make it numb. Using a fine needle and syringe, they’ll take a sample of cells from the lump and send it to the laboratory to check for cancer cells. The breast is sensitive, so the needle aspiration can be quite uncomfortable. You may feel a bit bruised and sore for a week or so afterwards.

If the surgeon can feel a lump, you may have a needle (core) biopsy without a mammogram to guide it.

Examining the tissue under a microscope (pathology) Back to top

A doctor who specialises in cell types (known as a pathologist) will examine the tissue taken at a biopsy under a microscope. The pathologist looks at the type of cells and how abnormal they are (the grade|).

All this information is reported back to your breast specialist.

If your biopsy results confirm that you have DCIS, you’ll be referred to a breast clinic for treatment|. You’ll be seen by a specialist breast surgeon and a breast care nurse for information and support.