The tests might include any of the following:
A doctor or nurse practitioner will very carefully examine and feel your breast tissue and the lymph glands under your arms and in your neck.
More mammograms taken at different angles or using magnification.
This test uses sound waves to build up a picture of the breast tissue. Ultrasound can often tell whether a lump is a solid lump (made of cells) or is a fluid-filled cyst. You will be asked to take off your clothes from the upper part of your body and lie down on a couch. An ultrasound specialist will then put gel onto the breast and gently rub a small device, like a microphone, over the area. This shows a picture of the internal tissue of the breast on a screen.
Ultrasound is usually a painless procedure and only takes a few minutes. Areas of scar tissue or lumpiness in the breast may be sore or painful when the ultrasound probe is moved over them. Let the person doing the ultrasound know if it is painful for you.
Needle (core) biopsy
A doctor uses a needle to take a small piece of tissue from the lump or abnormal area. A local anaesthetic is injected into the area first to numb it. Once the anaesthetic has taken effect, a small cut is made in the skin of the breast. The doctor will then insert a needle through the cut and remove a section of tissue measuring about 20mm x 2mm (3/4 to 1/5 inch). This is not painful but you may feel a sensation of pressure. Several biopsies may be taken at the same time. The sample is then sent to a laboratory to be looked at by a pathologist. Pathologists are doctors who are expert at diagnosing illness by looking at cells.
Depending on the number of biopsies taken, your breast may be quite bruised afterwards. This may take a couple of weeks to disappear completely.
Fine needle aspiration (FNA) cytology
A thin needle is inserted through the skin of the breast into the lump or suspicious area. The needle is used to draw off some breast cells and fluid. This may be done during a breast ultrasound. The cells and fluid are then sent to the pathology laboratory. If the lump is a cyst, the needle can draw off the fluid and the lump may disappear. If the lump is solid, the cells will be examined to see whether they are benign (non-cancerous) or malignant (cancerous). A fine needle aspiration can be painful for a short time. You may have some bruising for a few days afterwards.
There is no evidence that either a biopsy or a fine needle aspiration will cause any cancer that might be present to spread.
Sometimes core biopsies or FNA will be done by just feeling the breast lump for guidance. The biopsy needle can also be guided using ultrasound or mammogram. If the needle is guided by mammogram, this is known as a stereotactic biopsy. You will be positioned on a mammography machine that has a special device attached. In most units the test is done while you are sitting down, but in a few you will lie on your front. The radiographer then takes a picture of your breast from two different angles to work out the exact position of the abnormal area and put the needle into the right place.
Sometimes a thin wire will be inserted into the breast to mark the position of the abnormal area, and a breast surgeon will then do an operation to remove the area. This is known as a wire-guided biopsy.
A machine called a mammatome and a needle may be used for obtaining a biopsy. This method takes biopsies from the breast using a technique known as vacuum-assisted biopsy. It takes more tissue than a standard needle biopsy, which makes it particularly helpful for diagnosing abnormal areas in the breast where no lump can be felt or if a standard biopsy result is unclear. A needle is placed into the tissue breast and guided to the correct area with the help of ultrasound or x-ray imaging. When the needle is in position, a vacuum gently draws, cuts and collects some tissue into a small collecting chamber.
If you have any questions about the above tests you can ask the nurse in the assessment clinic. You can also contact our cancer support service.