BREAST CANCER DIAGNOSIS – HOW TO CONFIRM IT
Biopsy to Confirm a Breast Cancer Diagnosis
Mammography, ultrasound, MRI and BSGI (Breast Specific Gamma Imaging) can detect “suspicious” lesions in the breast. But the only way to confirm a breast cancer diagnosis is to perform a biopsy—that is, to remove a small piece of the tumor and have it examined under a microscope by a pathologist—a specialist in tumor identification. There are several ways to obtain a tissue sample.
A pathologist will confirm a breast cancer diagnosis
Fine Needle Aspiration
Fine needle aspiration, or FNA, is done with a very thin needle connected to a syringe. The material drawn into the syringe will be sent to the pathologist for examination. Some physicians feel that FNA provides cell samples that are too small to be accurate in confirming a breast cancer diagnosis.
Core Needle Biopsy – First-choice Method to Confirm a Breast Cancer Diagnosis
Core biopsy is consider the premier tool for breast cancer diagnosis. The core biopsy is performed with a device that works like an ear-piercing instrument: it propels a large needle very rapidly through the lesion. A special notch in the needle traps a sliver of tissue for examination. Samples obtained with core biopsy are large enough to be cut into thin slices for detailed examination under the microscope.
Today, the core needle biopsy is considered to be the standard of care because it provides reliable results without the need for a surgical procedure. It is done under a local anesthetic, takes only a few minutes, and unlike a surgical biopsy, it leaves virtually no scar.
Another way to obtain a sample of breast tissue is surgically, through a skin incision. The surgical biopsy to confirm a breast cancer diagnosis is done under local anesthesia, sometimes with sedation. It takes about an hour, leaves a small scar, and does require a trip to the operating room. Many experts feel that it is not the first-choice method to confirm a breast cancer diagnosis.
After the biopsy, the sample of tumor will be examined under a microscope by a pathologist, who will identify the cells and determine whether the tumor is benign or malignant, and confirm a breast cancer diagnosis. If the tumor is malignant, and a breast cancer diagnosis is made, many additional tests will be carried out in order to select the most effective treatment.
Invasive or in situ
lange productions If a breast cancer diagnosis was confirmed, it is important to determine whether the cancer cells are growing within the lobules or ducts (in situ) or have begun to penetrate the lining and invade the surrounding breast tissue (invasive). The treatment for an in situ cancer will be different from the one for the more serious invasive cancer.
Hormone Receptor Status
A receptor is an area on the surface of a cell that can bind with specific substances, much like a lock accepts a key.
Tumors that have estrogen or progesterone receptors are called estrogen receptor (ER) positive, or progesterone receptor (PR) positive, or simply hormone receptor positive. In these tumors, when the hormone binds to its receptor, it activates the cell, making it divide, and helping the tumor grow. In case of a breast cancer diagnosis this information is important, because hormone-receptor positive tumors can be treated with drugs that block the action of hormones. Tumors lacking estrogen and progesterone receptors are less likely to respond to hormone therapy.
Women with an abnormally high level of a substance called HER-2/neu tend to develop much more aggressive breast cancers. A test will determine your level of HER-2/neu and help your oncologist decide if you are a good candidate for treatment with drugs such as Herceptin.
Newly developed tests, called genomic testing, can evaluate a large number of genes in a tumor tissue sample. This information can be very valuable in deciding whether a particular tumor will respond to a specific treatment.
In certain cases, these gene assays can measure the likelihood of distant breast cancer recurrence, and help your healthcare team decide if chemotherapy should be recommended in a particular case of breast cancer diagnosis.
Cancer specialists are now using gene-based diagnostic tests in various ways to plan more effective treatments for women with early breast cancer. Tests such as Symphony MammaPrint analyze dozens of genes in the woman’s tumor to help women and their doctors make decisions about whether or not to include chemotherapy in their treatment plan, or whether the cancer has a low or high risk of recurrence within ten years after diagnosis.
What is a triple-negative breast cancer?
Having a triple-negative breast cancer means your tumor tested “negative” for estrogen receptors (ER-), progesterone receptors (PR-), and HER2. This cancer does not respond to hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin. Other medicines will need to be used. More than one out of every ten women are found to be triple-negative.
The Pathology Report
If you had a fine needle aspiration, the pathologist may be able to identify the general type of cancer and report within an hour of the biopsy. For a more complete identification of the cells, a larger sample, such as from a core needle biopsy or surgical biopsy, is required. This report will generally take several days.
Some women consider the waiting to be one of the most difficult aspects of treatment. But the final report can only be issued after the tumor and the lymph nodes are removed during surgery. This report will specify the size of the tumor, the type of cell the tumor is composed of, and whether there is tumor spread to lymph nodes. This information is essential for planning your treatment.
Why more tests? A biopsy can confirm that the diagnosis is cancer, but it will not show whether the cancer has spread to other parts of the body. This information is important to determine the stage of the tumor.
Therefore, additional tests may need to be performed, including chest X-rays, blood tests, CAT scans or MRIs of the abdomen or other parts of the body, and bone scans.
MRI or Magnetic Resonance Imaging uses a combination of magnetic energy and ordinary radio waves to create images of the inside of your body.
You may have an MRI scan of both breasts. This MRI will give the surgeon a more accurate idea of the size, shape and location of any additional tumors that may be present in either breast.
A body MRI will look for possible distant spread of the cancer. Because the MRI unit can feel cramped, notify the technologist or your physician if you feel uncomfortable in confined spaces. MRI is painless, and does not expose you to X-ray radiation. The test takes about an hour.
CAT scan, CT scan, or Computerized Axial Tomography all mean the same thing. This test uses ordinary X-rays, and a rotating film/source system to obtain detailed images of your body. The test is short and painless.
BSGI, or Breast-Specific Gamma Imaging is a new technique that can discover very small cancer cell clusters even in breasts that are difficult to examine with mammography or ultrasound. The patient is given a radioactive tracing agent that is absorbed by all the cells in the body. Cancerous cells, due to their increased metabolic activity, absorb a greater amount of the tracing agent than normal cells. This makes even small cancers show up as “hot spots” on the BSGI image.
Some of the more common sites to which breast cancer cells may metastasize, or spread, include bones. The most effective way to find these metastases is to perform a nuclear scan. This test is generally done if the tumor is large, or the lymph nodes are positive and there is a good chance that tumor cells may be found in other areas of the body.
For this scan, tiny amounts of radioactive substance are injected into a vein. Once inside the body, the radioactive substance concentrates in areas where there is an unusually increased number of blood vessels—a “hot spot”—that may correspond to a new growth of cancer cells.
The PET scan works on a principle similar to the bone scan, and is a valuable tool in evaluating a breast cancer diagnosis. One of the newest and most valuable imaging techniques is the combination of PET scans, which reflect tissue function, with CT scans, which show tissue structure. This combination provides outstanding information for diagnosis and treatment of cancer.