At North Atlanta Breast Care, we offer diagnostic and treatment services for both men and women with breast cancer. We also provide comprehensive care for patients experiencing breast changes or benign breast conditions.
The diagnosis of breast cancer is established after a tissue biopsy is performed and the pathology demonstrates cancer cells. This percutaneous (through the skin) needle biopsy is done when an abnormal area is seen on mammogram or ultrasound, or to further evaluate a lump felt on examination of the breast. The biopsy pathology report, usually finished within 48-72 hours of the biopsy, describes the type of cancer. The pathologist will also look at the molecular characteristics of the tumor. This takes a few additional days, and will establish if the cancer is positive or negative for estrogen and progesterone receptors, as well as the HER2 oncogene. These factors will all be considered when discussing options for treatment.
Other tests may be performed once breast cancer is diagnosed. Breast MRI is another imaging study to look at the tumor, its relationship to the chest wall and the skin, the surrounding lymph nodes, and the contralateral (other side) breast. A specialized CT scan or PET scan may be done to look for spread of the cancer to other parts of the body.
Unless the breast lump is consistent with a cyst (a fluid filled sac) on imaging studies, a tissue biopsy is typically performed to establish the diagnosis. This is almost always done percutaneously (through the skin) with a needle after the skin has been numbed. The tissue biopsy is sent to the pathologist who looks at the cells under the microscope. A diagnosis of benign, indeterminate, or malignant mass is established.
A cyst is a fluid-filled sac within the breast and typically feels like a smooth lump under the skin. Women may have a single cyst, or multiple cysts. On a physical exam, it may be difficult to distinguish a cyst from a solid mass, although cysts have a characteristic appearance on ultrasound. Typically a mammogram is performed along with the breast ultrasound, particularly if the woman is over the age of 40 and has not had a mammogram within the past year.
Discharge from the nipple may be noted by a woman when she changes clothes, often with dried fluid inside of her bra. This is usually spontaneous discharge, occurring without compression of the breast. Alternately, nipple discharge may be found on self-breast examination or during a breast exam performed by a health care provider. Nipple discharge is caused by a benign (non-cancerous) condition in the majority of cases.
Common causes of nipple discharge include:
The first step in the diagnosis of nipple discharge is a history and physical exam. Lab tests may have been ordered by your primary care provider. Next, your provider will order or ensure you have had recent imaging of the breasts. This usually consists of a mammogram and/or breast ultrasound. A specialized test to look at the duct system of the breast, called a ductogram, if often done as well. Using a fine tip catheter, contrast is injected into the breast duct causing the nipple discharge. The radiologist then takes x-rays to look for abnormalities in the duct illuminated with contrast dye. If an abnormality is found on imaging studies, a percutaneous (through the skin) needle biopsy is performed.
If a specific abnormality is discovered on imaging studies, treatment is based on the biopsy results. This may involve a breast biopsy or lumpectomy. If no abnormality is seen on the radiographic studies, a duct excision may be recommended. Removing the duct or ducts causing the discharge is both therapeutic and diagnostic.
When the breast radiologist finds an abnormality on a mammogram, he or she will compare the images to the woman’s prior mammograms, if applicable. Additional images are usually obtained with a diagnostic mammogram and/or breast ultrasound. Unless the abnormality has been previously biopsied or is stable in appearance, a percutaneous biopsy is performed. A percutaneous biopsy differs from a surgical biopsy in that the person is completely awake. The skin of the breast is numbed, and then a needle used to take a sample of tissue. The biopsy may be done stereotactically, which allows the abnormal area to be precisely targeted by the radiologist, or under ultrasound guidance.