Breast Cancer: Detection & Diagnosis

Pictured: Radiology procedure Radiologists at Memorial Sloan Kettering often use MRIs and other imaging technologies to precisely guide biopsies. Here a patient is prepared for a procedure.

Breast cancer may present as a physical change in the breast, including a lump or a thickening, or as an inflammatory change such as redness or hardening of the breast. Breast cancer may also be detected in a breast that feels normal, but appears on a screening mammogram as a mass or as calcium deposits, called calcifications. These changes are not always a sign of breast cancer, but if present, they should be evaluated by a physician in a timely manner.

Screening Methods

Early detection is the best way to find breast cancer in its earliest, most curable stages. Memorial Sloan Kettering offers early breast cancer detection programs, including mammography at the Breast Screening Program and the Breast Examination Center of Harlem.

Our Special Surveillance Breast Program (SSBP), located at the Evelyn H. Lauder Breast Center, follows women with a higher-than-average risk of breast cancer. As part of the program, we educate patients regarding their risk of developing breast cancer and present strategies for early detection and prevention. Patients in the SSBP also undergo clinical breast examinations twice yearly and have appropriate imaging examinations.

Breast cancer screening approaches include breast self-examination, clinical examination by a physician, and mammography. Ultrasound and MRI are also performed in selected women. See specific breast cancer screening guidelines.

Breast Biopsy Techniques

If either a physical examination or imaging tests show a suspicious change in the breast, the next step may be a biopsy. During a breast biopsy, a tissue sample is taken from the breast and examined under a microscope by a pathologist, who can determine whether or not it contains cancerous cells.

There are different types of biopsy methods. These include:

Fine Needle Aspiration (FNA)

During this procedure, the doctor inserts a very thin needle into the suspicious area of the breast. Fluids or cells are withdrawn (aspirated) from the lump and examined under a microscope by a pathologist. This type of biopsy is relatively quick, and any discomfort lasts only a few seconds.

Core Needle Biopsy

A core needle biopsy may be used if a tissue sample that is larger than can be obtained with a fine needle aspiration biopsy is needed, or if the tissue removed during a needle aspiration biopsy does not lead to a definitive diagnosis. This type of biopsy requires a local anesthetic, and uses a larger, hollow needle to remove a thin cylinder of tissue, which is then analyzed by a pathologist.

Image-Guided Biopsy

If the suspicious area cannot be felt, then a radiologist can use imaging techniques to biopsy the area. Ultrasound, stereotactic mammographic imaging, or MRI can be used, depending on what the abnormality looks like and which technique is most appropriate for visualizing it.

Breast imaging specialists at Memorial Sloan Kettering refined and demonstrated the benefits of stereotactic needle biopsy, a procedure for diagnosing a suspicious area that can be seen on a mammogram, but is too small to be felt by touch. The procedure uses computer-imaging techniques to guide a needle into the breast to collect cells or tissue from a suspicious area observed on a mammogram. For many women, stereotactic needle biopsy can spare them from a more uncomfortable and expensive surgical biopsy. It may also enable doctors to make a diagnosis more quickly and allow women to start their treatment sooner.

Surgical Biopsy

A surgical biopsy may be done if other biopsy procedures do not provide a definitive diagnosis. A surgical biopsy is also performed if the suspicious area is too deep or too superficial for a fine needle or core biopsy.

A surgical biopsy takes place in an operating room, but it does not usually require an overnight stay in the hospital. During a surgical biopsy, the patient undergoes “twilight” sedation using an intravenous anesthetic, and does not require general anesthesia. The surgeon makes a small incision and removes either the entire mass of suspicious breast tissue or a representative sample, depending on its size and location.

Advanced Imaging Technology for Breast Cancer

Memorial Sloan Kettering offers digital mammography, a technique that enables radiologists to produce an image of the breast more quickly and to see lesions more clearly.

We have integrated sophisticated imaging techniques, such as breast MRI and PET scans, into our arsenal of tools for early detection, tissue sampling, and surgical treatment planning. Our radiologists are leaders in the field of breast imaging and conduct research to improve imaging techniques used in the care of breast cancer patients.