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, such as a lump or a thickening, or as an inflammatory change, such as redness or hardening of the breast. It may also be detected in a breast that feels normal but shows an abnormality on a screening mammogram, such as a mass or calcium deposits, called calcifications. These symptoms are not always a sign of breast cancer, but if present, they should be evaluated by a doctor right away.

Screening Methods

Early detection is the best way to find breast cancer in its initial, most curable stages. Memorial Sloan Kettering offers early breast cancer screening options, including mammography, at the Breast Screening Program.

Our Breast Cancer High-Risk Screening Program (RISE: Risk Assessment, Imaging, Surveillance, and Education Program) at the Evelyn H. Lauder Breast Center offers women at increased risk for the disease a personalized, long-term surveillance plan designed to rapidly identify significant abnormalities so they can receive prompt attention. 

Advanced Imaging Technology for Breast Cancer

In addition to routine digital mammography, MSK offers advanced imaging techniques that may provide more accurate results for our patients. Personalized plans may include screening ultrasound, breast tomosynthesis (sometimes called 3-D mammography), contrast enhanced mammography, and breast MRI.

Our radiologists are global leaders in the field of breast imaging and conduct research to improve imaging techniques used in the detection of breast cancer and in the care of people with the disease.

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, a doctor inserts a very thin needle into the suspicious area of the breast. Fluids or cells are withdrawn (aspirated) from the lump and examined. 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’s larger than can be obtained with an FNA is needed, or if the tissue removed during an FNA doesn’t 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.

Image-Guided Biopsy

If the suspicious area can’t be felt, a radiologist can use imaging techniques to biopsy it. 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 MSK have 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 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 don’t provide a definitive diagnosis. It’s also performed if the suspicious area is too deep or too superficial for an FNA or a core biopsy.

A surgical biopsy takes place in an operating room, but it doesn’t usually require an overnight stay in the hospital. During the procedure, the patient undergoes “twilight” sedation using an intravenous anesthetic and doesn’t receive 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.