Breast Cancer Diagnosis
View an animation of the process of a breast biopsyGetting the diagnosis right for your breast cancer is one of the most important steps in ensuring that you receive the best and most appropriate care.
At the new Stanford Women's Cancer Center, our cutting-edge digital diagnostic equipment provides our patients with the most advanced mammographic and sonographic evaluations available.
Our all-digital mammography suite features a computer-aided detection (CAD) program that analyzes each mammogram and/or sonogram using computer algorithms pioneered at Stanford. This allows for clearer images, greater accuracy and greater convenience for sharing images with other specialists. MRI, ultrasound, and mammogram readings are interpreted in an integrated fashion by a core team of specialists, allowing for the most comprehensive and accurate interpretations of your breast imaging studies.
International leaders in breast MRI, the Stanford team is one of the few places to offer MRI-directed core biopsy, which provides an additional powerful method to detect and stage breast cancer.
This state-of-the-art technology, combined with experienced, dedicated physicians, can help detect breast cancer in the early stages, giving you the greatest advantage for a positive outcome.
Diagnostic Procedures
Your physician may use a variety of techniques to find abnormal growths, determine if they are cancerous, and assess the type and aggressiveness of any breast cancer found.
It is important to remember that a lump or other changes in the breast, or an abnormal area seen on a mammogram, may be caused by cancer or, more often, by other, less serious problems.
mammogram image showing a cancerous lump
Diagnostic procedures may involve:
- Physical exams (manual examinations of the breasts):
- breast self-exam (performed by the patient)
- clinical breast exam (performed by a health care provider)
- full physical exam (performed by a health care provider)
- Imaging tests (non-invasive tests that doctors use to look at the inner tissue of the breast):
- ultrasound – a technique that uses high frequency sound waves to create pictures of the breasts and other tissues and organs
- digital mammogram – Stanford's all-digital mammogram creates a digital image that can be manipulated in ways that improve resolution and contrast. The clearer image improves interpretation, making it easier to view dense breast tissue and small tumors, and often eliminates the need for additional follow-up imaging.
- breast MRI – MRI is particularly good for detecting very small tumors and can be used to clarify the size and extent of the lesion after a suspicious area has been detected by mammogram or ultrasound. MRI can help determine whether the cancer has spread further in the breast or into the chest wall. MRI is also especially useful for detecting tumors in women with breast implants (which can interfere with mammogram rays), and in women with dense breast tissue. It is also particularly helpful in women with hereditary susceptibility to breast cancer, as it can be used in women at a younger age when such hereditary tumors often occur, better visualizes potential lesions in younger women who normally have denser tissue that impact mammography, and is safer in that it does not involve radiation.
- Additional tests (used infrequently in women who present with early-stage breast cancer):
- PET (positron emission tomography) scan – a type of nuclear scan that monitors the biochemical functioning of cells by detecting how they process certain compounds, such as glucose (sugar). Cancer cells metabolize glucose at a much higher level than normal tissues.
- bone scan – a nuclear scanning test that identifies new areas of bone growth or breakdown.
- CT (or CAT) scan – a noninvasive procedure that takes cross-sectional images of internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
- Biopsy: a procedure in which a radiologist or surgeon takes a tissue sample from a breast abnormality. The tissue sample is then sent to a pathologist for a detailed analysis.
- fine needle aspiration biopsy – a very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help to differentiate a cyst from a lump, and is an excellent early warning tool for potentially suspicious lesions.
- core needle biopsy – a coring needle, usually 2 mm in width, is guided into a lump or suspicious area to remove a small cylinder of tissue. A very tiny incision is necessary.
- vacuum-assisted breast biopsy – used in conjunction with core needle biopsy tools, an inserted vacuum is applied to the core needle biopsy device to pull additional tissue into the coring chamber, improving tissue yield and sampling accuracy. This is often used after mammography reveals microcalcifications. Some vacuum devices also incorporate a coring cylinder that rotates, allowing 360 degree sampling of a suspicious area. The breast tissue is gently suctioned into the tube, and a rotating knife removes the tissue.
- stereotactic biopsy – stereotactic biopsy finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a three-dimensional (3D) picture of the breast. A sample of tissue is removed with a needle.
- MRI-directed core needle biopsy – this special procedure is performed only in specialized breast cancer centers like ours at Stanford. For MRI-guided biopsy, the woman lies between two “open” MRI magnets, allowing doctors to remain at the patient's side during the biopsy. The doctor then inserts a needle into the suspicious breast mass and takes samples of the suspicious breast mass. Doctors can also use this open MRI machine to place thin wires that direct surgeons to remove cancerous lesions seen only on MRI.
- incisional/excisional biopsy – a surgeon removes part/all of a lump (respectively) or suspicious area through an incision into the breast. During an incisional biopsy, a small part of the lump is removed; whereas during an excisional biopsy, the entire lump is removed.
- needle wire localization – in some cases, if the breast lump is very small, deep and difficult to locate, or if the lesion has been proven to represent a cancer, the wire localization technique may be used to guide surgery. With this technique, a special wire is placed into the lump under x-ray or MRI guidance. The surgeon follows this wire to help locate the breast lump. Sometimes multiple wires are used to “bracket” a lesion, helping to guide the surgeon to remove the lesion as best possible. Multiple wires are also used in some instances to remove multiple lesions for diagnostic or therapeutic purposes.
- sentinal lymph node biopsy – your surgeon locates and removes the sentinel node, or nodes—the first lymph node, or nodes, to which your breast tumor is likely to have spread. This node or nodes is checked for cancer. If the biopsy results are negative, no more surgery is necessary. If the results are positive, your surgeon may remove additional axillary lymph nodes.
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