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Diagnosis of Breast Cancer
Diagnostic Evaluation of Breast Cancer
Category 4: "Suspicious Abnormality - Biopsy Should Be Considered" - Findings in this category do not definitely look like cancer but could be cancer. The radiologist has sufficient concern to recommend a biopsy.
Category 5: "Highly Suggestive of Malignancy" - The findings in this category look like cancer and have a high probability (at least 95%) of being cancer. Biopsy is very strongly recommended.
Category 6: "Known Biopsy-Proven Malignancy" - This category is only used for findings on a mammogram that have already been determined to be cancerous by a previous biopsy.
Other Imaging Modalities for Breast Cancer
Ultrasound (sonogram) - This technique uses high-frequency sound waves to create an image and is frequently used as a targeted diagnostic examination to focus on a specific area of concern to distinguish between cyst and solid masses, and between benign and malignant masses.
Magnetic Resonance Imaging (MRI) - this imagning technique uses radiofrequency waves and a strong magnetic field rather than x-rays to provide remarkably clear and detailed pictures of internal organs and tissues. While MRI is generally used only for diagnosis of a suspected lesion seen on mammography, it may be helpful for women for whom mammography is not optimal, such as young women at high-risk of breast cancer because of BRCA mutations. It is also useful for identification of primary lesions in non-palpable lesions and axillary metastases with no evidence of primary focus, and for the assessment of response to neoadjuvant therapy.
Ductogram - Also called a galactogram, this is a type of x-ray test in which a fine plastic tube is placed into the opening of the duct into the nipple. A small amount of dye is injected, which outlines the shape of the duct on an x-ray picture and will show whether there is a mass inside the duct.
Positron Emission Tomography (PET Scan) - This technique is presently used to discover undetected metastatic lesions in distant organs and can assess the status of axillary lymph nodes prior to surgery. However, PET may fail to identify low-grade lesions and tumors less than 5mm in size.
Scintimammography - This is a type of nuclear breast imaging that may be used to investigate a breast abnormality found on mammography. Nuclear medicine breast imaging involves injecting a radioactive tracer (dye) which accumulates differently in cancerous and non-cancerous tissues - normal tissue will only accumulate a small amount of the radioactive tracer, but cancer cells tend to take up more of the dye. After the radioactive tracer has been injected, the patient is instructed to lie face down on a special table where a special camera is used to capture images of the breast from several angles. The procedure takes approximately 45-60 minutes to perform.
Thermomagraphy - This procedure uses a special heat-sensing camera to measure the temperature on the surface of the breast with the thought that the temperature rises in areas with increased blood flow and metabolism, which could signify a tumor. Thermography is not thought to be an effective screening tool for the early detection of breast cancer and can not be used as a replacement for mammograms. Researchers are attempting to improve the procedure to enhance its usefulness in the future.
