After an abnormality of the breast is found, tests are performed to see if the problem is cancer. One or all of these tests might be done:
- Mammogram: A mammogram is an X-ray picture of the breast. Two pictures are taken of the breast after it is compressed between two glass plates. One image is shot from the top and the second picture is taken from the side. A radiologist will look at the pictures and determine if anything looks abnormal. He or she may then decide to get other pictures of a certain area. These are called spot or magnification views.
- Ultrasound: Ultrasound sends high-frequency sound waves through your breast and converts them into images on a viewing screen. Ultrasound complements other tests. If an abnormality is seen on mammography or felt by physical exam, ultrasound is the best way to find out if the abnormality is solid (such as a benign fibroadenoma or a cancer) or fluid-filled (such as a benign cyst). Ultrasound cannot determine whether a solid lump is cancerous.
- Nipple discharge examination: If you have nipple discharge, some of the fluid may be collected and examined under a microscope to see if any cancer cells are present.
Biopsy: A biopsy is necessary to distinguish normal tissue from cancer tissue. If cancer is present, the biopsy also helps your doctors zero in on the size, type, and kind of breast cancer. Biopsies are performed on any kind of abnormality that your doctor can feel or that looks suspicious. (Because most breast cancers in men are discovered by feeling something abnormal, it's highly unusual to find an abnormality only by mammography or another imaging modality.) Various techniques are used to biopsy tissue, and it's likely that your surgeon will try to use the least invasive procedure possible while making sure that enough tissue is removed to make a clear diagnosis.
- Fine needle biopsy of palpable lesions (lesions that can be felt) is least invasive. It can be done in the doctor's office. Results are often available in 24 hours. A long, thin, hollow needle is placed in the palpable abnormality. If the lesion is only seen by mammography or another test, then your doctor may need the help of this test to guide the needle to the right place. Cells are extracted through the center of the needle. A collapsible hook at the end of the needle keeps the needle in place until the surgery is done. X-rays verify that the abnormal area seen on the original X-rays is the same area into which the surgeon inserts the needle. The tissue is then sent off to pathology for analysis. This biopsy technique has the highest risk of a "false negative" — a biopsy result that says "normal," even though a cancer is present. The reason for this is probably that the needle doesn't always pick up the cancer cells.
- Stereotactic needle biopsy (core biopsy) removes multiple pieces of a lesion. If the lesion can't be felt, the needle is guided to the area of concern with the help of mammography or ultrasound. If a cancer is only found by MRI (magnetic resonance imaging), then stereotatic needle biopsy may be guided by that technique. A small metal clip may be inserted into the breast to mark the site of biopsy in case the biopsy proves cancerous and additional surgery is required. But since most men diagnosed with breast cancer have mastectomy, a clip is usually unnecessary since the whole breast is removed.
- Incisional biopsy is more like regular surgery — it removes a bigger piece of tissue than a fine needle biopsy or a core biopsy. Often, incisional biopsies are done when needle biopsies are inconclusive or if the lump is too extensive or too big to be removed easily. The purpose of this procedure is to make a diagnosis. Because it only takes out part (not all) of the cancer, it is not a treatment. In men, once a breast cancer diagnosis is made, mastectomy is usually done.
- Excisional biopsy is the most involved kind of biopsy. It attempts to remove the entire suspicious lump of tissue from the breast. This is the surest way to establish the diagnosis without missing the cancer tissue (winding up with a false negative). Removing the entire lump may also provide you some peace of mind until the final treatment plan is put in place. Both incisional and excisional biopsies can be done in an outpatient center or hospital, using local anesthesia. The purpose of this procedure is to make a diagnosis. Even if the lumpectomy takes out all of the cancer in the breast with clear margins, if breast cancer is diagnosed, mastectomy is usually done.
If a cancer diagnosis is made, your doctor might recommend more tests. For example, an MRI can show how much cancer is in the affected breast relative to the normal tissue right under and next to the breast cancer. This information may help the surgeon plan the extent of surgery. Plus, an MRI can help evaluate the other breast to see if it's OK. Other tests, such as blood work, chest X-ray, and bone scan, might be done to see if the cancer has spread to other parts of the body.