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Breast lump investigation

This fact sheet is for people planning to have a breast lump investigated or who would like information about the triple breast assessment.

It describes some of the imaging and biopsy procedures used to diagnose breast problems.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.

About breast lump investigation

Breast clinics use a process called "triple assessment" to diagnose breast lumps as accurately as possible. There are three stages in triple assessment.

  • Examination - a doctor or nurse takes a history and examines your breast.
  • Imaging - pictures of the inside of your breast are created using ultrasound or X-rays.
  • Biopsy - a sample of breast tissue is removed and sent to a laboratory for testing.
  • Results from the triple assessment can help your doctor decide if you need any further treatment. The procedures described here are routinely done in an out-patient clinic.

Preparing for your examination

At the hospital your nurse will explain how you will be cared for during your visit. Your nurse may check your heart rate and blood pressure.

Your doctor will explain the tests and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

A nurse will stay with you throughout the examination, imaging and biopsy procedures.

The triple assessment

Breast examination

In a private room or cubicle, you will be asked to remove all your clothes above your waist. Your doctor will examine your breasts and armpits, pressing gently on the skin to feel any changes in texture.

Breast imaging

A picture of the inside of your breast may be needed to see where the lump is. This is called imaging. Imaging is normally done in the X-ray department by a specially-trained breast radiologist or a radiographer. There are two imaging procedures commonly used.

  • Ultrasound - high-frequency sound waves are used to scan the breast. During the scan gel is put on your breast and a sensor is moved over the skin. You will usually be asked to sit or lie on an examination couch for the scan. Ultrasound is quick and painless.
  • Mammography - X-rays are used to create a picture of the breast. Mammography is usually done while you are standing up. The breast is pressed between two plastic plates to keep it still. Some women find the pressure of these plates uncomfortable. The pressure is not harmful and the X-ray is done very quickly.

Breast biopsy

You may need a biopsy if a lump or abnormal tissue is found in the breast. This means a sample of breast tissue is removed and sent to a laboratory for analysis.

Breast biopsies may be done under local anaesthesia. This completely blocks feeling in your breast area and you stay awake during the procedure. The anaesthetic is injected into the breast. The injection may sting briefly. There are several different types of biopsy procedures available. Fine needle aspiration, core biopsy and vacuum assisted core biopsy are discussed here. Your surgeon will explain which procedure is most suitable for you.

Fine needle aspiration (FNA)

Cell samples from your breast are collected using a fine needle. The needle is passed through the skin of your breast (usually just once) into the lump or breast tissue being examined and cells are drawn out into a syringe. The procedure is quick and a local anaesthetic isn't often needed. The pin-prick left by the needle is covered with a plaster.

Core biopsy

Breast tissue samples are collected using a special hollow needle. The needle is passed through a small cut on your breast. The procedure is usually done under local anaesthesia. By releasing a spring, breast tissue is collected inside the hollow cylinder of the needle. Your doctor may insert the needle several times to get more than one sample of breast tissue. The spring action is quite sudden and can surprise you the first time.

Your nurse will apply firm pressure to the area for at least five minutes before covering the cut with a plaster or a paper stitch.

Vacuum assisted core biopsy (VACB)

Breast tissue samples are collected using a special, hollow probe attached to a gentle vacuum pump. VACB (sometimes called Mammotome) is done under local anaesthesia. Your doctor will make a small cut (about 5mm) on the breast over the area being examined to insert the probe. The probe sucks breast tissue into a cylinder. More than one sample can be taken without removing the probe.

VACB is useful for removing larger samples of breast tissue and sometimes a whole lump can be removed. Ultrasound may be used during a VACB to make sure the correct breast tissue is removed. The cut is covered with a plaster or a paper stitch. You may have a bandage wrapped round your breasts to reduce swelling.


What to expect after your biopsy

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

You will be able to go home when you feel ready. Your nurse will give you advice about caring for your breasts before you go home.

Using the triple assessment, it may be possible to diagnose a breast lump on the same day. A follow-up appointment with your doctor and specialist breast-care nurse may be arranged to discuss your biopsy results.

After a biopsy you should be able to return to your usual activities straight away. Don't do any strenuous lifting or exercise for the first 24 hours.

If you have any concerns or get pain that can't be controlled with painkillers, a high temperature or your breast feels unusually hot to touch, contact the hospital as you may have developed an infection.

What are the risks?

Breast biopsies are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects of a successful procedure. Your breast may feel sore and bruised for a few days depending on the type of biopsy you have.

It's unusual to have any noticeable scars after a breast biopsy but on rare occasions you may develop a small scar. This depends on the size and type of biopsy you have.

Complications

This is when problems occur during or after the procedure. Most people are not affected. The possible complications of any procedure include excessive bleeding, infection, and an unexpected reaction to the anaesthetic.

Occasionally, some people faint if they are having a biopsy done standing up. If this happens, you will be looked after until you feel ready to go home.

Your doctor will be very experienced at doing breast biopsies but, even so, the biopsy may not be successful. If this happens you may need to have another biopsy or an operation to remove the abnormal breast tissue or lump.

The exact risks differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to you.


Further information

Cancerbackup

Breast Cancer Care

Sources

  • Breast cancer tests. Cancer Research UK. www.cancerhelp.org.uk, accessed 19 October 2007
  • Ahmed I, Nazir R, Chaudhary MY, Kundi S. Triple assessment of breast lump. J Coll Physicians Surg Pak 2007; 17:535-538
  • Biopsy. Breakthrough Breast Cancer. www.breakthrough.org.uk, accessed 31 January 2008

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