Physical examination

This includes palpation of the breasts, axillary lymph nodes, and supraclavicular or cervical (in the neck) lymph nodes. You will also be examined to assess the skin on your breasts and nipples.

Imaging Studies

a) Mammography

This is the most commonly used test to detect breast lesions that cannot be felt. X-rays are taken of both breasts from different angles using a mammography machine.

Some women find the test to be somewhat painful and uncomfortable because of the position they must remain in during the test in order to obtain a clear image of the breasts.

A mammogram lets us observe any of the following:

  • Calcifications which, depending on their orientation, may make us suspect a malignancy.
  • Benign lesions such as fibrocarcinoma, or malignant lesions.
  • Cysts often containing fluids, which tend to be benign.

b) Ultrasound

Ultrasound uses sound waves to create an image of the breast and distinguish between fluid contents and solid masses. This is a test that complements the mammogram, especially in breasts with greater density, in which the mammogram loses definition.

Also, an ultrasound scan can be done of the lymph nodes in the underarms, and also the doctor may need to take a small sample of the lymph node (biopsy) to see if there is a lesion. During the procedure to take a sample, your doctor will give you local anesthesia to reduce the pain you feel in your breast.

There are different types of biopsy, and these will be explained toward the end of this section.

c) MRI

In order to perform this test, it will be necessary to administer a contrast medium so that your doctor can get a better idea of the size of the tumor and see what type of surgery is most appropriate. This is a test used to complement mammograms and ultrasound scans.

Tell your medical team before you receive a contrast agent if you have any kind of allergies or any prostheses or metallic implants.

d) Other imaging tests

In cases there is suspicion that the cancer has spread to other parts of the body, other complementary tests will be required, such as: CT scan, bone scan, and, in very concrete cases, a PET scan.

Types of biopsy

  • Fine-needle aspiration biopsy (FNAB) à makes it possible to confirm a diagnosis of a malignancy. This can be done on both the node in the breast as well as any lymph nodes that are suspect.
  • Ultrasound-guided core-needle biopsy à makes it possible to establish if there is tumoral infiltration and what the tumor grade is.
  • Ultrasound-guided vacuum-assisted core biopsy à uses a vacuum system to obtain the sample.
  • Ultrasound-guided open biopsy