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Breast cancer

Diagnosing breast cancer

Our doctors have the training and experience to diagnose and treat many breast cancer types, from triple-negative, inflammatory and metastatic to luminal, HER2-positive or others.

In diagnosing inflammatory breast cancer and other breast cancer types and staging the disease, our cancer experts use sophisticated diagnostic tools to locate the tumor and determine whether it has spread. Your care team may also test the tumor for specific genetic abnormalities or hormone sensitivities that suggest it may respond to targeted therapy or other personalized treatments. If a lumpectomy, breast-conserving surgery or mastectomy is part of your breast cancer treatment plan, we offer microsurgical and other innovative breast reconstruction techniques to help restore your breast to a more normal appearance, when appropriate.

As part of our commitment to delivering advanced treatments when possible, your oncologist may help determine if you are a candidate for one of our ongoing clinical trials.

Tools used for diagnosing breast cancer include:

Lab tests

Advance genomic testing: Genomic testing examines a tumor on a cellular level to look for the DNA alterations that are driving the growth of cancer. By identifying the mutations that occur in a cancer cell's genome, we can better understand what caused the tumor and tailor treatment based on these findings.

Oncotype DX®: The Oncotype DX test (also called the 21-gene test) is used to determine whether chemotherapy is likely to benefit women with early-stage breast cancer. This lab test also helps us to know the likelihood of disease recurrence. With this information, you and your doctor are better able to make more informed decisions about your breast cancer treatment.

Mammaprint+Blueprint®: The Mammaprint® and Blueprint® genomic lab tests are used to decode a breast tumor's unique traits to help us craft a targeted treatment plan specific to each patient’s individual needs. Mammaprint is used to determine the risk that a patient’s cancer will return. Blueprint is used to determine which of the tumor’s mutations are dictating the cancer’s behavior. When used with the Mammaprint assay, Blueprint narrowly defines each tumor into a subtype classification, affording us a clearer picture for a more precise treatment strategy.

Biopsy

Some common biopsies used to help doctors diagnose breast cancer include fine-needle aspiration biopsy, which uses a small needle; core needle biopsy, which uses a larger needle; MRI-guided biopsy; or surgical biopsy, in which all or part of a lump is removed and checked for cancer. Fine-needle aspiration and core needle biopsies may be performed using certain imaging tests, such as ultrasound, breast MRI, mammography or CT scan.

A sentinel lymph node biopsy may first be performed to determine whether cancer has spread to the lymph glands under the arm. A radioactive substance and/or a dye is injected directly under the skin of the breast. The first set of lymph nodes are then removed and reviewed by a pathologist to check for the presence of cancer cells.

Metastatic cancer detection

Interventional radiologists may use radiofrequency ablation for breast cancer patients with metastasis to the liver, endobronchial ultrasound system (EBUS) for metastasis to the lungs, or kyphoplasty for metastasis to the bone.

Imaging tests

Various imaging procedures are used to diagnose breast cancer, including:

Ultrasound: This imaging test detects even slight abnormalities in dense breasts and helps determine whether a lump is a cyst (sac containing fluid) or a solid mass. Ultrasound may also be used to locate the position of a tumor in order to guide the doctor during a biopsy or aspiration procedure. For example, in some cases, surgical oncologists will use an intraoperative ultrasound during a lumpectomy to mark out the boundaries of the tumor prior to its removal.

Mammography: Full-field digital mammography acquires sharp, digital images of the breasts with less radiation exposure. Once the digital images are received and transmitted to a high-tech, digital mammography workstation, a radiologist analyzes the images to determine the location and extent of the disease.

This advanced breast cancer detection technology offers the potential for significant advances in breast cancer diagnosis, including lower radiation doses, reduced breast compression pressure and improved breast cancer detection rates. Often, clinicians use mammography to find early-stage ductal carcinoma in situ.

Learn more about mammography

MRI (magnetic resonance imaging): With the technology, radiofrequency waves create detailed cross-sectional images of the breasts. MRI helps identify breast tumors that may have been missed by a mammogram.

MRI-guided breast biopsy: With this minimally invasive, image-guided procedure, specially trained radiologists use MRI technology and targeting software to locate and remove cells from a suspicious area in the breast for diagnosis and treatment planning.

PET/CT scan: This advanced nuclear imaging technique combines positron emission tomography (PET) and computed tomography (CT) into one machine. A PET/CT scan reveals information about both the structure and function of cells and tissues in the body during a single imaging session.

PET/CT scan creates detailed, computerized pictures of the breasts, identifying abnormal activity and the tumor location. This technology offers advanced motion management capabilities and may detect lesions as small as 2.8 millimeters.

Bone scan: This test may reveal whether breast cancer has spread to the bone. By capturing images of bones on a computer screen or on film, bone scans may reveal important information, such as the location of the bone metastasis.

Digital breast tomosynthesis: Tomosynthesis is similar to a standard mammogram in that it uses X-ray technology and applies the same amount of pressure to the breast. But rather than providing two views—from top to bottom and side to side—the 3-D approach captures multiple views from a variety of angles in seconds.