Diagnosing and Staging Breast Cancer

An accurate and thorough diagnosis is important so that your breast cancer team can develop the best treatment plan for you. At City of Hope, your care team will utilize the most advanced breast imaging technologies and laboratory techniques to guide your personalized treatment.

Breast Imaging

Imaging studies give your breast cancer team important information about changes that may be occurring in your breast tissue. Breast imaging is an important part of a woman’s health care, so that problems can be detected when they are most treatable.

A mammogram is a safe and reliable low-dose X-ray exam that provides a view inside breast tissue. Mammography is appropriate and effective for routine screenings, women experiencing symptoms and women with a history of previous breast cancer.
  • Screening mammography: A compression paddle is lowered slowly onto the breast. This prevents any movement and allows the maximum amount of tissue to be examined. A series of images is taken and then checked for quality.
  • Diagnostic mammography: During a diagnostic mammogram, a number of X-rays are taken to obtain views of the breast from several angles. Areas may be magnified to produce a detailed picture that can help the doctor make an accurate diagnosis. A diagnostic mammogram takes longer than screening mammogram because more X-rays are needed to obtain varying views of the breast.
  • Digital mammography: This specialized form of mammography uses digital receptors and computers instead of X-ray film to help examine breast tissue for cancer.
Breast MRI
Magnetic resonance imaging (MRI) combines magnetic fields, radio waves and a computer system to obtain cross-sectional images in all three dimensions. Breast MRI is often performed once a woman has been diagnosed with breast cancer to determine the extent of disease for surgical planning. It can also be used for screening women with an extremely high risk of developing breast cancer (such as a genetic mutation). This test does not use radiation.

Diagnostic ultrasound
An ultrasound uses high-frequency sound waves to create an image of the breast tissue on a viewing screen. An ultrasound may be used to distinguish between a solid mass, which may be cancer, and a fluid-filled cyst, which is usually not cancer.

A biopsy is a test in which a sample of breast tissue is obtained through a needle or by removing a piece of tumor. The removed tissue is then carefully examined, which can answer questions about cancer or other abnormality.
  • Fine needle aspiration biopsy: In this minor surgical procedure, a thin, hollow needle is inserted into a breast lump to take a small sample of cells that are examined under a microscope.
  • Needle-localized open surgical biopsy: This type of biopsy is performed when you have an abnormality that cannot be felt but is visible on a mammogram. A local anesthetic is administered and a small needle is inserted into the breast to mark the area to be sampled. Mammogram images are then taken to confirm the needle is correctly positioned. A guide wire is then inserted through the needle to show the surgeon exactly where to take the biopsy.
  • Stereotactic biopsy: This type of biopsy uses a computer and X-rays to locate the abnormal breast tissue. A sample of tissue is then removed using a fine needle aspiration biopsy.
  • Ultrasound-guided biopsy: During ultrasound-guided biopsy, your doctor will use ultrasound to guide the needle to the appropriate area. The sample of tissue or fluid then is evaluated in the laboratory.
  • MRI-guided biopsy: MRI-guided biopsy is used when an abnormal area cannot be visualized well by mammogram or ultrasound or when an abnormality can only be seen on an MRI scan.
Stages of Breast Cancer

To properly plan for treatment, breast cancer patients are staged in accordance to how advanced the disorder is. This is primarily done by taking a number of factors into consideration, including:
  • Size of the tumor
  • If the tumor have grown into the chest wall or skin
  • Whether the cancer has spread to nearby lymph nodes and how many lymph nodes are affected
  • If the cancer has metastasized to distant organs, such as the bone, liver, brain or lung
Based on these factors, patients are staged according to their risk level, with higher risk patients typically requiring more intensive treatments.

Additional information about staging criteria is available on the National Cancer Institute’s website.

If you have been diagnosed with breast cancer or are looking for a  second opinion consultation about your treatment, find out more about  becoming a patient or contact us at 800-826-HOPE.