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Breast lump investigation

Breast lump investigation is any technique used to diagnose breast conditions, including imaging and biopsy procedures.

You will meet the doctor carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

A process called triple assessment is used to diagnose breast lumps. There are three stages in triple assessment although you may not need to have all three tests.

  • Examination. A doctor or nurse will ask about your medical history and examine your breast or breasts.
  • Imaging. A radiographer (a health professional trained to carry out imaging procedures) will take pictures of the inside of your breast. He or she may use ultrasound, X-rays or a combination of both.
  • Needle biopsy. A doctor will remove a sample of your breast tissue and send it to a laboratory for testing. This will determine if the lump is cancerous (malignant) or non-cancerous (benign).

The results of the triple assessment can help your doctor decide if you need any more tests or treatment.

The tests described here are usually done in an outpatient breast clinic at a hospital and may all be done during a single visit.

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How a core breast biopsy is taken
This is a procedure to investigate a lump in the breast

Details

  • Preparation Preparing for breast lump investigation

    Your doctor will explain how to prepare for your procedure. Your doctor will also discuss with you what will happen before, during and after your triple assessment, and any pain you might have. This is your opportunity to understand what will happen. You can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedures. This will help you to be informed, so you can give your consent for the procedures to go ahead. You may be asked to do this by signing a consent form.

    Bupa Health Assessment: Breast check

    If you are concerned about breast cancer, Bupa can help you get a diagnosis.

  • The procedure What happens during breast lump investigation?

    Breast examination

    You will need to remove your clothes above your waist. Your doctor will examine your breasts and armpits and press gently on your skin to feel for any changes in texture.

    Breast imaging

    In breast imaging, your doctor will take pictures of the inside of your breast.

    Imaging is usually done in the X-ray department of a hospital by a radiographer. Alternatively, a radiologist may do your test. A radiologist is a doctor who specialises in using imaging methods to diagnose medical conditions.

    The type of imaging you have will depend on your age and your personal circumstances. The most common types of breast imaging are mammography and ultrasound.

    Mammography

    Mammography uses X-rays to create a picture of your breasts. It's usually done while you’re standing up. Your radiographer will press your breast between two plastic plates to keep it still. Some women find the pressure of these plates uncomfortable but the test doesn’t take long (less than 10 minutes).

    Ultrasound

    An ultrasound uses sound waves to produce an image of the inside of your breast. You will lie on an examination couch for the scan. Your radiologist or radiographer will put gel on your breast and then move a sensor over your skin. He or she can see the images on a screen and is likely to save them to look at again later.

  • Breast biopsy Breast biopsy

    A biopsy is the third stage of the triple assessment although you may not need to have one. In a breast biopsy, your doctor will use a small needle to take a sample of tissue from your breast. He or she may take several samples and send them to a laboratory for testing to find out if the lump is cancerous or not.

    A breast biopsy is usually done under local anaesthesia. This completely blocks pain from your breast and you will stay awake during the procedure.

    There are several different biopsy procedures including core biopsy, fine needle aspiration, vacuum-assisted core biopsy (VACB) and open biopsy. Your doctor will explain which procedure is most suitable for you.

    Core biopsy

    Your doctor will collect breast tissue samples using a hollow needle. He or she will pass the needle through your breast to the lump. Your doctor may use ultrasound to help him or her guide the needle. Your doctor will then release a spring in the needle and collect breast tissue inside a hollow cylinder. Your doctor may need to insert the needle several times to get more than one sample of breast tissue.

    Play video
    How a core breast biopsy is taken

    Fine needle aspiration

    Your doctor may collect cell samples from your breast using a fine needle that is slightly narrower than the one used for core biopsy. He or she will pass the needle through the skin of your breast and into the lump or breast tissue. Your doctor will then draw cells out into a syringe. Your doctor may use ultrasound to help guide the needle to the correct position.

    Play video
    How a fine needle aspiration breast biopsy is taken

    Vacuum assisted core biopsy (VACB)

    In VACB, your doctor will collect breast tissue samples using a hollow probe attached to a gentle vacuum pump. Your doctor will make a small cut in your breast over the lump and then insert the probe. The probe will suck some of your breast tissue into a cylinder. Your doctor can take more than one sample without needing to remove the probe.

    VACB is useful for removing larger samples of breast tissue and sometimes a whole lump can be removed in this way. Your doctor may use ultrasound or X-rays to help guide the probe.

    Play video
    How a vacuum-assisted core breast biopsy is taken

    Open biopsy

    Although rare now, you may need to have a small operation to remove the lump to find out if it’s cancerous or not. If your doctor just removes a sample of breast tissue, it's called an incisional biopsy. If you have the entire lump removed, it's called an excisional biopsy or lumpectomy.

    An open biopsy may be done under local or general anaesthesia. If you have a general anaesthetic, you will be asleep during the procedure.

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  • Aftercare What to expect afterwards

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

    If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    It may be possible for your doctor to diagnose your breast lump in one visit. However, it can take a few days to get the results from some tests. Your clinic will get your results to you as soon as possible – ask your doctor or breast care nurse when to expect them. You may be invited to have a follow-up appointment to discuss your biopsy results.

  • Recovery Recovering from breast lump investigation

    After a triple assessment you can often return to your usual activities straight away. However, it's important to follow your doctor’s or breast care nurse’s advice.

    If you have pain (that can't be controlled with painkillers), swelling or your breast feels unusually hot to touch, contact the hospital. It's possible you may have developed an infection.

  • Risks What are the risks?

    As with every procedure, there are some risks associated with triple assessment. We haven't included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having a 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

    Complications are when problems occur during or after the procedures.

    Your doctor will be experienced at taking 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.

  • FAQs FAQs

    Does a breast lump mean I have breast cancer?

    Answer

    Finding a lump in your breast doesn't usually mean you have cancer. Most breast lumps aren't cancerous and may be a cyst or fibroadenoma.

    Explanation

    Breast cysts are sacs of fluid in your breast. Fluid can build up in your breast tissue as a result of hormonal changes. For example, just before your period it's normal to have lumpy, tender breasts, especially near your armpits. Breast cysts can be painful and usually move easily under your skin. If a cyst is causing you pain or discomfort, a doctor can drain the fluid using a needle.

    Fibroadenomas are harmless overgrowths of your breast tissue. They are usually diagnosed after a needle biopsy. Fibroadenomas are most common in women under 40 but can occur at any age. They are often painless and move easily under your skin. Most fibroadenomas will slowly shrink in size and don't need treatment, but if the lump gets bigger, you can have it removed.

    It's important for both men and women to check their breasts regularly. If you see any change or feel a lump, have it checked by your GP.

    What causes nipple discharge?

    Answer

    Nipple discharge is a common problem, especially in women of childbearing age, and it's not usually caused by cancer.

    Explanation

    Nipple discharge is fluid that comes from your nipples. All women have fluid in their breasts and it's possible that some of this may come out if you squeeze your nipples. The discharge may come from your milk ducts in your breast and be milky in appearance. Or, it can be other colours, such as yellow, or clear and watery, and be caused by a health condition. If you get a blood-stained discharge for example, you may have condition called intraductal papilloma. This is when you have a wart-like growth in the milk duct in your breast. You might be able to feel a small lump behind or next to your nipple.

    If you notice any blood-stained or unusual discharge coming from your nipple, get it checked by your GP. Nipple discharge can occasionally be a symptom of breast cancer. Ask your GP for more information.

    Will the breast biopsy hurt?

    Answer

    A breast biopsy shouldn't hurt as you will usually have a local anaesthetic. This completely blocks pain from your breast.

    Explanation

    In a fine needle biopsy, your doctor will only take a small sample of tissue from your breast. You will probably be given an injection of local anaesthetic before the procedure to block pain from the area. Ask your doctor whether or not you will have an anaesthetic. During the procedure, your doctor will pass a fine needle through your skin into the breast lump (usually just once). He or she will draw out cells into a syringe that's attached to the needle. If you haven't had a local anaesthetic, you may feel a slight sting similar to having an injection.

    A core biopsy involves removing a larger sample of your breast tissue. Your doctor will usually give you an injection of local anaesthetic before the biopsy. The anaesthetic will be injected into your breast and this may sting briefly. The anaesthetic completely blocks pain from your breast and you will stay awake during the procedure. You may need pain relief to help with any discomfort as the anaesthetic wears off.

  • Resources Resources

    Further information


    Sources

    • Breast cancer. PatientPlus. www.patient.co.uk/patientplus.asp, published 13 June 2012
    • Secondary care – triple assessment clinic. Map of Medicine. www.mapofmedicine.com, published 15 January 2014
    • Breast stereotactic core biopsy/fine needle aspiration. Medscape. www.emedicine.medscape.com, published 21 October 2013
    • Early and locally advanced breast cancer: diagnosis and treatment. National Institute for Health and Care Excellence (NICE), February 2009. www.nice.org.uk
    • Clinical breast exam. American Cancer Society. www.cancer.org, published 17 September 2013
    • Breast lumps and breast examination. PatientPlus. www.patient.co.uk/patientplus.asp, published 13 June 2012
    • Information for patients visiting a symptomatic breast clinic with breast symptoms. Royal College of Radiologists. www.rcr.ac.uk, published December 2010
    • Best practice diagnostic guidelines for patients presenting with breast symptoms. Department of Health. www.associationofbreastsurgery.org.uk, published November 2010
    • Image-guided vacuum-assisted excision biopsy of benign breast lesions. National Institute for Health and Care Excellence (NICE), February 2006. www.nice.org.uk
    • Follow-up tests to diagnose breast changes. National Cancer Institute. www.cancer.gov, published 2 November 2012
    • Open biopsy. National Cancer Institute. www.cancer.gov, published 20 February 2014
    • Personal communication, Mr Simon Cawthorn, Consultant Breast Surgeon, 26 February 2014
    • Surgical site infection. National Institute for Health and Care Excellence (NICE), October 2008. www.nice.org.uk
    • Ultrasound-guided breast biopsy. Radiological Society of North America. www.radiologyinfo.org, published 7 March 2013
    • Breast biopsy with needle localization. Medscape. www.emedicine.medscape.com, published 7 August 2013
    • Benign breast disease. PatientPlus. www.patient.co.uk/patientplus.asp, published 7 March 2013
    • Fibrosis and simple cysts. American Cancer Society. www.cancer.org, published 14 January 2014
    • Breast abscess and masses clinical presentation. Medscape. www.emedicine.medscape.com, published 6 June 2012
    • Nipple discharge. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Mammary duct ectasia and periductal mastitis. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 April 2012
    • Breast imaging in nipple discharge evaluation. Medscape. www.emedicine.medscape.com, published 4 September 2013
    • Large, central intraductal papillomas. Medscape. www.emedicine.medscape.com, published 17 January 2014
  • Related information Related information

  • Author information Author information

    Reviewed by Rachael Mayfield-Blake, Bupa Health Information Team, March 2014.

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