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Breast lump investigation

Key points

  • A process called triple assessment is used to diagnose breast lumps.
  • Tests are often done in an outpatient breast clinic at a hospital and may all be done during a single visit.
  • It may be possible for your doctor to diagnose your breast lump at this visit. However, it can sometimes take a few days to get the test results.

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.

About breast lump investigation

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.

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.

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).

A woman having a mammogram, with the radiographer operating the machine behind a screen.

                                                                 Mammogram

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.

A technician performing a breast ultrasound, with the woman lying on a treatment table on her back.

                                                                Breast ultrasound

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.

Video: how a core breast biopsy is taken 


A Flash plug-in is required to view this animation

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.

Video: how a fine needle aspiration breast biopsy is taken


A Flash plug-in is required to view this animation

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.

Video: how a vacuum-assisted core breast biopsy is taken


A Flash plug-in is required to view this animation

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.

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.

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.

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.


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

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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