Breast lump investigation

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who are having a breast lump investigated, or who would like information about it.

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.

• Examination - a doctor or nurse asks about your medical history and examines your breast.
• Imaging - pictures of the inside of your breast are created using ultrasound or X-rays.
• Biopsy - a sample of your breast tissue is removed and sent to a laboratory for testing to determine whether the cells are cancerous (malignant) or not cancerous (benign).

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

The procedures described here are usually done in an out-patient breast clinic at a hospital.

Preparing for triple assessment

Your doctor will 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, and 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, which you may be asked to do by signing a consent form.

What happens during triple assessment

Breast examination

You will need to remove all 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 order to see where the lump is, you may need to have a picture taken of the inside of your breast. This is called imaging. Imaging is usually done in the X-ray department by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) or a radiographer (a health professional trained to perform imaging procedures). There are two imaging procedures commonly used.

• A mammography uses X-rays to create a picture of your breast. Mammography is usually done while you're standing up. Your breast will be pressed between two plastic plates to keep it still. Some women find the pressure of these plates uncomfortable.

                                                                 Mammogram

• An ultrasound uses sound waves to produce an image of the inside of your breast. Your radiologist or radiographer will put gel on your breast and then move a sensor over your skin. You will probably be asked to sit or lie on an examination couch for the scan.

                                                                Breast ultrasound

Breast biopsy

A breast biopsy is a small sample of tissue that is taken from your breast. The sample will be sent to a laboratory for testing to determine the type of cells and if these are cancerous or not.

A breast biopsy may be done under local anaesthesia. This completely blocks pain from your breast and you will stay awake during the procedure. The local anaesthetic is injected into your breast. The injection may sting briefly.

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

Fine needle aspiration
Your doctor will collect cell samples from your breast using a fine needle. He or she will pass the needle through the skin of your breast, into the lump or breast tissue being examined and draw cells out into a syringe. Sometimes ultrasound or X-rays are used to help guide your doctor to the area that needs to be checked.

How a fine needle aspiration breast biopsy is taken

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Core biopsy
Your doctor will collect breast tissue samples using a hollow needle. Your doctor will pass the needle through your breast to the area to be checked. Sometimes ultrasound or X-rays are used to help your doctor guide the needle. He or she will then release a spring in the needle and breast tissue will be collected inside the hollow cylinder. The needle may need to be inserted several times to get more than one sample of breast tissue. The spring action is quite sudden and can surprise you the first time.

How a core breast biopsy is taken

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Vacuum assisted core biopsy (VACB)
Your doctor will collect breast tissue samples using a special, hollow probe attached to a gentle vacuum pump. Your doctor will make a small cut in your breast over the area being examined and insert the probe. The probe will suck some of your breast tissue into a cylinder. More than one sample can be taken without your doctor removing the probe.

VACB is useful for removing larger samples of breast tissue and sometimes a whole lump can be removed in this way. Ultrasound may be used to make sure the correct breast tissue is removed.

How a vacuum-assisted core breast biopsy is taken

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Open biopsy
You will have a minor operation to remove the whole lump under a general anaesthetic. This means you will be asleep during the procedure. Most hospitals will do the biopsy as a day case but you may need to stay a night in hospital. An open may also be referred to as an excision biopsy.

What to expect afterwards

You will 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 have any pain, take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information 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 on the same day. However, some tests can take a few days to carry out. Your clinic will get your results to you as soon as possible - ask your doctor or breast care nurse when to expect your results. Often, you will be invited to a follow-up appointment with your doctor and breast care nurse to discuss your biopsy results.

Recovering from triple assessment

After a triple assessment you should be able to return to your usual activities straight away, but don't do any strenuous exercise or lifting for the first 24 hours.

If you have any pain that can't be controlled with over-the-counter painkillers, a high temperature or your breast feels unusually hot to touch, contact the hospital as you may have developed an infection.

What are the risks?

A triple assessment is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

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

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.

Occasionally, some people faint if they are having a biopsy done standing up. If this happens, the team at the hospital will look after you until you feel ready to go home.

Your doctor will be very 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.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your doctor to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.