Breast Cancer Diagnosis

Assessment of a breast problem is made by combining features in the clinical history & examination, breast imaging and tissue diagnosis. This is termed the “Triple Assessment” and is the standard approach in assessing a breast concern. The different components of the triple assessment must be concordant with each other. If the clinical features and breast imaging do not show any concerns, it may not be necessary to proceed with tissue diagnosis. The details of the triple assessment are described below:

1.) Clinical History and Examination: A thorough history is taken from the patient, focusing on the symptoms and any high risk features in the personal and family history. Breast examination is performed to determine the nature of the concern and to check for any palpable lumps or nodal enlargement.

2.) Breast Imaging includes Diagnostic Mammogram and targeted Breast Ultrasound. Mammography is performed to check for any suspicious features, abnormal density or microcalcification. Ultrasound is used to complement Mammography by targeting the area of concern. Combining mammography and ultrasound increases the sensitivity of detecting any abnormality in the patient with a specific breast symptom. Occasionally, Breast MRI may be utilized to provide further information regarding an area of concern in the same breast, to determine the size of an involved area, to rule out any multifocality and to check on the opposite breast. Note: In Tauranga, there are 2 private providers of breast imaging service: Bay Radiology and Medex Radiology. Currently, there is no mammography setup within Tauranga Public Hospital and mammography investigation is subcontracted out to both providers.

3.) Tissue Diagnosis: This is usually obtained by performing a needle test. Core Biopsy can be performed either by palpation or with ultrasound guidance. If an area of abnormality is not palpable and not visible on ultrasound, a stereotactic core biopsy technique using mammography can be performed. Occasionally, further tissue is required for analysis and this may necessitate an excision biopsy of the area of concern.

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