Diagnosis
Assessment of breast problems
If you have concerns about any breast symptoms, you should make an appointment to see one of our breast physicians. Because it is often not easy to distinguish between normal breast tissue, benign conditions or cancers using just one test, the breast physician will use an approach called triple assessment.Triple assessment involves investigating the breast problem using three techniques:
• Clinical examination
• Imaging
• Needle biopsy
In the clinical examination, the breast physician will take a detailed history of your problem, including any family history and your current medications (including any herbal medicines or supplements). She will then examine your breasts for any skin changes, nipple changes and changes to the shape of your breasts. After this, she will palpate both of your breasts and the armpits (axilla). This will be done with you lying comfortably on a couch. If any abnormality is found, it will be assessed.
Imaging is important, as it may show changes which are not palpable and will also help confirm the clinical findings. Two imaging techniques are commonly used. These are mammography and ultrasound. Both tests are used because they have different strengths and weaknesses, and therefore compliment each other. A mammogram will usually be performed routinely for women over the age of 35, unless there is a specific reason not to do it (eg pregnancy).
If a specific lesion is found, a needle biopsy will be performed. This can usually be done in the same session, and the results are normally available in a few days. Sometimes, if the lesion is only visible on your mammogram, you may have to come back again to have further mammograms and a needle biopsy under X-ray guidance.
The tests will be discussed at a multi-disciplinary biopsy review meeting. If all the tests agree that the breast problem is benign, normally no further treatment is required. If any of the elements of the triple test show a cancer, or if the results are discordant (the individual components do not agree), a further plan of management will be formulated. For instance, the biopsy may need to be repeated or an open surgical biopsy performed. Sometimes a further clinical review or further imaging may be needed. You will only be discharges if all members of the team agree that all your tests are concordant and show benign disease.
A positive or discordant triple test requires further management
THE MODERN TRIPLE ASSESSMENT
• Clinical Breast Examination
• Breast Imaging Mammography Breast ultrasound
• Needle biopsy Fine needle aspiration Core biopsy