What to expect during a clinical breast exam

Evaluation of a breast lump typically begins with a clinical breast exam. During this exam, your doctor will likely:

  • Ask about any symptoms and your risk factors for breast cancer or benign breast conditions
  • Examine your breasts, noting their shape and size
  • Observe the condition of the skin on your breasts
  • Check for nipple problems, such as inversion or discharge
  • Examine the deeper tissue in your breasts and armpits for lumps or areas of thickening

If your doctor confirms that you have a breast lump or other area of concern, you'll likely need testing to determine what's causing the problem.

Procedures to evaluate a breast lump

To further evaluate a breast lump, your doctor might recommend one or more of the following procedures. The size, location and other characteristics of the lump — as well as your personal preferences — can all influence which procedure your doctor recommends.

Depending on the circumstances, your doctor might be able to do the procedure in his or her office. In other cases, you might be referred to a radiologist or surgeon.

A diagnostic mammogram — a specialized breast X-ray — helps your doctor investigate breast lumps and other signs and symptoms, such as nipple discharge.

Unlike a screening mammogram, which is done when there are no particular breast concerns, a diagnostic mammogram provides views from several angles at higher magnification — focusing on the suspicious area. This can help your doctor precisely locate and determine the size of the lump or abnormality.

A diagnostic mammogram is often done in combination with an ultrasound of the breast to further evaluate the abnormality. During an ultrasound, sound waves are used to create images of your breast on a monitor.

If your doctor suspects cancer, he or she will likely use a needle to collect a small amount of breast tissue (biopsy) for lab analysis.

During an ultrasound, sound waves are used to create images of your breast on a monitor.

If the breast lump isn't painful and the ultrasound appears normal, further testing or treatment might not be needed.

If the breast lump hurts, your doctor might use ultrasound to guide fine-needle aspiration — a procedure in which any fluid is removed from the lump with a special needle. This can help relieve pain.

If ultrasound reveals that the lump is solid, your doctor will likely use a needle to collect a small amount of breast tissue (biopsy) for lab analysis.

Magnetic resonance imaging
Magnetic resonance imaging (MRI) is a technique that uses a magnetic field and radio waves to create detailed images of your breast. If diagnostic mammogram and ultrasound results are normal but the clinical breast exam reveals an area of concern, an MRI might be helpful.

When MRI is used to detect breast cancer, a special dye (contrast agent) must be injected into your veins before the procedure. The dye enhances the appearance of certain tissues in the MRI images, allowing a radiologist to tell which areas are most likely to be cancerous or noncancerous.

MRI scans can be challenging to interpret. This can lead to a false-positive result — when the test result is positive but cancer isn't actually present — or the need for additional testing.

Fine-needle aspiration
During fine-needle aspiration, a special needle is inserted into the lump and any fluid is removed (aspirated). Your doctor might use ultrasound to help place the needle and remove any fluid.

If the lump contains clear fluid, it's most likely a cyst — a sac that can be filled with air, fluid or other material. Most cysts are noncancerous (benign) and will disappear as the fluid is removed.

If the lump contains bloody or cloudy fluid or it's solid, a sample of fluid or tissue will be sent to a lab for analysis. This might be followed by additional tests of tissues samples to determine whether the lump is cancerous.

Breast biopsy
If the breast lump is solid, a tissue sample is needed to make the diagnosis. This is known as a biopsy.

Options for breast biopsy might include:

  • Fine-needle aspiration biopsy. During fine-needle aspiration, a special needle is used to collect a tissue sample. Ultrasound might be used to help place the needle.
  • Core needle biopsy. During a core needle biopsy, a larger needle than used with fine-needle aspiration is used to obtain a small, solid core of tissue. Ultrasound might be used to help place the needle.
  • Stereotactic biopsy. During a stereotactic biopsy, mammography is used to produce stereo images — images of the same area from different angles — of the breast. A sample of breast tissue in the area of concern is then removed with a needle.
  • Vacuum-assisted biopsy. During a vacuum-assisted biopsy, a small incision is made in the skin and a hollow probe connected to a vacuum is used to remove tissue from an abnormal area. Ultrasound might be used to guide the tissue removal.
  • Surgical biopsy. In some cases, the entire breast lump plus a small amount of surrounding tissue is surgically removed. This is known as an excisional biopsy. If the lump is too large to be removed easily, your doctor might recommend an incisional biopsy — when only part of the lump is surgically removed.

After any type of biopsy, the tissue sample is sent to a lab for analysis. Your doctor will let you know when to expect the test results.

Follow-up after breast lump evaluation

If the breast lump doesn't seem to be cancerous, your doctor might suggest short-term monitoring followed by another exam in a few months to assess the area for stability. Consult your doctor if you notice any changes in the lump or develop any new areas of concern.

If the diagnosis is in question — the clinical breast exam and the mammogram show areas of suspicion, for example, but the pathology report from the biopsy reveals benign tissue — you'll be referred to a surgeon or other specialist for further consultation.

If the breast lump is cancerous, you'll work with your doctor to create a treatment plan. The stage and type of breast cancer will influence your treatment options. If you're unsure how to proceed, ask your doctor to help you make the best treatment decisions.

June 22, 2012 See more In-depth