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 symptoms and your risk factors for breast cancer or benign breast conditions
  • Examine your breasts, noting their shape and size, while you're standing and while you're lying down
  • Examine the skin on your breasts
  • Check for nipple problems, such as inversion or discharge
  • Feel (palpate) the deeper tissue in your breasts and armpits to detect 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.

Procedures to evaluate a breast lump

Imaging tests

To further evaluate a breast lump, your doctor might recommend one or more of the following procedures.

  • Mammogram. A diagnostic mammogram — a specialized breast X-ray — helps your doctor investigate breast lumps and other signs and symptoms, such as tissue thickening, skin dimpling or nipple inversion.

    A diagnostic mammogram focuses on one area of your breast, providing views from several angles at higher magnification than does a screening mammogram. This test helps your doctor pinpoint the location and the size of the abnormality.

    A diagnostic mammogram is often done along with an ultrasound of the breast.

  • Ultrasound. Sound waves create images of the inside of your breast on a monitor. Ultrasound imaging is helpful for determining whether a breast lump is solid or filled with fluid.
  • MRI. A magnetic field and radio waves create detailed images of the inside of your breast. A breast MRI usually is reserved for when the diagnosis is in question.

    When an 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 likely to be cancerous.

    MRI scans can be challenging to interpret. This can lead to a false-positive result — when the test result is positive but there's no cancer — or the need for additional testing.

  • Ductogram. Also called a galactogram, this test is sometimes used to find the cause of nipple discharge. A small amount of dye is injected into a duct in the nipple. The dye shows up on an X-ray and can reveal a tumor in the duct.

Breast biopsy

Sometimes removing a tissue sample to examine under a microscope (biopsy) is the only sure way to determine if a breast lump is cancer. The type of biopsy depends on the size and location of the suspicious area.

Breast biopsy options include:

  • Fine-needle aspiration biopsy. With a special needle — thinner than the ones used for blood tests — your doctor withdraws (aspirates) a sample of tissue from the suspicious area.
  • Core needle biopsy. Using a larger needle than is used for fine-needle aspiration, your doctor obtains a small, solid core of tissue from your breast. This type of biopsy can remove more tissue than can fine-needle aspiration. Your doctor will likely give you an injection of medicine to numb your breast before starting the biopsy.
  • Stereotactic biopsy. During a stereotactic biopsy, mammography produces images from several different angles (stereo images) of the area in question. Your doctor then removes a sample of breast tissue with a needle. This test is often used to biopsy tiny calcium deposits seen only on a mammogram.
  • Vacuum-assisted biopsy. After giving you an injection of numbing medication, your doctor makes a small cut (incision) in your breast to insert a hollow probe into the breast tissue. The probe connects to a vacuum that's used to remove a tissue sample. This type of biopsy can remove tissue from more than one area through a single incision.
  • Surgical biopsy. In this procedure, a surgeon cuts open your breast to remove part of the lump (incisional biopsy) or the entire breast lump plus a small amount of surrounding tissue (excisional biopsy). This type of biopsy usually is done using medication to numb your breast and possibly medication to make you sleepy or general anesthesia in an outpatient facility.

All biopsies can cause bruising, bleeding and swelling. A surgical biopsy will likely leave a scar, and depending on how much tissue is removed, may change the shape of your breast.

After a biopsy, the tissue sample is sent to a lab for analysis. Your doctor will let you know when to expect the test results and discuss the results with you when they're available.

Follow-up after breast lump evaluation

If the breast lump isn't cancerous, your doctor might suggest short-term monitoring followed by another clinical breast exam or repeat breast imaging in a few months to reassess the area. Consult your doctor if you notice changes in the lump or develop 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.

May 15, 2015 See more In-depth