A lump found in the breast is a very scary occurrence for any woman at any stage in life.
Firstly, DO NOT PANIC!
Secondly, ALL BREAST LUMPS ARE NOT CANCER!!
Thirdly, PROPERLY TREATED, BREAST CANCER IS CURABLE!!!
Before self-diagnosing and falling into a well of misery, it is advisable to get an examination done from a competent doctor. In dealing with any breast lumps, there are three golden steps which direct us to the correct diagnosis.
They constitute the TRIPLE TEST.
1st Test: CLINICAL EXAMINATION
A complete history is elicited from the patient with special emphasis on the duration of the lump, any associated pain or nipple discharge. History of premenstrual breast pain, previous breast lumps, recent or ongoing lactation, family history of Breast cancer and menstrual complaints are all relevant to the investigative process.
A thorough clinical examination is done by the surgeon, whereby the breast is examined along with the opposite breast, both armpits, and the neck region.
2nd Test: RADIOLOGICAL INVESTIGATIONS
The gold standard for radiological investigations in breast conditions is Mammography. This gives us a characteristic radiological picture of the lump, which helps us to characterize its type, whether benign, malignant or indeterminate. It also enables us to see any other impalpable, similar or different lesions inside the breasts, axillae or armpits.
3rd Test: PATHOLOGICAL CONFIRMATION
Biopsy of the lesion is the most reliable test to confirm the diagnosis. The biopsy can be carried out in three ways:
- Surgical open biopsy: The entire lump or part of the lump is removed and is sent for testing.
- FNAC (Fine Needle Aspiration Cytology): In this procedure, under strict sterile conditions, a thin needle is introduced into the lump and some material is collected for cytology. FNAC has a false negative rate of 10%. Also, the sample collected is very thin and hence the information that one can get may be inadequate to plan further management.
- Core Needle Biopsy: In this procedure, under strict sterile conditions, local anesthesia is given at the site of the lump. It is then visualized under sonography guidance. A biopsy gun is used to target the lump and a core of tissue is extracted in a single throw. Multiple cores are extracted. The accuracy of this type of biopsy is very good as each throw of the gun is seen and tracked under sonography guidance. The cores give us adequate tissue for histopathology and for evaluation of tumor markers. This helps in the proper evaluation of patients and helps in planning proper treatment.
Sometimes, additional radiological investigations may be required to augment our knowledge about the stages of certain patients diseases. These include:
- MRI of the Breast
- PET Scan