1.1 How to diagnose breast cancer? Triple assessment !
If you are concerned about breast cancer, your doctor will recommend Triple Assessment to diagnose whether you have breast cancer. Through the process of Triple Assessment, the majority of breast conditions can be accurately diagnosed, enabling the doctor to develop a suitable surgical plan. The Triple Assessment consists of the following three components:
- Clinical Examination: This involves a physical examination of the breasts and surrounding areas by a healthcare professional to assess any abnormalities or signs of breast cancer.
- Imaging Studies: Various imaging techniques are used to examine the breast tissue, including mammography (breast X-ray), ultrasound, and magnetic resonance imaging (MRI). These tests can help identify any suspicious areas or lesions that may require further investigation.
- Pathological Examination: A definitive diagnosis is made through a pathological examination of the breast tissue. This typically involves a biopsy, where a small sample of tissue is taken for laboratory analysis. The results of the biopsy can determine whether the tissue is cancerous or benign.
By combining the findings from these three components of the Triple Assessment, doctors can accurately diagnose breast conditions and develop appropriate treatment plans.
1.2 Clinical examination
Clinical examination is performed by a doctor and aims to assess the patient’s breasts for any lumps or abnormalities and check for swollen lymph nodes in the armpit and neck area.
The doctor begins by visually inspecting the breast, examining the skin and nipple for any signs of dimpling, redness, or changes resembling the texture of an orange peel.
Next, the doctor performs a manual palpation to feel for any noticeable lumps in the breasts and assesses if there is any nipple discharge. If a lump is detected during the examination, the doctor evaluates its hardness, mobility, clarity of borders, and surface smoothness to assess the likelihood of malignancy.
In general, benign breast lumps tend to feel softer, have a smooth surface, high mobility, clear borders, and no associated skin changes or nipple discharge. Conversely, malignant breast lumps may feel harder, have low mobility, irregular borders, and associated skin dimpling or color changes, such as an orange peel appearance.
Finally, the doctor examines the patient’s armpit and neck areas to check for any swollen lymph nodes, as lymph node enlargement can indicate the possibility of tumor spread.
1.3 Imaging studies
Imaging examinations include mammography, ultrasound, and magnetic resonance imaging (MRI) to analyze images and detect tumor characteristics, assess the extent of the tumor, and determine signs of spreading.
Mammography
Mammography uses X-rays to examine breast tissue for abnormal densities and calcifications. During the procedure, you will stand bare-chested in front of a specialized mammography X-ray machine. A radiographer will assist in positioning your breast on the machine’s platform, which applies plastic compression from above and below as well as from the sides. X-ray images of the breast tissue are taken, typically two images per breast. You may experience some discomfort during the examination.
3D Mammography
Conventional mammography provides 2D images, and some areas of breast tissue may be overlapped and difficult to assess due to compression. 3D mammography captures images from multiple angles, with a one-millimeter interval between each image, significantly improving image clarity. This allows for better visualization of breast tissue and helps doctors detect subtle differences and abnormalities. 3D mammography improves cancer diagnosis while maintaining the X-ray dose and examination time used in 2D mammography, ensuring a safe and comfortable examination.
Breast Ultrasound
Breast ultrasound involves projecting ultrasound energy into the breast and analyzing the echoes reflected back from the breast tissue. The received ultrasound energy echoes are converted into images to understand the breast’s internal structure. Different types of lesions have different densities and ultrasound reflection characteristics. By analyzing the ultrasound images, abnormalities in the breast tissue can be identified, and the nature of the lesions can be assessed. Ultrasound can provide information about the size and location of the lesions, the clarity of their borders, the presence of calcifications, and vascular proliferation, enabling doctors to evaluate the nature of the lesions.
In general, cysts/fluid-filled sacs in the breast exhibit low ultrasound echo characteristics, while breast hyperplasia, fibroadenomas, and even malignant tumors tend to exhibit high echo characteristics. Benign breast fibroadenomas typically have clear borders and uniform echoes in ultrasound images. Conversely, malignant breast tumors may have unclear borders, invasive characteristics, and heterogeneous echoes in ultrasound images.
Breast MRI
Magnetic resonance imaging (MRI) is a cross-sectional scanning technique used to examine the breast tissue. It involves using a strong magnetic field and radio waves to generate detailed images. Breast MRI is often used as a supplemental tool in cases where mammography or ultrasound results are inconclusive or to assess the extent of the disease. It can provide detailed information about the size, location, and characteristics of breast lesions.
It’s important to note that the specific imaging examinations conducted as part of the triple assessment may vary based on individual cases and the recommendations of the healthcare professionals involved in the diagnosis process.
1.4 Pathological examination
If a breast lump is detected, whether suspected to be a cyst, fibroadenoma, or even a malignant tumor, ultrasound-guided needle aspiration can be used to extract cells or tissue from the breast lesion for laboratory analysis, resulting in a pathological diagnosis to determine whether the patient has cancer.
In general, pathological examination has the highest accuracy, but there can be sampling errors for the same lump in different locations. Therefore, the other diagnostic methods in triple assessment of the breast are also important for diagnosing breast cancer.
