Breast Cancer: Diagnosis
Tests for Diagnosis of Breast Cancers:
Doctors use several methods to diagnose cancer. They also perform
tests to confirm the spreading of cancer to a part of body other than breast
and the lymph nodes under the arm. This condition is called metastasis. Doctors
may also compare the efficiency of tests to determine which treatment could
work better. The sure way to confirm the area of cancer is biopsy. In biopsy, a
small sample of tissue is taken for testing in a laboratory.
The list of tests below may not be used for every person. The
selection of diagnostic test depends on following factors.
·
Suspected type of cancer
·
Symptoms and signs
·
General health and age
·
The results of all earlier
medical tests
The series of tests for possible test cancer begins with the
discovery of a mass or abnormal calcification on a screening mammogram or a
nodule or lump in the woman’s breast self or clinical examination. A woman may
notice a mass or nodule under the arm or a red or swollen breast.
The following tests can be used for diagnosis of breast cancer or
for follow-up testing after a breast cancer has been diagnosed.
Imaging tests
Imaging tests are used to show inside pictures of the body. The
suspicious area found in the breast during screening can be further evaluated
by using following imaging tests.
·
Diagnostic mammography
Diagnostic
mammography is nearly similar to screening mammography having exception of
taking more pictures of breast. It is generally used when a woman has experienced
signs such as discharge of a new lump or nipple. Diagnostic mammography is also
applicable in case of finding something suspicious during screening
mammography.
 |
| A snapshot of mammography |
· Ultrasound
An ultrasound involves the use of sound waves for creating a
picture of the breast tissue. An ultrasound can be used to distinguish between
a solid mass, which may be a fluid filled cyst and may be a cancer.
· MRI
An MRI involves the
use of magnetic field not x-rays for creating the complete image of the body. A
contrast medium which is a special dye is given before the scan for creating a
clear picture of the possible cancer. This special dye is injected into
patient’s vein. A breast MRI may be used when a woman has been diagnosed with
breast cancer to scan the other breast for cancer or for finding the extent of
cancer throughout the breast. Along with mammography, breast MRI is also a
screening option for women having higher risks of developing cancer.
Biopsy
A biopsy is the
removal of a small amount of tissue for examination under a microscope. Other
tests can suggest that cancer is present, but only a biopsy can make a definite
diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor
who specializes in interpreting laboratory tests and evaluating cells, tissues,
and organs to diagnose disease. There are different types of biopsies,
classified by the technique and/or size of needle used to collect the tissue
sample.
 |
| Biopsy |
A biopsy involves the removal of
a small amount of tissue for analysis under microscope. Other tests direct the
presence of cancer but only a biopsy can make a clear diagnosis. Biopsies are
classified into different types on the basis of technique and size of needle
used to collect the tissue sample.
· Fine needle aspiration biopsy. This type of biopsy
involves the usage of a thin needle for removing a small sample of cells.
· Core needle biopsy. This type of biopsy involves the usage of wider needle for removing a larger sample of tissue. This is generally preferred type of biopsy to find whether an abnormality is cancer. The patient’s discomfort is lessened by using local anesthesia to block the pain during the procedure.
· Surgical biopsy. This type involves the removal of largest amount of tissue. A surgical biopsy is generally not recommended for diagnosis of breast cancer. Mostly non-surgical core needle biopsies are recommended for diagnosis of breast cancer.
·
Image-guided biopsy. This procedure involves the guidance of a needle to locate the cancer by
using an imaging technique such as ultrasound, mammography, or MRI. A
stereotactic biopsy is done by utilizing mammography to guide the needle. The breast where the biopsy sample was taken is marked by putting
a small metal clip. This clip is usually made of titanium so it will not cause
future problems.
· Sentinel lymph node biopsy. This type is used to find the location of cancer in the lymph nodes near the breast.
Analysing the biopsy sample
The sample obtained during biopsy is then analysed to determine
specific features of a cancer for further treatment options.
· Tumor features. The tumor is examined under
microscope for determining the nature of tumor that either it is invasive or in
situ, lobular or ductal and to determine the spreading of cancer to the lymph
nodes. The margin width is also determined to confirm the margins or edges of
the tumor and their distances from tumor.
·
ER and PR. Both the patient’s risk of recurrence and the type of treatment for
lowering the risk of recurrence are determined by testing for ER and PR. DCIS
are often measured by ER and PR as well. Hormonal therapy is usually best for
ER-negative and ER-positive cancers.
·
HER2. HER2 status helps to find
out whether drugs targeting HER2 receptor such as trastuzumab (Herzuma,
Ontruzant, Herceptin, Ogivri), may help for treating the cancer. This test is
only applicable for invasive cancers. ASCO and CAP recommend that HER2 test is
only done after the diagnosis confirmation of invasive breast cancer.
HER2 tests are generally clearly
positive or negative which means that your cancer contains either high levels
or low levels of HER2. If the test results are not clearly positive or negative,
testing should be done again, either with a different test or on a different
tumor sample.
If the cancer is HER2 is
positive, treatment may be followed by HER-targeted therapy. If the cancer is
HER2 negative, then the treatment may not be recommended by HER2 targeted
therapy.
· Grade. Biopsy is also used to determine tumor grade. Grade gives the extent of difference between healthy cells and tumor cells and also the rate of their growth. If the cancer cell is looking similar to healthy cell and having different cell groupings, it is called “low grade” or “well differentiated tumo”r. If the cancer tissue is looking very different from healthy tissue, it is called “high grade” or “low differentiated tumor”.
Molecular testing of the tumor
If the cancer is locally
advanced or metastatic breast cancer, the testing having the following
molecular features may be recommended:
o
PD-LI, that protein is present on the
surface of cancerous cells and also on some of the immune cells of the body.
This protein inhibits the immune cells of the body from destroying the cancer.
o
Microsatellite instability-high (MSI-H) or DNA mismatch repair
deficiency (dMMR). Tumors having MSI-H or dMMR
contain difficulty repairing damage to their DNA. This refers that they are
developing several changes or mutations. These changes prepare abnormal proteins
on the tumor cells that allow it easier to immune cells of finding and attacking
the tumor.
o
NTRK gene fusions is a specific
genetic change encounter in a range of cancers as well as breast cancer.
o
PI3KCA gene mutation, which is a specific genetic
mutation usually encounter in breast cancer.
Genomic tests for the prediction of recurrence risk
Doctors perform genomic tests to identify specific substances by
the genes called proteins that are present on or in cancerous cells. Doctors
can better diagnose the unique features of each patient’s breast cancer by using
these genomic tests. These tests also give estimation of the risk of cancer coming
back after cancer. These tests allow the doctor and patient to make suitable decision
for appropriate treatment.
The following genomic tests can be done on a tumor sample that was
removed during surgery or biopsy. There is no need of more surgery or extra
biopsy for these tests.
·
Oncotype Dx™. This test can be adopted for people with
PR-positive and/or ER-positive, HER2-negative breast cancer that has not been
spread to the lymph nodes. This test tells whether the
chemotherapy should be added in addition to hormone therapy. This test looks 5
reference genes and 16 cancer related genes for calculating a “recurrence score”
that gives the estimation of risk the cancer coming back within a duration of
10 years after diagnosis. This recurrence score also determine the use of
chemotherapy which may also vary with age. These recommendations by age group
are listed below:
For patients of 50 or younger age
o
Recurrence score less than 16: Chemotherapy is normally not recommended along with hormonal
therapy
o
Recurrence score of 16 to 30: Chemotherapy may be recommended in addition to hormonal
therapy
o
Recurrence score of 31 or
higher: Chemotherapy is generally
recommended to hormonal therapy
For patients older than age of 50
o
Recurrence score less than 26: Chemotherapy is usually not recommended in addition to
hormonal therapy
o
Recurrence score of 26 to 30: Chemotherapy may be recommended in addition to hormonal
therapy
o
Recurrence score of 31 or
higher: Chemotherapy is usually recommended along with hormonal therapy
· Mamma Print™
This test is an option for people with PR-positive and/or ER-positive,
HER2-negative breast cancer that has only spread to 1 to 3 lymph nodes or has
not spread. This test adds information from 70 genes for estimation of the risk
of recurrence for developing early-stage breast cancer.This test is recommended for high risk of cancer coming back and allows
the doctor and patient to make decisions for chemotherapy. This is not a
recommended test for people having low risks of cancer coming back
· Breast Cancer Index™
This test is an option for people with PR-positive and/or ER-positive,
HER2-negative breast cancer that has not been spread to the lymph nodes. This
test helps the doctor and the patient to estimate the actual duration of taking
hormonal therapy.
There is also need to do vatious types of blood tests. These tests
may be performed before or after the surgery. These are listed below:
·
Complete blood count. A complete blood count (CBC) is employed for measuring the number
of various types of cells, such as white blood cells and red blood cells in a
sample of blood of a person. This gives the surety of proper functioning of
bone marrow
·
Blood chemistry. This test is done to evaluate the proper working of liver
and kidneys.
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