Tests for breast changes

Breast imaging or pictures are used to investigate lumps or other changes in your breast. A biopsy may also be recommended. 

Imaging includes:

• mammograms
• ultrasounds.

Your doctor will talk with you about the tests that you need. Women often worry that any change in their breast is cancer but even though the changes might be uncomfortable, painful or worrying to women, they are rarely cancer. There are many reasons for unusual breast changes, and most are not dangerous or harmful. 

Some women also worry about the tests they are going to have. Mammograms and ultrasounds are not dangerous and not usually uncomfortable. The clinical staff are generally happy to answer your questions or to address your concerns. No question is too stupid or unecessary so don't hold back. 

Mammogram

This is an X-ray of the breast. Usually, at least two pictures are taken of each breast, one breast at a time. The radiographer will position your breast firmly between two flat plates on the X-ray machine for up to a minute. This might feel uncomfortable, but if it feels painful, tell the radiographer.

Ultrasound

An ultrasound uses sound waves to give a picture of all the soft parts of the breast. The machine is like the one used to see a baby inside a womb. It is made up of a hand-held probe that looks like a microphone. This is connected to a computer. The technician or specialist will put a clear gel on your breast and then move the probe gently across the surface of each breast, stopping to take pictures.

An ultrasound usually takes about 30 minutes and is not painful.

Results of mammograms and ultrasounds

At least one specialist radiologist will look at all of the pictures from your mammogram and/or ultrasound. They will report to your specialist or doctor. 

Sometimes the pictures are not clear enough and need to be done again. At other times a specialist might mark an area on a picture for special checking. These steps are taken to make sure you get a correct diagnosis. They do not mean there is something wrong with your breast.

You will need to return for another appointment to discuss the results of your tests with a specialist. Results usually cannot be given over the phone. Your General Practitioner (GP) is usually notified of your results.

About biopsy

Biopsies involve taking some tissue or cells from the body and looking at the sample under a microscope. Specialists use a variety of methods to take a sample. The method your specialist chooses for you will depend on:

• where the lump or other change is located
• the size of the lump or other change
• your personal and family health history.

The two most common biopsies are called fine needle aspiration (FNA) and core biopsy.

Your specialist will talk with you about which kind of biopsy you need.

Fine needle aspiration (FNA)

In this procedure, the specialist uses a needle to take fluid or cells from the area for testing. This needle is finer than one used to take blood. FNA can be uncomfortable but usually it is not painful.

Sometimes there is bruising or slight bleeding where the needle was inserted. This should heal quickly. You can go home straight away after FNA.

Core biopsy

In this procedure, the radiologist uses a slightly bigger needle to take tissue from the area for testing. Core biopsies are always performed with a local anaesthetic. Usually they are not painful, but you need to keep very still while the procedure takes place.

Usually a number of samples of tissue are taken from the one site. Occasionally samples are taken from different sites.

In a core biopsy, the needle is usually guided by an ultrasound, while you lie on your back on a table.

Sometimes the needle is guided by breast X-rays (mammograms). This procedure is called a stereotactic core biopsy. The machine that is used is different to the one used for ordinary mammograms. Instead of standing up, you lie on your stomach on a special table, which has an opening for your breast. A radiographer or nurse helps to position your breast in the opening so that the radiologist can take the X-rays and insert the needle more easily. Your breast is compressed, like in a regular mammogram machine, but it should not feel too uncomfortable because you are lying down.

When your breast is in the right place and you feel comfortable, the radiologist takes a series of X-rays to guide the needle and take the core samples. You might feel a slight pressure when the samples are taken but you should not feel any pain.

The core biopsy usually takes 45 to 60 minutes and the anaesthetic wears off after a couple of hours.

Some clinics ask you to rest a while after a core biopsy and to have someone to drive you home.  They also suggest avoiding activities that put stress on your arm on the biopsy side (such as hanging out clothes or vacuuming) for 24 hours.

Often there is some bruising or slight bleeding where the needle was inserted. This should heal quickly.

Your specialist might put a waterproof dressing on the site. This does not need to be changed and you can wear it in the bath or shower. Check with your specialist about how long to leave the dressing on.

If you feel sore after a core biopsy, mild pain relief such as paracetamol should help.

Practical information

• You do not need to prepare specially for FNA or a core biopsy.
• Neither of these biopsies wil usually require a stay in hospital, you should be able to go home on the same day.
• Your visit could take two to three hours, although the actual biopsy will probably take less than an hour.
• You will need to take your top and bra off for the biopsy.
• There will probably be a radiologist, a radiographer and a nurse present. A laboratory technician might also come in to collect the sample.

Results of biopsies

Once the cells or tissue have been taken out, the sample will be sent to the laboratory. It may take a week or two for results to come through. You will usually need to return for another appointment to discuss the results of your tests with a specialist. Results cannot usually be given over the phone. 

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