Investigation of the breast
Although an accurate history and clinical
examination are still the most important methods of detecting breast disease
there are a number of investigations which can assist in the diagnosis as
follows
Mammography (Fig.
46.2)
Soft tissue X-rays are taken by placing the
breast in direct contact with ultrasensitive film and exposing it to
low-voltage, high-amperage X-rays. The dose of radiation is approximately 0.1 Gy
and therefore mammography is a very safe investigation.
Ultrasound
Ultrasound is particularly useful in young
women with dense breasts in whom mammograms are difficult to interpret, and in
distinguishing cysts from solid lesions (Figs 46.3 and
46.4). It can also be
used to localise impalpable breast lumps.
Magnetic
resonance imaging
Magnetic resonance imaging (MRI) is of
increasing interest to breast surgeons in a number of settings: it can be useful
to distinguish scar from recurrence in women who have had previous breast
conservation therapy for cancer (although it is not accurate within 9
months of radiotherapy because of abnormal enhancement); it is the gold
standard for imaging the breasts of women with implants; it may prove useful as
a screening tool in high-risk women; and it is being evaluated in the management
of the axilla in both primary breast cancer and recurrent disease (Fig. 46.5).
Needle
biopsy/cytology
Histology can be obtained using a fine needle
such as a Trucut or Corecut biopsy device under local anaesthesia (Fig.
46.6).
Cytology is obtained using a 21 or 23 Gauge needle and 10-ml syringe with
multiple passes
Triple
assessment
In any patient who presents with a breast lump
or other symptoms suspicious of carcinoma, the diagnosis should be made by a
combination