Results and Further Testing: What to expect

1. Imaging
2. Biopsy

1. Ultrasonography
2. Mammography
3. Breast magnetic resonance imaging (MRI).

1. Stereotactic Core Biopsy: This procedure is less invasive method to get the samples for diagnosis. It this procedure your breast is compressed and the tissues are removed with a biopsy needle. It is similar to the mammogram. This biopsy does not cause any significant scarring and can heal in very short time period.
2. Fine Needle Aspiration (FNA) Biopsy: In this procedure a sample of women’s breast lump is taken, this procedure may produce a small mark n the location. FNA often helps to get the results of the lump diagnosis within two three days.
3. Needle (Wire) Localization Biopsy: This process involves the use of wire and needle in order to locate the abnormal lump in the breast. When your mammogram shows abnormality, needle localization can be helpful. This is an outpatient type of biopsy, which is performed in two steps in one day.

Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, a biopsy may be done.

There are four types of biopsy used to check for breast cancer:

• Excisional biopsy : The removal of an entire lump of tissue.
• Incisional biopsy : The removal of part of a lump or a sample of tissue.
• Core biopsy : The removal of tissue using a wide needle.
• Fine-needle aspiration (FNA) biopsy : The removal of tissue or fluid, using a thin needle.(2)

Staging breast cancer

Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer’s stage helps determine your prognosis and the best treatment options.

Complete information about your cancer’s stage may not be available until after you undergo breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

• Blood tests, such as a complete blood count
• Mammogram of the other breast to look for signs of cancer
• Breast MRI
• Bone scan
• Computerized tomography (CT) scan
  Positron emission tomography (PET) scan

Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing.

Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.

Breast cancer staging also takes into account your cancer’s grade; the presence of tumor markers, such as receptors for estrogen, progesterone and HER2; and proliferation factors.(3)

If cancer is found, tests are done to study the cancer cells.

Decisions about the best treatment are based on the results of these tests. The tests give information about:

• how quickly the cancer may grow.
• how likely it is that the cancer will spread through the body.
• how well certain treatments might work.
• how likely the cancer is to recur (come back).

Tests include the following:

• Estrogen and progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more estrogen and progesterone receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
• Human epidermal growth factor type 2 receptor (HER2/neu) test : A laboratory test to measure how many HER2/neu genes there are and how much HER2/neu protein is made in a sample of tissue. If there are more HER2/neu genes or higher levels of HER2/neu protein than normal, the cancer is called HER2/neu positive. This type of breast cancer may grow more quickly and is more likely to spread to other parts of the body. The cancer may be treated with drugs that target the HER2/neu protein, such as trastuzumab and pertuzumab.
• Multigene tests: Tests in which samples of tissue are studied to look at the activity of many genes at the same time. These tests may help predict whether cancer will spread to other parts of the body or recur (come back).

There are many types of multigene tests.

The following multigene tests have been studied in clinical trials:

• Oncotype DX : This test helps predict whether early-stage breast cancer that is estrogen receptor positive and node negative will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.
• MammaPrint : This test helps predict whether early-stage breast cancer will spread to other parts of the body. If the risk that the cancer will spread is high, chemotherapy may be given to lower the risk.

Based on these tests, breast cancer is described as one of the following types:

• Hormone receptor positive (estrogen and/or progesterone receptor positive) or hormone receptor negative (estrogen and/or progesterone receptor negative).
• HER2/neu positive or HER2/neu negative.
• Triple negative (estrogen receptor, progesterone receptor, and HER2/neu negative).

This information helps the doctor decide which treatments will work best for your cancer.