What happens if I have an abnormal mammogram and/or ultrasound?
It is not the end of the world. You may find it difficult to believe, but the majority of breast disorders or abnormalities detected are benign. Even so, it is a normal reaction for any person to ask the question, “Is it CANCER?”
If an abnormality is detected on screening mammogram, further assessment is required to determine if the “abnormality” is real. If the abnormality is real, then, biopsy (which means tissue sampling) is recommended for confirmation.
The biopsy performed can be needle biopsy. Needle biopsies include:
Fine needle aspiration
Core needle biopsy
Mammotome (vacuum assisted large core needle) biopsy
Needle/hookwire localisation biopsy
Stereotactic localisation biopsy
Localisation procedures would be followed by surgery.
These can be performed as an office procedure/outpatient clinic setting. That means, you do not need to be admitted but it can be done in the mammography suite or ultrasound room. No special preparations are also necessary and you can return home almost immediately after the procedure.
Fine needle aspiration cytology (FNAC) deserves further mention. It involves aspirating cells with a fine needle from the lump or abnormal area in the breast, with a syringe, spreading the cells onto a slide and examining the cells with a microscope. As mentioned above, this can be can be done in the outpatient clinic, is rapid and relatively painless. However it requires an experienced cytopathologist. In a specialised clinic (usually called the Breast Clinic), an immediate report can be given, reducing the waiting time for the result, a period which can be very distressing for the woman. This is currently the biopsy method used in breast clinics around the world. Combined with clinical examination and mammography (known as “triple assessment”) the accuracy is nearly 99%.
Core needle biopsy involves sampling with a larger bore needle. A local anaesthetic is necessary and the results are not immediate. However, this gives a larger sample of tissue for diagnosis by the pathologist.
In all lesions that are not palpable, the needle biopsy or localisation biopsy will be done under ultrasound or mammography guidance, depending on whether the lesion is visible by ultrasound or mammography. If the lesion were visible on both mammography and ultrasound, ultrasound would be the choice for guiding the biopsy in most centres.
Some patients will have a surgical biopsy done following the detected abnormality, if the lesion is palpable or after a needle localisation procedure. Surgical biopsies can either be excisional or incisional. An excisional biopsy with clear margins is similar to a lumpectomy. This involves anaesthesia and a second definitive operation is necessary, if the results are malignant (cancerous).
Depending on whether the lesion tested, turns out to be cancer or not, the flow of events may include follow up mammograms and/or ultrasound, repeat biopsy or just routine follow up. The following flow chart only serves as a guide.
Remember that each patient is unique and will have their recommendations tailored to themselves and their condition. Do be surprised if your friend or relative may not have undergone similar tests for an abnormality of their breast.
Flow Chart of Events Following an initial
ABNORMAL Mammogram and/or ultrasound