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Diagnosis of Breast Problems

Your physician may use one or more of the following procedures to evaluate your breasts and make a diagnosis.

Physical Exam
Your doctor will first do a breast exam to determine if what you are feeling is normal.

Your doctor may order a mammogram to obtain a detailed image of your breast.

If the physical exam or the mammography indicates an abnormality, an ultrasound may be performed to further evaluate that abnormality. Ultrasound is a painless procedure that uses sound waves to produce a picture of the breast. Unlike mammography, an ultrasound can accurately show a difference between a fluid filled lump from a solid mass. However, an ultrasound cannot determine if the solid lump is cancerous (malignant) or noncancerous (benign). Sometimes, there might be slight differences in the ultrasound appearance of one breast compared with the other. If this is the case, the radiologist may recommend an ultrasound or a second mammogram in four to
six months.

Fine Needle Biopsy (Aspiration)
If an ultrasound shows that a lump is solid, the doctor may use a small needle to aspirate (or remove) some cells to examine under the microscope.

Large Core Needle Biopsy
This is a procedure done by a radiologist when guided by ultrasound or mammography. The technique allows fine slivers of tissue to be removed from a specific area in the breast. These tissue samples are then evaluated by a pathologist. No stitches are required. At times, this procedure may take the place of a surgical biopsy.

Needle Localization
Often a mammogram will show small calcifications or other conditions that cannot be felt during a physical exam. Occasionally, this tissue will need to be biopsied. If so, your doctor may use a procedure called needle localization.

For this procedure, a thin needle is placed into the breast near the site of the abnormality, and a mammogram is taken to show the exact placement of the needle. This needle is secured by a tiny wire. The surgeon then uses the needle as a guide to do the biopsy, and removes a small amount of breast tissue along with the wire. This requires a small incision.

Surgical Biopsy
This is a procedure done by a surgeon. Either the entire abnormality or a portion of it may be removed. Stitches are required.

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