Investigations of breast symptoms

To diagnose whether changes in your breast are cancerous or not, your GP will refer you to a breast clinic for further tests. This article outlines the different breast investigation techniques.

What happens at the breast clinic?

Before examining your breasts, a doctor or a nurse will ask you about your medical history. The lymph nodes under your arms and at the base of your neck will also be checked to identify any swelling present.

Once the examination is complete, you may require more accurate diagnostic tests such as breast imaging and/or biopsies, especially if a breast lump has been found and/or you have symptoms such as nipple discharge, or significant changes in the way your breast looks or feels. These tests may be carried out on the same day or you may be asked to book another appointment.

What is breast imaging?

Imaging is the technique used to photograph the inside of your breast. The most common types of breast imaging include:


This non-invasive imaging technique uses a low-dose X-ray to take pictures of breast tissue – the resulting images are called mammograms.

During the procedure (which is usually carried out while you’re standing up), each breast will be pressed between two plates to flatten it as much as possible, so that a clear image can be taken with a low dose X-ray.

The pressure exerted may cause moderate discomfort lasting a few seconds to a few minutes, but it won’t harm your breast. Some women may feel slightly sore for a few days after the mammography.

Since both silicone and saline breast implants can make the image difficult to analyse, make sure to tell your doctor or the nurse in charge if you have implants: they will know how to position your breast so as to get the best image possible.

What can a mammogram show?

The mammograms will be analysed by a specialist to identify any abnormal tissue growth, cysts or calcification. The images can also detect very early-stage non-invasive cancers that can become cancerous with time.

Is a mammography safe?

According to Cancer Research UK, experts estimate that for every 10,000 women aged between 47 and 73 who go for screening every three years, radiation will cause 3 to 6 extra cases of breast cancer. In other words, while mammography does expose you to some radiation, the amount is very small and detecting a cancer at an early stage might outweigh the risks of radiation from the mammography.

What if you’re pregnant?

X-rays may affect an unborn baby – if you’re pregnant or think you may be expecting, inform the radiographer. If the mammography cannot be postponed until after you deliver your baby, you may be given a lead apron to wear over your lower abdomen. The lead will absorb X-rays, thus protecting your baby from radiation. Ultrasound may also be suggested in lieu of a mammography.


A breast ultrasound utilises sound waves to produce an image of the inside of your breast. A radiologist or radiographer will spread some cold gel on your breast and will then move a sensor over it.

This rapid and painless imaging technique is normally used for women under 35 – younger women usually have denser breasts and the mammograms may not be clear enough to be helpful.

You may also need an ultrasound if a breast lump does not show up on a mammogram – the ultrasound will detect whether the lump is solid or whether it’s a fluid-filled cyst.

Magnetic resonance imaging (MRI)

This imaging technique is usually used to screen high-risk women under the age of 50. As the name suggests, this procedure uses magnetism to produce a detailed picture of the breast.

During the scan, you will be asked to lie very still inside the tube of the scanner and wear earphones for sound protection – the procedure is painless but you may feel slightly claustrophobic or uncomfortable due to the noise made by the scanner.

Preparing yourself for breast imaging

Avoid using any body lotion, talcum powder, spray-on deodorant or perfume on your breasts on the day of the test – these could affect the quality of the mammogram.

What is a biopsy?

During a breast biopsy, one or several small sample(s) of your breast will be removed with or without anaesthesia. The tissue will then be sent to a laboratory to identify whether or not the changes to your breast are cancerous.

The different types of breast biopsy procedures include:

Fine needle aspiration cytology (FNAC)

This involves passing a very fine needle through your skin to draw out some breast tissue from the area being investigated into the syringe. You will only feel a mild sting as the needle is passed into your breast. This procedure is quick and you will not normally need an anaesthetic.

Needle biopsy

Also referred to as a ‘core biopsy’ or a ‘Tru Cut biopsy’, this procedure involves the use of a hollow needle, which is slightly wider than the one used in FNAC. The area to be checked may need to be located using an X-ray machine or an ultrasound.

The doctor performing the biopsy will generally numb the area from which the sample is to be obtained by injecting a local anaesthetic. A small cut is then made on your breast just over the area to be investigated and the needle is passed through it and into your breast. The doctor will release the needle’s spring and breast tissue will be collected inside the needle’s hollow cylinder. The process can be repeated if more samples are required.

Vacuum assisted core biopsy (VACB)

VACB is a minimally invasive breast biopsy (MIBB) that is usually performed under local anaesthetic. Once the anaesthetic has taken effect, a small cut will be made on your breast just above the area to be investigated. A biopsy probe or tube will then be inserted in the cut and your doctor may use ultrasound to ensure that the probe is in the proper place. Suction is used to draw the tissue into the probe and a cutting device separates the sample from the surrounding tissue. If more samples are needed, the process can be repeated without having to remove the probe.

Punch biopsy

The doctor will remove a small piece of skin tissue for analysis if Paget’s disease of the nipple or inflammatory breast cancer is suspected.

Excision biopsy

Also called a ‘surgical biopsy’, the excision biopsy is a minor surgery used to remove the whole breast lump under local or general anaesthetic.

Wire guided biopsy

This technique, also known as a wire localisation, is used when calcium spots (but no lump) are identified on a mammogram. Since the surgeon cannot properly see or feel which area has to be excised, she/he will place a fine wire right in the centre of the area containing the calcium spots – the tissue to be removed is where the wire ends.

Waiting for the test results can be a stressful time, so don’t hesitate to contact relatives, friends or a cancer support group if you need someone to talk to.

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