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You Found a Breast Lump: What Happens Now?

It’s every woman’s worst fear: finding a lump in your breast. Before you panic, get advice from experts on the next steps to take.

Is It Cancer? How to Know for Sure

Once it's established that your lump is not a cyst, the next step is to rule out other noncancerous lesions, such as fibroadenoma (benign tumor) or intraductal papilloma (small, wart-like growth in a milk duct).

This is frequently accomplished by testing the suspicious area for the presence of cancer cells.

For many years, this routinely meant surgery -- which, when cancer wasn't found, became a harshly unnecessary procedure.

Today, however, the advent of minimally invasive biopsy is changing the way breast cancer is diagnosed. It began with the development of ultrasound guided core needle biopsy -- an in-office procedure that can diagnose cancer.

"Using the real-time ultrasound image as a guide we insert a slender needle into the breast and suck out a small sampling of cells which we test for cancer," says Jules Sumkin, DO, professor of radiology and chief of radiology at Magee Women's Hospital in Pittsburgh.

In the event that the lesions can't be seen on ultrasound -- which Sumkin says occurs about a third of the time -- a similar procedure known as a "stereotactic needle biopsy" uses a mammogram to guide the procedure.

"In this instance we insert the needle and then scan the breast with the mammography equipment to ensure accuracy," says Sumkin.

More Diagnostic Advances

As successful as needle biopsy is, it does have some limitations.

"The needle is very small and thin, and getting a sample can be difficult. Or on occasion sampling is inconclusive," says Lehman. This, she says, sometimes results in an unnecessary surgical biopsy.

By the late 1990s however, doctors had another tool -- vacuum-assisted biopsy. Instead of just removing cells, the addition of suction and a larger needle allowed for the removal of actual tissue fragments.

"This enabled us to get a better sampling in less time and in some instances, have a better, more accurate diagnosis," says Gail Starr, MD, director of breast imaging at Hackensack University Medical Center.

Moreover, two very recent advances further improved the technology. The first is the MRI-guided vacuum-assisted biopsy.

"This is the really big advance because before this, we did not have the ability to biopsy things we could only see on an MRI. But now we can, without having to resort to surgery," says Sumkin.

Even more recently researchers developed BLES -- short for breast lesion excision system. This removes not just fragments, but larger pieces of tissue. Some believe this may be a more accurate biopsy for women diagnosed with atypical ductal hyperplasia (ADH) -- abnormal cells in the breast that increase their risk of cancer.

"The reason this kind of technology is particularly exciting is because it is moving us closer towards the goal of removing an entire cancer without fragmenting, which in turn would give us the ability to move breast cancer treatment from the surgical [operating room] to the doctor's office," says Lehman.

But even with the technologies available now, Lehman tells WebMD, she is concerned that too many American women are still being led to believe surgical biopsy is their only option.

"It's important that women understand that in all but a few rare instances, diagnosing breast cancer should not have to involve surgery," says Lehman.

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