1. Mammography
a. Sensitivity of mammography increases with age as the density of the breasts reduces with age.
b. Digital mammography and tomo mammography are now available with more sensitivity.
2. Ultrasound
a. Used in young women with dense breasts
b. Can be used to identify cysts from solid lesions
c. Can also be used to impalpable areas of pathology
d. Used to scan axillary tissues
e. Useful in guided percutaneous biopsy
3. MRI (Magnetic Resonant Imaging)
a. Used to distinguish scar from recurrence
b. Best modality to investigate women with implants
c. Useful as screening tool for high risk women
4. Needle biopsy/Cytology
a. Biopsy is taken under local anaesthesia
b. Histology – By taking a spring loaded core needle biopsy device – Core cut biopsy of the Breast
c. Fine Needle Aspiration Cytology – 21G or 23G needle with 10 ml syringe, sample is taken by passing the needle several times through the lump with negative pressure. Then it is smeared on to slide and air dried or fixed.
5. Large needle biopsy with vacuum system
a. 8G or 11G needles are used
b. Useful in the management of the micro calcification or complete excision of fibroadenomas
Triple Assessment of Breast Symptoms
1. Clinical Assessment
a. Age
b. Examination
2. Radiological Imaging
a. Ultrasound Scan
b. Mammography
3. Cytology or Histology
a. Fine Needle Aspiration Cytology
b. Core cut
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