1. InvestIgatIons of
Breast CanCer
-By preetam goswamI
8th semester,unIt-1

2. Contents
• InvestIgatIons for DeteCtIon.
• InvestIgatIons for stagIng.
• InvestIgatIons for treatment.

3. INVESTIGATIONS FOR
DETECTION
MODALITIES:
 Mammography.
Ultrasound of Breast
 MRI of Breast
FNAC (Fine Needle Aspiration Cytology)
 Biopsy
 Other Investigations

4. Mammography
• It is a non invasive procedure for detection of breast
cancer by using low energy x-rays.
• Principle : It identifies the areas of microcalcifications
and tissue densities.
• Procedure: Compression X-rays of superior and
medial aspects.
• Detection:
 Malignant Lesions show irregular densities and
intraductal calcifications
 Benign Lesions show well defined borders and peripheral
calcifications.
• It is a part of triple assessment therapy which also includes
clinical assessment and cytological diagnosis by FNAC

5. NORMAL BREAST BENIGN LESION MALIGNANT LESION

6. USG of Breasts
Benign Cyst It is a Non Invasive technique that uses sonic
energy in the frequency range of 1 – 10 MHz.
Appearance
1.Cysts : Fluid Filled Lesions – No internal echo.
2. Benign : Solid Lesions – Smooth and Well
defined border
3. Malignant : Jagged Borders.
Malignant Cyst

7. MRI of Breast
 Contrast : Gadolinium Chelate.
 Dose : 0.1mmol/Kg i.v
 Characteristics of Tumor :
o Hypervascularity
o Increased Capillary Permeability.
o Increased Interstitial Space
 Advantages :
o High Sensitivity
o Distinguish Scar from Recurrence
o Image Breasts with Implants.
o Choice of Imaging in Pregnancy
o Management of Axillary Infiltration
Disadvantage:
Costly, Non Available,
Not Sensitive to Premalignant lesions

8. FNAC
 Done in case of cystic lumps of
breast.
 Criteria for
malignancy
1. Blood stained aspirate.
2. Mass does not completely.
disappear after aspiration.
 FNAC Scoring
Co : No epithelial cells.
C1 : Scanty epithelial cells, Benign.
C2 : Benign Cells.
C3 : Atypical Cells.
C4 : Suspicious Cells.
C : Malignant Cells.
BIOPSY
 TYPES
 Frozen Section Biopsy.
 Corecut/Trucut Biopsy.
 Excision Biopsy.
 Edge Biopsy.
 It is used for definitive
diagnosis of malignancy.

9. Other Investigations
• Oestrogen Receptor Study
• Progesterone Receptor Study
• Ductal Lavage
• Tumor Markers – CA 15/3, CEA, CA 27-29
• Ductography
• Breast Ductal Endoscopy
• Thermography
• Newer Investigation Modalities :
o Stereotactic Core Biopsy using computer mammography
o Vacuum Assisted Biopsy
o Needle Localised Biopsy under mammographic guidence.
o I125
– Seed Localisation Biopsy

10. INVESTIGATIONS FOR
STAGING
MODALITIES
 For Tumor Size - MRI Scan
 For Nodal involvement – Lympho Scintigraphy
- CT Scan
 For Metastatic Involvement – Bone X-Ray
- Bone Scan (PET)
- Chest X-Ray
- USG/CT Abdomen
- X-Ray/CT Spine
- Biochemical Studies
:- ALP (Bone and Liver)
:- GGT (Liver)
:- Urinary Steroids
:- Urinary Hydroxy Proline

11. Bone Scan showing metastasis
due to advance Carcinoma
Breast.
Liver Scan showing
Metastatic mass.
CT Scan of Chest and Abdomen
showing mediastinal and
retroperitoneal lymphadenopathy

12. INVESTIGATIONS FOR
TREATMENT
MODALITIES
•Routine Blood Investigations – Complete Blood Haemogram
(TC, DC, Hb%, ESR)
• For Anaesthesia Fitness – Chest X-Ray
- ECG
•Sentinel Lymph Node Biopsy
• Lymphoscintigraphy
• Axillary Sampling

13. Sentinel Lymph Node Biopsy
 Sentinel Node indicates first node encountered by the tumor cells
and its histological status predicts the status of distant Lymph
Nodes.
Merits:
 It is not done in clinically palpable axillary node as there is already
distortion of lymphatic flow due to tumor.
If there is no involvement of sentinel node further axillary
dissection is not required.
Demerits:There is high chance of false negative results.
Contraindications – Allergy to vital blue dye or radio colloid,
pregnancy, inflammatory carcinoma of breast.
Complications – Blue Tattooing of skin, Bluish green urine and
stool, anaphylaxis, seroma-formation.

16. To conclude with…
Mammography is highly reliable for evaluation of breast
cancer as it has a sensitivity of over 90%.
Core needle biopsy has to be done wherever the FNAC
is inconclusive.
USG may not detect lesions less than 1cm size.
USG is the Investigation of choice in young women less
than 30 years of age.
ER and PR status are important for treatment by
hormonal therapy.
Senitnel Lymph node Biopsy has to be done all in cases
of node negative patients in clinical grounds.
Most of the deaths due to breast cancer is due to distant
metastasis,hence early diagnosis of metastasis has to be
done whenever suspected.