Biopsy – this is a test where a piece of tissue is drawn to be examined under the microscope to determine its validity. A biopsy can be conducted in a variety of ways:
Vacuum Biopsy – or
mammotomy – this is a biopsy done with a thick needle and using vacuum. The test is done under local anesthesia, mostly as a stereotactic biopsy (guided by a mammograph) but can also be guided by ultrasound.
Fine Needle Biopsy (FNA) – a biopsy done using a fine needle, like a blood test, that takes a few cells that are sent to be examined under a microscope. Can also be guided by ultrasound.
Thick Needle Biopsy – also called core biopsy or trucut biopsy, done under local anesthesia and a piece of tissue sample from the finding is removed to be microscopically examined. Can also be done guided by ultrasound.
Stereotactic Biopsy – this is a vacuum biopsy guided by a mammograph. The test is done lying on your abdomen, when the breast is “hanging” through a hole in the bed, and pressed between two plates like a mammography. This is the biopsy conducted when discussing a finding that is only observed in a mammography, mostly calcifications.
Breast MRI – A magnetic resonance test of the breasts, that does not involve radiation at all. For the test, we inject the vein with gadolinium. The test lasts for 30-40 minutes and is conducted lying on your abdomen. An MRI test is rather sensitive to diagnose breast findings, but its over-sensitivity is the test’s major disadvantage: the breast MRI also discovers non-malignant findings, but once such a finding was identified, there is no escape from performing a biopsy to make sure this is not a cancerous tumor. In order to decrease the rate of “false positive” findings and improve the test quality it is recommended to perform it on the 7-14 day of your menstrual cycle. Post menopause, the timing of the test is insignificant.
Breast Ultrasound – an ultrasonic exam of the breast tissue, which can identify and characterize lumps in your breasts and armpits. Ultrasound has no radiation at all, and it is a great test for women with thick breasts – a situation that a mammography can miss small findings. However, the ultrasound does not replace the mammography, but is a complimentary exam only, since there are findings such as calcifications that are invisible for ultrasound, but can be viewed excellently in the mammography, even with thick breasts.
Cancer – cancer is a malignant tumor, which is a tumor that has the potential to spread and send metastases to distant organs.
Carcinoma – This means cancer.
Clip, or Clips – Small marking pins that are made of titanium, and inserted into the breast tissue after performing a thick needle biopsy (through the same needle used for the biopsy) in order to mark the place the biopsy was taken from. The clip can remain in the breast and if there is a need to dissect the finding, there is no need to extract the clip. It does not interrupt the breast MRI, does not buzz on magnetic gates, and does not disrupt in any way. Another type of clips are surgically inserted to mark the area for the complimentary radiation therapy. When the intra surgical radiation is performed, there is no need for clips. The clips, also called “pins” can stay forever, they do not disrupt the breast MRI, don’t buzz on magnetic gates and don’t disrupt in any way.
Complimentary Radiation Therapy (Radiations) – Radiation therapy is an external therapy provided to the sick breast. After a partial mastectomy, there is almost always need for complimentary radiation therapy. Sometimes it is also needed after a complete mastectomy. The therapy is given in dosages (fractions), every day, for 5 days a week, along 3 to 7 weeks. Every session lasts only a few minutes. Radiations does not induce hair loss, nausea or vomiting, at the most, local redness is developed with time around the radiation area, and it passes in a few weeks.
Fibroadenoma – This is a benign breast tumor, especially common amongst young women, although it can appear at any age. Fibroadenoma is usually discovered as a lump in the breast, but it can be found also in an ultrasound or mammography. Most lumps in young women’s breasts are fibroadenomas. The size of the fibroadenoma ranges from a few millimeters to a few centimeters. A large part of the fibroadenomas decrease on their own or remain unchanged, and only a few of them grow. The dissection of a fibroadenoma is recommended only when it is large and bothering, otherwise, there is no need for surgery. Fibroadenomas have distinct characteristics in ultrasound tests, and therefore, when the lump is small you can avoid a biopsy and suffice with a short term follow up (usually for 6 months). When there is need for dissecting a fibroadenoma, because it has grown or it is bothering, this is a simple procedure that lasts about 20 minutes and can sometimes be done under local anesthesia.
Genetic Tests – there are certain cases in which the breast cancer evolves based on genetic tendencies. These cases are usually characterized with women with a family history of breast and/or ovarian cancer (on the maternal or paternal side), and tumors that appear in a relatively young age. A genetic test is a blood test conducted after a genetic consult by a genetic doctor or consultant that determine if there is a need to perform a genetic test and which test to perform.
Lymph nodes – Mistakenly called lymph “glands”. These are nodes that are a part of the immune system, and the lymphatic fluid from the various organs drains to them. In the case of the breast, these are nodes that are mostly in the armpit (but can also be in the thoracic cavity). The standard lymph nodes can be increased for many reasons, including some kind of infection, or as a result of a tumor. An ultrasound test can identify increased lymph nodes, and also show, according to various characteristics, if there is any suspicion for a tumor or if this is an increased lymph node due to benign reasons.
Mammorgraphy – this is an x-ray conducted to diagnose tumors in your breasts. A routine exam conducts two shots of each breast, in two different postures, and 4 shots in total. The radiation amount in a mammography is miniscule. A mammography can identify small lumps and characterize findings, and it is the best test to identify calcifications, that can be an expression of DCIS (and sometimes of a cancerous tumor).
PET CT – an integrated test of CT and nuclear medicine, which is highly efficient in identifying tumors and metastases. This is a full body examination, conducted by injecting a small dosage of radioactive substance and collecting images from a CT scanner.
Receptors – are expressed on the surface of breast cancer cells. The important receptors screened are for estrogen and progesterone (hormones), and for the protein called Her2, whose over-expression testifies for sensitivity to a biological treatment with a drug called Herceptin. It is common to test the cells for Ki67, that testifies for the division rate of the cells. As the division edge is higher, the tumor is considered more violent.
Tumor – a generic name for a process in which there is a proliferation of tissue that normally forms a lump. A tumor can be either benign or malignant.
Ductal Carcinoma in situ (DCIS) – this is a tumor composed of cancerous cells that are limited to the milk ducts and still did not penetrate the tissues around, so there is no potential for the development of metastases, and no need for chemotherapy. The treatment of the DCIS includes the extraction of the finding with clean margins. When conducting a partial mastectomy, we usually recommend complimentary radiation treatments.
Malignant Tumor – This is a cancerous tumor, which are cells that have the potential to spread to distant locations.
Benign Tumor – This is a growth of regular cells, not malignant and not dangerous. From its definition as benign, there is no risk that it will turn malignant.
Papilloma – this is an intra-ductile tumor of the cells that coat the milk ducts. Mostly, this is a benign tumor, but to verify this, sometimes there is a need to dissect the entire finding. A papilloma can be expressed as a secretion from the nipple or as a lump in a breast or imaging test. Determining this is a papilloma requires a biopsy.