DIAGNOSIS 

It is very important to diagnose the disease in its early stages in order to be successful in the treatment of the breast cancer. Thus, it is possible to treat 95% of the breast cancer diagnosed at an early stage. There are many different diagnostic methods in the breast cancer. Today, we call the triple diagnosis method for the diagnosis of the breast cancer; clinical examination, imaging methods and biopsy (tissue sampling) are performed. After the age of 20, women should perform the breast examinations on their own every month, a doctor’s examination should be performed once a year from the age of 35 and an age-appropriate imaging method should be applied to the breast structure. In women who are considered to be at high risk for the breast cancer, medical examination and annual follow-up should begin at an earlier age. 

• • Physical (Clinical) Examination
  • Imaging Methods
  • » Breast Ultrasonography,
  • » Mammography,
  • » Breast MR,
  • » PET
  • Biopsy
  • » Fine needle biopsy
  • » Thick needle biopsy (tru-cut)
  • » Surgical biopsy
  • Marking on the Breast

PHYSICAL (CLINICAL) EXAMINATION 

The examination performed by a specialist physician is called a physical examination. Learning the patient’s past history (anamnesis) about the disease, performing the examination, and performing some tests if necessary are called physical examination. In this way, the patient’s problem is diagnosed and treatment is given if necessary. A good and detailed physical examination is the first step for a correct diagnosis. A woman who has no complaints about her breast should be seen by a specialist physician once a year starting from the age of 40. The patients with any problems in their breasts detected can be followed at closer intervals. 

There are cases of the breast cancer diagnosed only by physical examination, although it cannot be demonstrated by any other diagnostic method (while no suspicious lesions are seen on mammography). 

In addition to mammography and breast ultrasound, the breast examination by a specialist physician is important for early diagnosis of the breast cancer. After the breast examination, the specialist physician decides on the imaging methods according to the patient’s age, breast structure, history (breast MRI can be requested in high-risk cases). In this respect, the first step should be a clinical examination by an expert hand. 

BREAST ULTRASONOGRAPHY (US) 

Ultrasound is an imaging method obtained by different reflection of the sound waves. Reflections of the sound waves are collected by a computer and an image (picture) is created on the screen. It is often used to look at a specific area found with a mammogram. In addition, it provides the opportunity to distinguish between liquid filled cysts and solid masses. It allows biopsy of masses detected in the breast ultrasound that are not palpable in the examination. The breast ultrasound can be used as the first examination method and generally in young women (under the age of 35), pregnant and breastfeeding, breast inflammation where mammography cannot be performed, women with dense breast structure, for marking before the breast surgery and in addition to mammography. 

MAMMOGRAPHY 

It is an x-ray film of the breast taken with x-ray. It is taken at intervals recommended by your doctor for screening purposes. It is a simple method. When it is done for scanning purposes, the ideal thing is to compare the first film with the films shot later to evaluate if there is any change or a new formation. It is done for diagnostic purposes when there is a complaint about the breast tissue. With the development of mammography technologies, there is less exposure to radiation in mammography and less pain and ache during shooting. Mammography gives detailed information about the shape, distribution of the masses in the breast and the calcifications we call microcalcification. Together with breast ultrasonography, it is a very important diagnostic tool. 

Galactography method is a film taken by applying a dye called contrast agent to the milk ducts in the breast head discharges. It is rarely done. It gives detailed information about the formation that causes discharge in milk channels. 

BIOPSY 

Biopsy is a process of taking cell and tissue samples from the suspicious formation and making a definitive diagnosis by microscopic examination of these samples by the pathologist. The breast biopsy gives the final and definitive diagnosis. At the same time, if the result is cancer, it gives detailed information about the characteristic features of cancer. 

The surgeon and radiology specialist should decide together about how the biopsy will be in suspicious formations that require biopsy after clinical examination and imaging methods, the process of taking samples. There are many different methods for breast biopsy: 

Fine Needle Aspiration Biopsy (FNAB): It is an easy and inexpensive method. Not the tissue itself, but the cells detached from the tissue are taken into the needle. It allows only the (cytological) examination of these cells and it can be said that the cells from which the sample is taken are benign or malignant. 

Thick-Cutting Needle (Core) Biopsy: It is done with the help of a larger diameter needle. This process is performed after local anesthesia is applied to the breast skin. 4-6 tissue samples are taken with a special gun. Since tissue sample can be taken, it gives more and precise information about the tumor. The process can take 10-20 minutes. The integrity of the skin and the integrity of the mass remain intact. After the biopsy process, cold compression with ice is applied to the biopsy. The patient can go home after resting. 

In cases where suspicious findings cannot be detected by hand examination, it is appropriate to perform needle biopsy under the guidance of imaging methods. 

The needle biopsies do not cause the tumor to spread and the disease to progress. 

Vacuum Biopsy: It is a biopsy method that is applied by removing the breast formations in the breast with the help of a special device. 

Stereotactic Biopsy: It is a biopsy process performed under the guidance of a special wire or needle with the help of mammography or breast ultrasound of some lesions (often microcalcifications) that are not palpable within the breast tissue but detected by imaging methods. 

Incisional Biopsy: It is an open surgical biopsy performed by removing a part of the suspicious mass in the breast tissue. It is made with a small incision over the mass. While it was common in the past, it is now rarely used today. 

Excisional Biopsy: It is an open surgical biopsy in which all the mass in the breast tissue is removed. Due to the development of needle biopsy techniques, it is not a preferred biopsy method today. 

MARKING IN THE BREAST  

It is the process of pre-operative marking of the tissue that is not palpable in the breast examination, but is found suspicious after imaging methods and decided to be removed. 

Marking is done with wire or with the help of radioactive material. After the marking is done under the guidance of mammography, ultrasound or MR, the breast surgeon sends the tissue to the film during the operation to remove the suspicious formation and make sure that the correct area is removed and a film of what we call specimen mammography is taken. In this film, it is examined whether the correct area has been removed and the surgeon is informed and the process is completed. 

Marking Techniques; 

Marking with wire 

This process is done on the same day as the surgery. After local anesthesia is applied, a marking needle with a thin wire is placed in the suspicious area under imaging guidance. The process is performed in the radiology department and the patient is taken to the operating room from there. Since the end of the wire is in the form of a hook, it is attached to the tissue. In the surgery, the breast surgeon first finds the wire and then removes the surrounding tissue and sends the specimen for mammography. 

ROLL (Radionuclide-Guided Occult Lesion Localization) 

With this method, after local anesthesia is made, radioactive material is injected into the suspicious area. In the surgery, the location of the radioactive substance is determined with the help of a radioactive substance detector device called gamma probe, which is moved over the breast and gives a warning when it detects the substance. Through the activity in the surgery, the suspicious area is removed with a minimum of normal breast tissue, thus preventing deformity and more aesthetic results are obtained in the breast. 

It is easier to detect the suspicious area in surgery for surgeons who are experienced in this field. The radioactive material used is at a very low dose and there is no significant radiation risk. 

It is recommended to start treatment with drug therapy first in large masses diagnosed with the breast cancer. In this case, since the size of the tumor will decrease after treatment, it is necessary to determine the location and borders of the tumor. At this stage, before starting the treatment together with the radiologists, a special millimeter-sized metallic hook is placed in the center of the tumor and the Tattooing (tattoo) and the location of the tumor is marked. This method is very important and should be applied if the patient is to undergo the breast-conserving surgery, in which only the mass will be removed and the breast will be preserved after the drug treatment.