Health Concerns

Fibrocystic Breast Disease

Diagnosing Fibrocystic Breast Disease

A healthcare provider experienced in diagnosing breast conditions should examine any new breast mass or lump. Additionally, if there is any skin irritation, dimpling, nipple pain or retraction, redness or scaling of the nipple or breast skin, or nipple discharge other than breast milk in lactating women, see a physician for an evaluation. Breast conditions usually can be diagnosed by an examination by a physician. It is not unusual for a physician to recommend a mammogram, ultrasound, or biopsy procedure to assist or confirm the diagnosis (National Cancer Institute 2001b).

A mammogram, the most frequently used diagnostic tool for breast lumps, is a type of x-ray examination. If the mammogram suggests that abnormal tissue is benign, follow the physician's recommendations and recheck the lump (in perhaps 4 to 6 months) (National Cancer Institute 2001b). If the mammogram is inconclusive or indicates the need for further examination, your physician may recommend a computer-aided diagnostic procedure using ultrasound. This additional diagnostic procedure is designed to improve identification of a potentially malignant lesion.

Ultrasound uses high-frequency waves to outline a part of the body and is useful to further evaluate possible abnormalities found during mammograms or physical examinations. Besides aspiration, ultrasound is the only way to determine if the lump is a fluid-filled cyst. Fluid-filled cysts have a distinctive appearance on an ultrasound screen.

Fine-needle aspiration biopsy (FNAB) is used if the physician is almost certain that the lump is a cyst. Aspiration is also used to extract material from a lump for further analysis (National Cancer Institute 2001b). A very thin needle is inserted into the breast tissue as the doctor palpates the lump. The procedure is essentially painless because nerves are located primarily in the skin, not in the breast tissue itself. Ultrasound is used to guide the needle when a lump is either difficult to palpate or very small. FNAB has decreased the need for surgical biopsy.

Core-needle biopsy uses a needle larger than the type employed with FNAB. The procedure is performed in a physician's office with local anesthesia of the breast area to be biopsied. Core-needle biopsy removes a small cylinder of tissue for examination.

Stereotactic biopsy is a newer approach that relies on a three-dimensional x-ray to guide the needle biopsy of non-palpable mass (National Cancer Institute 2001b). The breast is x-rayed from two different angles and a computer plots the position of the suspicious area. Once the area is precisely identified, the radiologist uses a needle to biopsy the lesion.

Surgical biopsy may also be necessary to remove all or part of a lump for examination (National Cancer Institute 2001b). This procedure is done either in a physician's office or an outpatient hospital facility under intravenous sedation or local anesthesia.

There are newer methods, such as vacuum-assisted biopsy, which remove even more tissue, but so far there is no universal agreement about when these procedures should be used, even though current studies show consistent reliable results (Fine 2001; Maganini 2001; Ohsumi 2001; Jackman 2002; Perlet 2002).