Breast cancer diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

Biopsy is the gold standard test for the diagnosis of breast cancer. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. Magnetic resonance imaging (MRI) is also recommended in selected patients. Compared to the Mammography, MRIhas higher sensitivity and lower specificity.

Diagnostic Study of Choice

Study of choice

Biopsy is the gold standard test for the diagnosis of breast cancer. Either fine needle aspiration (FNA), core needle aspiration, or surgical biopsy (excisional biopsy) might be the first step or confirmatory test in selected patients. Meanwhile, the diagnostic study of choice for breast cancer screening is mammography. Magnetic resonance imaging (MRI) is also recommended in selected patients. Compared to the Mammography, MRI has higher sensitivity and lower specificity. For more information please refer to breast cancer screening. For more information about breast biopsy please click here.

Investigations:

Among the patients who present with clinical signs of breast cancer, the Mammography is the most specific test for the diagnosis.
Estimates of mammography sensitivity range between 75% and 90% with specificity between 90% and 95%. The PPV ranges from 20% in women under age 50 to 60% to 80% in women age 50-69. Although there are reports of the sensitivity (67.8%) and specificity (75%), particularly in older studies.^[1]
Among the patients who present with clinical signs of breast cancer, the MRI is the most sensitive test for diagnosis.^[2]^[3]

The comparison of various diagnostic studies for breast cancer

Test	Sensitivity	Specificity
Mammography	75-90%	90-95%
Breast MRI	37-97%	99%

Mammography is the preferred investigation based on the sensitivity and specificity and cost effectiveness. In selected cases MRI is recommended.

Diagnostic results

The following finding(s) on performing biopsy are confirmatory for breast cancer:

Increased mitosis
Pleomorphism
Calcification
Necrosis
Invasion
For more detailed information please refer to breast cancer pathophysiology.

Sequence of Diagnostic Studies

The biopsy must be performed when:

The patient presented with lamps and bumps in breast, or axillary lymphadenopathy without sign and symptoms of infectious disease.
A positive/doubtful mammography or MRI suggesting malignancy, to confirm the diagnosis.

Name of Diagnostic Criteria

There are no established criteria for the diagnosis of breast cancer.

References

↑ Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK; et al. (2007). “Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians”. Ann Intern Med. 146 (7): 511–5. doi:10.7326/0003-4819-146-7-200704030-00007. PMID 17404353.
↑ Orel SG (1999). “Differentiating benign from malignant enhancing lesions identified at MR imaging of the breast: are time-signal intensity curves an accurate predictor?”. Radiology. 211 (1): 5–7. doi:10.1148/radiology.211.1.r99ap395. PMID 10189447.
↑ Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J; et al. (1999). “Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?”. Radiology. 211 (1): 101–10. doi:10.1148/radiology.211.1.r99ap38101. PMID 10189459.

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[pmid17404353-1] Qaseem A, Snow V, Sherif K, Aronson M, Weiss KB, Owens DK; et al. (2007). “Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians”. Ann Intern Med. 146 (7): 511–5. doi:10.7326/0003-4819-146-7-200704030-00007. PMID 17404353.

[pmid10189447-2] Orel SG (1999). “Differentiating benign from malignant enhancing lesions identified at MR imaging of the breast: are time-signal intensity curves an accurate predictor?”. Radiology. 211 (1): 5–7. doi:10.1148/radiology.211.1.r99ap395. PMID 10189447.

[pmid10189459-3] Kuhl CK, Mielcareck P, Klaschik S, Leutner C, Wardelmann E, Gieseke J; et al. (1999). “Dynamic breast MR imaging: are signal intensity time course data useful for differential diagnosis of enhancing lesions?”. Radiology. 211 (1): 101–10. doi:10.1148/radiology.211.1.r99ap38101. PMID 10189459.

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