Investigations
Triple assessment
– Clinical examination.
– Mammography +/- Ultrasound, for over 35 years old.
– Ultrasound for the under 35 years old.
– Histology, If there is a palpable or radiological abnormality, a CORE needle biopsy is a must to make and confirm a diagnosis.
– Histology – Estrogen and Progesteron and Her2 receptors. (Er,Pr,Her2)
– Fine needle sample carries a high false negative rate and cannot
differentiate between various types of tumors.
– If a malignant tumor is confirmed:
o Chest x-ray is basic.
o Complete blood picture.
o Kidney function tests.
o Liver function tests.
o CT Scan, only if Inflammatory cancer or tumor larger than
5 centimeter or locally advanced cancer or abnormal Liver
function test or heavy Lymph nodes involvement.
o Bone Scan, is ONLY needed if CT scan shows bone lesions
or there is localized bone pain.
o Tumor markers: like ca15.3 is UNNECESSARY.
o MRI, is indicated if:
– Discrepancy between clinical and radiological
findings.
– Invasive Lobular Cancer and the patient is keen
on preserving the Breast.
– To screen the very young patient.
– Paget`s disease 9if the patient is keen on breast
preservation.
– The very dense breast.
– Suspected implant leak
