Breast Cancer: Advanced Diagnosis

In order to be able to determine whether a suspicious change in the tissue is benign or malignant, tissue samples from the breast are necessary. The tissue is removed using a biopsy. The samples taken are histologically examined for cancer cells. If the histological finding is benign, the doctor usually suggests an early check-up. In the event of a malignant finding, therapy is planned with the patient. The exact type of cancer is also determined in the histological findings.

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Biopsy procedure
Who Performs Biopsies?
Assessment and diagnosis
Classification of a malignant tumor

Biopsy procedure

To confirm the diagnosis, tissue samples are taken using biopsies. Closed (minimally invasive) biopsies that do not require surgery are preferred. Open (invasive) biopsies allow a larger amount of tissue to be removed.

In closed biopsy techniques, tissue is removed from the suspicious tissue area or lump using a thin needle. These include high-speed punch biopsy and vacuum biopsy. In order to be able to carry out the tissue removal as precisely as possible from the suspicious lesion, the tissue removal is controlled by an ultrasound image in "real time", provided that the suspect area can be recognized in the ultrasound. The vacuum biopsy is also performed using special mammography equipment. A punch or vacuum biopsy takes around 30 minutes. The patients are discharged home shortly after the procedure.

In contrast to the minimally invasive biopsy, the open biopsy is a surgical procedure. It is carried out when no clear result can be obtained with other diagnostic methods. The open biopsy is performed under general anesthesia. A hospital stay is necessary for open biopsies. Since non-palpable changes are increasingly being discovered in early detection, the number of histological investigations of the tumor using biopsies is increasing.

Who Performs Biopsies?

Closed biopsies are performed from:

Specialist in gynecology
Specialist in radiology
Hospital outpatient department for gynecology and obstetrics
Breast center or certified breast center

Note Patients need a referral from the treating specialist. It is important to take existing findings, doctor's letters or x-rays with you.

Assessment and diagnosis

The tissue samples are examined under a microscope by a pathologist. If cancer cells are found, the diagnosis of breast cancer is considered confirmed. The type of tumor is determined in further studies. Using special molecular biological processes, the condition of cell receptors that influence cell growth is checked. These include hormone receptors and HER2 receptors. Receptors are attachment points of cells through which signals are transmitted. So-called hormone-dependent tumor types with a strong expression of hormone receptors in the tumor tissue can be treated with medication with "anti-hormone therapy".

Other tumor types increasingly have a special receptor molecule, the HER2 molecule, which is responsible for faster growth. Special antibody drugs are used for this type of cancer.

Classification of a malignant tumor

In order to decide which therapy should be used, it is common in medical practice to classify the malignant tumor according to certain criteria after the biopsy. A common classification in diagnosis is the so-called TNM system of the UICC (Union for International Cancer Control). The tumor is classified according to its size (T), the involvement of lymph nodes (N) and the presence of distant metastases (M).

The so-called tumor grading also evaluates the degree of malignancy, usually in three stages (grade 1 to 3). This is done using a microscopic examination. Lung x-rays, an ultrasound examination of the liver or tomograms of certain parts of the body using computer or magnetic resonance imaging (CT or MRT) are used to estimate the spread of a tumor and possibly existing metastases. Further information on the most common diagnostic methods (e.g. mammography, biopsy, preoperative tumor marking) can be found on the homepage of the Austrian Radiological Society.

At the end of the examinations, the doctor discusses the findings with the patient. With a benign tumor (negative result), no further treatment or surgery is usually necessary. However, more frequent check-ups may be suggested for certain benign tumors. A malignant tumor (positive result) requires individual therapy. For a reliable diagnosis of a lesion (tissue change), examinations may be necessary that require interdisciplinary cooperation between specialists in gynecology, radiology, surgery and pathology.