Evaluation of Breast Lumps/Abnormal Mammograms

Finding a breast lump or learning you have an abnormal mammogram can be a frightening experience. The good news is that 80 percent of all breast abnormalities turn out not to be cancer. To be certain you don't have cancer and to help all of our patients maintain their breast health, Lahey Clinic's Breast Center relies on state-of-the-art technology to accurately diagnose lumps and/or other changes in the breast.

What can I expect?

Following a comprehensive clinical breast exam that includes questions about your personal and family medical history, you will most likely be sent to our Radiology/Breast Imaging Department for a mammogram. Lahey uses digital mammography with computer-aided detection (CAD) for increased accuracy. Should your mammogram show an abnormality, ultrasound, MRI and breast gamma imaging technologies are available in certain circumstances to further assist in the diagnosis of a suspicious mass that could represent a breast cancer. If the diagnosis of breast cancer is made, PET/CT imaging may also be useful in detection of distant metastatic disease, evaluating for suspected recurrence, or evaluating for response to therapy.

My mammogram shows calcifications. What does that mean?

Calcifications are tiny mineral deposits in the breast that can be seen on a mammogram. Causes vary and include calcium within the fluid of a noncancerous cyst, dilated milk ducts, previous injury to the breast, and calcifications of the arteries of the breast. Calcifications can be broken down into two types: macrocalcifications and microcalcifications.

Macrocalcifications are a common benign finding in women over the age of 50. They are larger and most likely due to aging arteries or previous injuries or inflammation.

Microcalcifications are smaller areas of calcium in the breast, and may appear alone or in clusters. The shape and distribution of microcalcifications help a radiologist determine whether there is cause for concern. While some more-suspicious microcalcifications require biopsies to determine whether cancer is present, others only require a follow-up mammogram in six to 12 months.

Calcium deposits are not related to the intake of dietary calcium or calcium supplements.

What Types of Biopsy Procedures Do You Offer?

Lahey Clinic patients have access to state-of-the art breast biopsy procedures. Each case is looked at individually. The type of biopsy used will depend on the characteristics of your presenting problem. These include, but are not limited to, your medical history and the size and location of your breast abnormality.

If you have a lump that can be felt, tissue samples can be taken by using a needle and a local anesthetic to numb the area, right in the physician's office:

Fine needle aspiration (FNAB) involves drawing out a few cells and/or fluid from the suspicious area through a thin needle. Often, this procedure is used to determine whether a troublesome lump is a cyst (liquid-filled sac) or a solid mass.

Core needle biopsy (CNB), also referred to as true-cut biopsy,is similar to FNAB but a larger needle is used to withdraw small cylinders (or cores) of tissue from the abnormal area of the breast. A local anesthetic is used to numb the area before the tissue samples are taken.

Some women, however, have abnormalities that cannot be felt but only seen on a mammogram. These patients are better served by an imaging-guided breast biopsy, including stereotactic core needle biopsy, ultrasound-guided biopsy or, occasionally, MRI-guided biopsy, performed by breast experts in our Radiology Department.

Surgical Breast Biopsy

Lastly, for some women, a surgical biopsy to remove a lump may be the most effective procedure. If an abnormality cannot be felt (for example, microcalcifications that are found on a mammogram), a needle-localized biopsy can be performed. This is a two-step process that begins prior to surgery, when a radiologist in Lahey's Breast Imaging Department uses X-ray images to guide a wire (via a needle) into the suspicious area of the breast. This wire provides the necessary guidance for the surgeon to remove the suspicious area in the operating room.

The Lahey Breast Center team is available to answer any further questions you may have about breast biopsies.

I've Been Told I have Breast Cancer. What Happens Now?

If a diagnosis of breast cancer is made, you can expect to meet one-on-one with a board-certified breast surgeon, nurse practitioner, social worker, radiation oncologist, medical oncologist, and plastic and reconstructive surgeon - all with specialized training in breast cancer care - in a single, comprehensive consultative appointment. Family members are welcome and are encouraged to attend any of your consultations. Our expert staff will help you weigh your options, consider the impact on your life, and understand what to expect every step of the way. Visit our Breast Cancer Treatment Center for more information.