Triple breast assessment

About breast lump investigation

A process called triple assessment is used to diagnose breast lumps. There are three stages in triple assessment.

  • Examination. A doctor or nurse asks about your medical history and examines your breast.
  • Imaging. Pictures of the inside of your breast are made using ultrasound, X-rays or a combination of both.
  • Needle biopsy. A sample of your breast tissue is removed and sent to a laboratory for testing to find out whether the lump is cancerous (malignant) or non-cancerous (benign).

The results of the triple assessment can help your doctor decide if you need any more investigations before treatment.

The tests described here are usually done in an outpatient breast clinic at a hospital and can sometimes all be done during a single visit.

Preparing for triple assessment

Your doctor will discuss with you what will happen before, during and after your triple assessment, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedures. This will help you to be informed, so you can give your consent for the procedures to go ahead, which you may be asked to do by signing a consent form.

What happens during triple assessment

Breast examination

You will need to remove your clothes above your waist. Your doctor will examine your breasts and armpits and press gently on your skin to feel for any changes in texture.

Breast imaging

Your doctor will take pictures of the inside of your breast. This is called imaging.

Imaging is usually done in the X-ray department by a radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) or a radiographer (a health professional trained to perform imaging procedures).

The most common types of breast imaging are mammography and ultrasound.

A mammogram uses X-rays to create a picture of your breasts. Mammography is usually done while you're standing up. Your breast will be pressed between two plastic plates to keep it still. Some women find the pressure of these plates uncomfortable.

                                                                 Mammogram

An ultrasound uses sound waves to produce an image of the inside of your breast. Your radiologist or radiographer will put gel on your breast and then move a sensor over your skin. You will probably be asked to sit or lie on an examination couch for the scan.

                                                                Breast ultrasound

Breast biopsy

A breast biopsy is a small needle sample of tissue taken from your breast. Several samples may be taken and sent to a laboratory for testing to find out if the lump is cancerous or not.

A breast biopsy may be done under local anaesthesia injected into your breast. This completely blocks pain from your breast and you will stay awake during the procedure.

There are several different biopsy procedures including fine needle aspiration, core biopsy, vacuum assisted core biopsy (VACB) and open biopsy. Your doctor will explain which procedure is most suitable for you.

Fine needle aspiration

Your doctor will collect cell samples from your breast using a fine needle. He or she will pass the needle through the skin of your breast, into the lump or breast tissue being examined and draw cells out into a syringe. Sometimes ultrasound or X-rays are used to help guide your doctor to the area that needs to be checked.

How a fine needle aspiration breast biopsy is taken

Core biopsy

Your doctor will collect breast tissue samples using a hollow needle slightly wider than the one used for fine needle aspiration. Your doctor will pass the needle through your breast to the area to be checked. Sometimes ultrasound or X-rays are used to help your doctor guide the needle. He or she will then release a spring in the needle and breast tissue will be collected inside a hollow cylinder. Your doctor may need to insert the needle several times to get more than one sample of breast tissue. The spring action is quite sudden and can surprise you.

How a core breast biopsy is taken 

Vacuum assisted core biopsy (VACB)

Your doctor will collect breast tissue samples using a special, hollow probe attached to a gentle vacuum pump. Your doctor will make a small cut in your breast over the area being examined and insert the probe. The probe will suck some of your breast tissue into a cylinder. More than one sample can be taken without your doctor removing the probe.

VACB is useful for removing larger samples of breast tissue and sometimes a whole lump can be removed in this way. Ultrasound may be used to make sure the correct breast tissue is removed.

How a vacuum-assisted core breast biopsy is taken

Open biopsy

Occasionally, a minor operation may be needed to remove the whole lump to find out if it is cancerous or not. This is done under general anaesthesia. This means you will be asleep during the procedure. Most hospitals will do the biopsy as a day case but you may need to stay a night in hospital. An open biopsy is sometimes called an excision biopsy.

What to expect afterwards

You will be able to go home when you feel ready. Your nurse will give you advice about caring for your breasts before you go home.

If you have any pain, take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist.

It may be possible for your doctor to diagnose your breast lump in one visit. However, some tests can take a few days to carry out. Your clinic will get your results to you as soon as possible – ask your doctor or breast care nurse when to expect your results. Often, you will be invited to a follow-up appointment with your doctor and breast care nurse to discuss your biopsy results.

Recovering from triple assessment

After a triple assessment you should be able to return to your usual activities straight away, however, always follow your doctor’s or breast care nurse’s advice.

If you have any pain that can't be controlled with over-the-counter painkillers, a high temperature or your breast feels unusually hot to touch, contact the hospital as you may have developed an infection.

What are the risks?

As with every procedure, there are some risks associated with triple assessment. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having a procedure.

Your breast may feel sore and bruised for a few days, depending on the type of biopsy you have. It's unusual to have any noticeable scars after a breast biopsy, but on rare occasions you may develop a small scar. This depends on the size and type of biopsy you have.

Complications

Complications are when problems occur during or after the procedures.

Your doctor will be experienced at taking breast biopsies but, even so, the biopsy may not be successful. If this happens you may need to have another biopsy or an operation to remove the abnormal breast tissue or lump.

Does a breast lump mean I have breast cancer?

Answer

Finding a lump in your breast doesn't usually mean you have cancer. Most breast lumps aren't cancerous and may instead be a cyst or fibroadenoma.

Explanation

Breast cysts are sacs of fluid in your breast. Fluid can build up in your breast tissue as a result of hormonal changes. For example, it's normal to have lumpy, tender breasts just before your period, especially near your armpits. Cysts are most common in women over 35, before they go through the menopause. Breast cysts can be painful and usually move easily under your skin. If a cyst is causing pain or discomfort, the fluid can be drained using a needle.

Fibroadenomas are harmless overgrowths of your breast tissue. They are usually diagnosed after a needle biopsy. Fibroadenomas are most common in women under 30 but can occur at any age. They are often painless and move easily under your skin. Most fibroadenomas will slowly shrink in size and don't need treatment, but if the lump is getting bigger, you can have it removed.

It's important for both men and women to check their breasts regularly. If you see any change or feel a lump, it's best to have it checked by your GP.

What causes nipple discharge?

Answer

Nipple discharge is usually caused by swelling of the ducts underneath your nipple.

Explanation

Nipple discharge is fluid that comes from your nipples. All women have fluid in their breasts and it's possible that some of this may come out if you squeeze your nipples. Most often the discharge comes from the milk ducts in your breast and is milky in appearance.

You can get a blood-stained discharge if you have a duct infection or if you develop a wart in the ducts, called papilloma.

As you grow older, the ducts widen and sometimes get blocked, causing nipple discharge. This may be thick or watery, vary in colour or be blood-stained, and can come from one or both of your nipples. This is more common in women reaching the menopause. A skin infection on the surface of your nipple can also cause your nipple to leak fluid.

If you notice any blood-stained or unusual discharge coming from your nipple, it's best to have it checked by your GP.

Will the breast biopsy hurt?

Answer

How much discomfort you feel during a biopsy depends on the type of breast biopsy you’re having and whether your doctor gives you local anaesthesia before the procedure.

Explanation

A fine needle biopsy involves only a small sample of tissue being taken from your breast. You may be given an injection of local anaesthetic before the procedure to block pain from the area. Ask your doctor whether or not you will be given an anaesthetic. A fine needle is passed through the skin into the breast area being examined (usually just once) and cells are drawn out into a syringe attached to the needle. If you haven't had a local anaesthetic, you may feel a slight sting similar to having an injection.

A core biopsy involves removing a larger sample of your breast tissue and it can be painful. Your doctor will usually give you an injection of local anaesthetic before the biopsy to help minimise any discomfort. The anaesthetic is injected into your breast and this may sting briefly. The anaesthetic completely blocks pain from your breast and you will stay awake during the procedure. You may need pain relief after the effects of the local anaesthetic wear off.