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Diagnosing Breast Cancer

Our experts use a variety of imaging and diagnostic procedures to diagnose breast cancer. 
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Screening Technology

Mammography: Mammogram screening is the best tool to detect early breast cancers or other breast abnormalities. We offer digital mammography for the clearest, most accurate images, to help with correct diagnosis. Our radiologists will review the images and discuss the results with you immediately. If the physician feels you need any additional assessment, treatment, or biopsy, you may be able to get it the same day or within a week. Ultrasound and MRI equipment also is available for the assessment of suspicious masses.

Labratory Research

There are two kinds of mammograms. Screening mammograms are done when there are no signs or symptoms of a problem. However, they help provide a picture for health care providers of what the patient's healthy breast tissue looks like, so that changes in breast tissue can be easily identified. Diagnostic mammograms are used for patients with a breast lump, thickening or nipple discharge and for patients who have had previous lumps or cancer. In addition to standard film mammography, the Johns Hopkins Breast Center offers digital mammography. Unlike film-based mammography, digital mammography uses computer-based electronic conductors to convert X-rays to light and light to digital data, ultimately displayed on computer monitors as picture of the interior of the breast.


Ultrasound: Abnormalities identified through mammography or physical exam by the patient or physician can be imaged through ultrasound. This diagnostic technique can help determine if a lump is fluid-filled, like a cyst, or solid, like a benign or cancerous tumor. It also can help determine if an area of thickening is breast tissue or a tumor.

Galactography: This technique is used during mammography to evaluate the cause of nipple discharge. By injecting a dye in the duct giving rise to the discharge, the radiologist can determine if the nipple discharge is caused by a growth in the milk duct and its precise location.

Scintimammography: The newly-developed technology uses a radiotracer injected into the arm of the patient that travels to the breast tissue to pinpoint breast abnormalities. It is most commonly used in women with dense breast tissue that is more difficult to examine through other techniques, women with increased risk for breast cancer, and women with abnormal mammograms.

Fine Needle Biopsy: A small needle is inserted into the breast lump to extract a small number of cells. The cells are examined under a microscope for cancer.

Ultrasound-Guided Core Needle Biopsy: In a core need biopsy, the physician uses a special needle to remove a small sample of tissue from the lump. The tissue is examined under a microscope for cancer cells. The procedure is very accurate, usually painless, and does not cause scarring.

Magnetic Resonance Imaging (MRI): This technique uses a magnetic field to image the body. An intravenous injection of a dye is given to the patient. The dye is absorbed better by cancers but not by benign lesions, helping physicians determine if a suspicious mass is a cancer.


Stereotactic-Guided Core Biopsy: Also known as minimally invasive breast biopsy, this techniques is used to retrieve multiple samples of breast tissue from abnormalities such as microcalcifications that cannot be seen with ultrasound. Computer and mammography technology are used to accurately pinpoint the abnormality. Then, a needle is inserted into the breast through a tiny incision to retrieve the tissue samples. The incision is so small that no stitches are required.

Surgical Biopsy: Johns Hopkins clinician-scientists are pioneering efforts to phase out surgical biopsies. However, surgical biopsies continued to be used in selected patients. They may be used to evaluate an abnormality that can be felt but did not show up in a mammogram or ultrasound or to remove a mass that is not accessible by needle biopsy. Usually surgical biopsy requires only local anesthesia. A radiologist injects a blue die into the mass as visual cue for the surgeon. The surgeon removes the suspicious tissue to be evaluated by a pathologist. Surgeons often can often provide a tentative diagnosis the same day through visual examination of the tumor. However, a definitive diagnosis can not be given until the pathologist examines the tissue under the microscope of the presence of cancer cells.

Dr. Wolff Directs New National Screening Guidelines

Dr. Wolff served as co-chair of a national panel of oncologists and pathologists that released new practice guidelines in 2010 recommending that all patients with invasive breast cancers and breast cancer recurrences be tested for estrogen receptor and progesterone receptor status, and that those tests be considered positive if as little as 1 percent of the tumor cells test positive.

Overall, about 65 percent of breast cancers are ER-positive, 15 percent to 20 percent are positive for human epidermal growth factor 2 (HER2), and 15 percent are “triple negative,” meaning they lack receptors for estrogen, progesterone and HER2. The guideline, released through the American Society of Clinical Oncology and the College of American Pathologists, aims to improve the accuracy of test results and ensure all patients receive appropriate care for their specific breast cancer subtype. Endocrine treatments can substantially improve survival in patients with hormone receptor-positive invasive breast cancer.

“Our main goal was to improve the accuracy of predictive biomarker testing in everyday practice and ensure that patients receive the right treatment for their specific breast cancer subtypes to maximize their chances of surviving breast cancer,” Dr. Wolff says. “Widespread access to high-quality routine pathology assessment and accurate testing for ER, PR and HER2 is a critical issue worldwide.”

Read an interview with Dr. Wolff.


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