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Diagnosis has three parts: examination, imaging, and a needle sample where the first two leave a question. Together they are very accurate.
This page explains what each test does, what it cannot do, and how to read the report at the end. Written by Dr Swapnil Sharma, MBBS, MS, FMAS, DrNB (Surgical Oncology), Consultant Surgical Oncologist, at Apollo Hospital International Ltd, Bhat, Gandhinagar.
Once a diagnosis is made, the operations available are set out separately. The wider picture sits on the breast cancer surgery page.
Breast diagnosis worldwide follows the same three steps, done in one visit where possible: clinical examination, imaging, and pathology. No single one of the three is relied on alone. A benign scan does not overrule a lump that feels suspicious, and a worrying scan is not treated as cancer without tissue.
| Test | What it shows | Where it is used | Limits |
|---|---|---|---|
| Ultrasound | Solid lump against fluid-filled cyst, size, margins, armpit nodes | First test under forty; any age for a felt lump | Misses microcalcification; depends on the operator |
| Mammogram | Density, distortion and microcalcification across the whole breast | Screening, and diagnosis from about forty | Less useful in dense young breasts |
| Tomosynthesis | A mammogram in thin slices, less overlap of tissue | Dense breasts, unclear mammograms | Slightly higher dose; not everywhere |
| MRI | The fullest picture of extent and of hidden second tumours | Unclear extent, several tumours, inherited risk, response to chemotherapy | Finds things that turn out benign, which then need further tests |
BIRADS is the radiologist’s shorthand for what should happen next. It runs from 1, normal, to 5, highly suspicious. It is a plan, not a verdict.
BIRADS 1 is a normal study and BIRADS 2 a clearly benign finding such as a simple cyst. BIRADS 3 means very probably benign, and is usually handled with a repeat scan in six months rather than a needle. BIRADS 4 covers a range of suspicion and calls for a sample. BIRADS 5 is highly suspicious and also needs a sample. BIRADS 0 simply means the study was incomplete and another test is needed.
A BIRADS 4 result is not a diagnosis of cancer. Many BIRADS 4 lesions turn out benign on biopsy, which is exactly why the biopsy is done.
A core biopsy takes three or four thin cylinders of tissue under local anaesthetic. It takes about fifteen minutes.
A core needle biopsy is done in the clinic under local anaesthetic, usually guided by ultrasound so the needle is watched into the target. A tiny nick is made in the skin and three or four thin cylinders of tissue are taken. It takes about fifteen minutes. Most women drive home afterwards and have some bruising for a few days.
Where a finding is visible only as microcalcification on a mammogram, the biopsy is guided by the mammogram instead, and a small marker clip is left behind so the spot can be found again at surgery.
If cancer is found, the report carries more than the diagnosis, and every line of it changes the treatment plan.
The type is most often invasive ductal or invasive lobular. The grade runs from 1 to 3. It says how different the cells look from normal ones. The report also says whether the cancer is invasive or in situ.
Then come the receptor tests. ER and PR decide whether hormone tablets will work. HER2 decides whether targeted treatment is added. Ki-67 shows how fast the cells divide.
These results are the reason a biopsy is preferred to a cytology smear. They also decide whether chemotherapy is better given before surgery or after it.
Not everyone needs them. For a small tumour with a clear armpit, staging scans usually add nothing and are skipped. Where the tumour is larger, or the nodes are involved, a CT of the chest and abdomen and a bone scan, or a PET-CT, are used to confirm the disease has not travelled.
Bring the mammogram, ultrasound and any MRI on film or disc rather than as photographs of the report. Bring the biopsy report, and the slides and paraffin blocks if a biopsy has already been done elsewhere. Blocks matter, because receptor tests can be repeated from them without a second needle.
If you are travelling from outside Ahmedabad, send the reports ahead on WhatsApp. A short call often settles whether the trip is needed at all.
It depends mostly on age. Under about forty, ultrasound reads dense breast tissue better and is the first test. Over forty, a mammogram is added, because it shows microcalcification that ultrasound misses. They answer different questions and are often done together.
The breast is compressed for a few seconds and most women find it uncomfortable rather than painful. The radiation dose is very low, comparable to a few weeks of ordinary background exposure.
It is the radiologist’s summary of how likely a finding is to be benign. BIRADS 1 and 2 are normal or clearly benign. BIRADS 3 is very probably benign and usually followed up. BIRADS 4 and 5 mean a sample is needed. It is a plan for the next step, not a diagnosis.
FNAC draws out cells with a fine needle. A core biopsy takes a small cylinder of tissue with a slightly thicker needle. The core biopsy is preferred, because it shows the tissue architecture and allows the receptor tests that decide treatment.
A core biopsy report usually takes three to five working days. The receptor and HER2 tests may add a few days. Claims of a result within twenty-four hours generally refer to a frozen section or a cytology smear, which answer a narrower question.
No. This is a common worry and it is not supported by the evidence. Needle tracks are planned so that they are removed with the specimen at surgery.
Only sometimes. It is used when the extent is unclear, when there are several tumours, in very dense breasts, in some inherited risk situations, and to judge response to chemotherapy given before surgery. It is not a routine test.
Send your scans and any biopsy report ahead, then call to fix a time.
Dr Swapnil Sharma — MBBS, MS, FMAS, DrNB (Surgical Oncology)
Consultant Surgical Oncologist
Consultations and surgery: Apollo Hospital International Ltd, Bhat, Gandhinagar
Appointments: +91 63555 64601 · WhatsApp
Last updated: 24 September 2026. Reviewed by Dr Swapnil Sharma, MBBS, MS, FMAS, DrNB (Surgical Oncology), Consultant Surgical Oncologist.
This page is for information. It is not a substitute for an examination and a personal opinion.
