Invasive Ductal Cancer (IDC)

Invasive Ductal Cancer

Diagnosis

Invasive ductal Cancer is diagnosed by the 'Triple Test Score'. This includes :

(b) Imaging of the breast through mammography or ultrasound and/or MRI

The triple test is considered positive if any one of the three component is indeterminate, suspicious or malignant. This will then merit further investigations.

For IDC to be ruled out, all three parts of the triple test must be definitely benign.

Diagnosis of Invasive Ductal Cancer

Medical History: A thorough medical history to assess the risks of breast cancer should be taken. Risk factors, particularly strong family history of breast /ovarian cancer should be noted down.

The Breast Cancer Risk Assessment Tool (BCRAT) can be used by health personnel to assess a women's risk of getting invasive breast cancer over a 5-year period of time and up to age 90 (lifetime risk).

A detailed history of the lump - how long it has been present, whether painful, any changes since first noted, relation to the menstrual cycle, presence of lumps elsewhere specially in the armpit or neck - should be noted down.

Breast Examination: A thorough breast examination will help identify breast lumps or enlargement of the lymph nodes in the axilla. Any nipple discharge or itchy or patchy area should also be identified.

The breasts should be first examined while the woman is seated to see whether any changes are visible. Then the breasts are again examined while she is lying down. Both the armpits (axilla) should also be examined.

Screening Mammography: Mammography is usually the first test which identifies IDC. Invasive ductal carcinoma shows up as a dark mass with spiculated edges. Spiculated means irregular finger-like projections indicating the spread of the cells to the surrounding tissue. Deposits of calcium, called microcalcifications, can also be seen.

Diagnostic Mammography: If microcalcifications are seen on the screening mammogram, a more detailed study of the breast called diagnostic mammogram, which takes views at higher magnification and from more angles, may be needed.

Mammography and ultrasound are often used in a complementary capacity to give more detailed information in the evaluation of breast abnormalities.

Ultrasound of the Breast: Ultrasound imaging, also known as ultrasonography or sonogram, produces a picture of the internal structures of the breast and can help identify a breast mass and its characteristics. A special type of ultrasound, known as Doppler ultrasound can evaluate blood flow or lack of flow in any breast mass. A malignant mass will have more blood flow than normal tissue. Ultrasounds can help determine whether a new breast lump is a solid mass or a fluid-filled cyst. A solid mass is more likely to be cancerous.

MRI of the Breast: Magnetic resonance imaging (MRI) of the breast is primarily used as a supplemental tool to breast screening with mammography or ultrasound.

A breast MRI is mainly used in women who have been diagnosed with breast cancer, to help measure the size of the cancer, look for other tumors in the breast and to check for tumors in the opposite breast.

For certain women at high risk for breast cancer, a screening MRI is recommended along with a yearly mammogram.

MRI is not recommended as a screening test for women at average risk of breast cancer since it is known to give some false positive results.

Breast Biopsy: If the areas identified by mammography and ultrasound need more evaluation, the next step is a breast biopsy. A biopsy is the only definitive way to diagnose breast cancer.

The tissue sample taken during a biopsy is also analyzed to determine the type of cells and the type of breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors that may respond to hormone therapy or influence the treatment options.

There are different types of breast biopsies.

Fine Needle Aspiration Biopsy/Cytology (FNAC): This procedure uses a very thin needle and syringe to remove either fluid from a cyst, or clusters of cells from a solid mass. Removal of tissue from a small mass with a fine needle requires a great deal of expertise and is done under ultrasound guidance.
Core Needle Biopsy: This procedure uses a somewhat larger needle with a sharp cutting edge. A core of tissue is cut out from inside the mass. If the breast mass is quite large, as many as 15 samples, each about the size of a grain of rice, may be taken and sent to a lab for microscopic analysis. A small metal marker may be left at the site within the breast so that the area can be easily identified in future imaging tests.
Stereotactic Biopsy: This is a procedure in which tissue is removed from lumps which can be seen on a mammogram but cannot be felt on physical examination. It is done under the guidance of a mammogram or ultrasound. It helps in accurate localizing of the suspicious area.
Surgical Biopsy: In surgical biopsies, the suspicious area is first identified by mammogram. A needle is then inserted and fixed in the mass. Using this needle as a guide, the lump can be more accurately identified on the operating table and biopsied. If the lump is small enough, it may be completely removed - it is then called an excision biopsy.

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