Clinical Management

Abstract

A breast cancer diagnosis is established using the triple assessment approach (‘triple test’). This comprises the clinical, imaging and pathological assessment of a breast lesion. Not all components of the triple test are necessarily required to establish a benign diagnosis. Mammography and ultrasonography are the most frequently used methods of assessing palpable breast lesions, and mammography is widely used for breast cancer screening before a palpable mass develops. Significant findings that can be identified on imaging include a mass lesion (regular, irregular or spiculated), a non-specific or asymmetric density, an architectural disturbance and microcalcifications. The final component within the ‘triple assessment approach’ is cytopathological or histopathological correlation. The goal of biopsy is to obtain sufficient material using the least invasive approach to obtain a diagnosis. In all cases, correlation of the FNAB and/or CNB results with the clinical and imaging findings is essential for accurate diagnosis. With appropriate use of the triple test, it should be possible to obtain a definitive diagnosis in almost all cases. Optimal management of breast cancer patients requires a multidisciplinary approach.

The following chapter discusses the IAC Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy management protocols associated with the five categories and their risk of malignancy.