Understanding your diagnosis
A treatment plan is only as reliable as the diagnosis behind it.
A breast cancer diagnosis usually involves several types of information. These may include mammography, ultrasound, magnetic resonance imaging, biopsy findings, biomarker testing and an assessment of the lymph nodes.
The purpose of diagnostic review is not simply to confirm that cancer is present. It is to determine what type of cancer has been found, how extensive it appears to be and which information is still missing.
The information that shapes treatment planning
Imaging
Breast imaging helps define the location and extent of an abnormality. Mammography and ultrasound are commonly used during initial assessment. Breast magnetic resonance imaging may be considered when additional information about disease extent is required.
An imaging review may ask:
- Is the abnormality confined to one area?
- Are there additional suspicious areas?
- Is the opposite breast adequately assessed?
- Are suspicious lymph nodes present?
- Does the imaging agree with the biopsy result?
Pathology
A pathology report describes the tissue obtained during biopsy or surgery. It may identify invasive cancer, ductal carcinoma in situ or another breast condition.
The pathology report may include:
- Histological type
- Tumor grade
- Presence of invasive disease
- Presence of in situ disease
- Lymphovascular invasion
- Surgical margins, when surgery has already been performed
Biomarkers
Breast cancer is not a single disease. Biomarkers help determine which systemic treatments may be effective.
Commonly reported biomarkers include:
- Estrogen receptor, or ER
- Progesterone receptor, or PR
- Human epidermal growth factor receptor 2, or HER2
Additional tests may be recommended depending on the tumor type, stage, age, family history and proposed treatment.
Lymph nodes
The lymph nodes under the arm are an important part of breast cancer staging. Imaging may identify suspicious nodes, but imaging alone does not always establish whether cancer is present.
Sentinel lymph-node biopsy or another lymph-node procedure may be considered as part of surgery.
When might a second pathology review be considered?
A second pathology review may be useful when:
- The original report is incomplete
- The diagnosis is unusual
- Biomarker results are missing or uncertain
- The pathology and imaging findings do not agree
- Treatment recommendations depend on a distinction that remains unclear
- The patient has already undergone treatment and the original material must be reassessed
A second review does not automatically mean that the original diagnosis was incorrect.
Will every test need to be repeated in Korea?
Not necessarily.
Previous imaging and pathology may be usable when the original files and reports are complete and of sufficient quality. Additional testing may be requested when the existing information is incomplete, unavailable or inconsistent.
Patients should avoid assuming that every examination must be repeated or that no additional testing will be necessary.
What to obtain before requesting a review
- Original pathology report
- Biopsy procedure report
- ER, PR and HER2 results
- Mammography images
- Breast ultrasound images
- Breast MRI images, when performed
- CT, PET or bone imaging, when performed
- Previous operative reports
- Previous chemotherapy or radiotherapy records
- Family and genetic testing history, when relevant