What imaging tests are used to stage Breast Cancer

Imaging Tests for Breast Cancer Staging

Imaging tests are a crucial part of understanding your breast cancer diagnosis. They help your care team see the extent of the cancer and determine your stage. Let me walk you through the main imaging tests used in breast cancer staging.

Primary Breast Imaging Tests

Mammography (Mammogram) A mammogram uses low-dose x-rays to create detailed pictures of breast tissue. During the test, your breast is gently compressed between two plates while x-rays are taken from different angles. According to NCCN Guidelines, there are two types:

• Screening mammograms: Done routinely when there are no symptoms
• Diagnostic mammograms: Used when you have symptoms (like a lump or nipple discharge) or to get a closer look at an abnormal area found on screening

Modern mammograms can use either standard 2D imaging or 3D mammography (called tomosynthesis), which creates layered images for better detail.

Breast Ultrasound Ultrasound uses high-energy sound waves to create images of breast tissue. A small wand-like probe is moved across your breast using gel. According to NCCN Guidelines, ultrasound is particularly good at showing small areas of cancer near the skin and is often used alongside mammography for diagnostic evaluation.

Breast MRI (Magnetic Resonance Imaging) An MRI uses powerful magnets and radio waves to create detailed images without x-rays. Per NCCN Guidelines, breast MRI:

• Is performed with IV contrast (a dye injected into your vein to improve image clarity)
• Requires you to lie face-down with your arms above your head
• May be used to define the full extent of cancer in your breast
• Can help identify multifocal or multicentric cancer (multiple tumors in the same breast)
• Can screen the opposite breast at the time of initial diagnosis
• Is helpful before and after preoperative (before surgery) systemic therapy to assess treatment response

Important note: False-positive findings on breast MRI are common, so surgical decisions should not be based solely on MRI findings.

Tests to Check if Cancer Has Spread

CT Scan (Computed Tomography) A CT scan takes multiple x-ray images from different angles and combines them into detailed cross-sectional pictures. This helps detect whether cancer has spread to organs like the lungs or liver.

Bone Scan According to NCCN Guidelines, a bone scan uses a radioactive substance (called a radiotracer) injected into your vein. A special camera then takes pictures as the tracer travels through your bones. Areas where cancer has spread to bone show up as bright spots. This test helps determine if cancer has metastasized (spread) to your skeleton.

PET/CT Scan (Positron Emission Tomography combined with CT) Per NCCN Guidelines, PET/CT scans use a radioactive tracer to identify where cancer cells are active in your body:

• FDG-PET/CT: Uses a glucose-based tracer; cancer cells show up as bright spots because they use more sugar than normal cells. You'll need to fast for at least 4 hours before this test.
• FES-PET/CT: Uses a radioactive form of estrogen; may be used instead of FDG-PET/CT for hormone receptor-positive breast cancers
• Sodium fluoride PET/CT: Specifically looks for bone involvement

Brain and Spine MRI If your care team is concerned about cancer spreading to your brain or spine, dedicated MRI scans of these areas may be ordered. These use contrast material to improve image clarity.

Understanding Contrast Material

Many imaging tests use contrast material—a substance that makes images clearer. According to NCCN Guidelines, contrast can be:

• Oral: Taken by mouth; passes through your system naturally
• IV (intravenous): Injected into a vein; leaves your body through urine

Important: Tell your care team if you've had allergic reactions to contrast in the past, as this affects which tests can be safely performed.

Key Questions to Ask Your Care Team

1. Which imaging tests will I need, and why? Different situations require different tests.
2. What should I expect during each test? (fasting requirements, how long it takes, what to wear)
3. When will I get my results, and how will they be explained to me?
4. Do I have any allergies or medical conditions that might affect which tests I can have? (like kidney issues or claustrophobia)
5. Will these tests be repeated during my treatment to monitor how well it's working?

Important Reminders

According to NCCN Guidelines for Breast Cancer, imaging results are interpreted by radiologists (imaging specialists) who send detailed reports to your healthcare team. These results, combined with biopsy findings and other tests, help determine your specific treatment plan.

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.