Patients who develop breast symptoms will be investigated using the concept of the Triple Assessment an explanation of which follows:

Clinical Examination
The Clinical examination is combined with taking the history of the current symptoms and knowing any past history.

Imaging
Imaging involves mammography in patients over 35 with new symptoms. Ultrasound is usually added for further information. It is particularly useful in identifying the difference between a solid lump and liquid which means a cyst. MRI is valuable in complicated cases and is being used more frequently.

Biopsy
The ideal form of needle biopsy is a core cut. This provides tissue for histology and is the most informative type. It will differentiate between pre-invasive and invasive tumour, provide the grade of tumour and also the receptor status of the tumour.  In certain cases a fine needle aspirate for cytology is an acceptable alternative. Cytology can identify malignant cells but does not identify invasive tumour with certainty and cannot diagnose the grade or receptor status of the tumour. Cytology is the usual form of testing when a fluid cyst is aspirated or when there is nipple discharge.

The grading system for clinical examination, imaging, cytology and pathology is numbered from 1-5. '
1 = normal;
2 = benign;
3 = indeterminate, probably benign;
4 = suspicious;
5 = Cancer;

As an example M4, U5, B5 is a suspicious mammogram and a diagnostic ultrasound and core cut biopsy showing cancer.  Alternatively M2, U2, C2 would be a benign looking opacity on the mammogram proving to be a cyst on the ultrasound and benign cells on the fine needle aspirate.