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NCCN Guidelines for Patients


Breast Cancer - Early-Stage


, Version 1.2016


Treatment planning

Imaging tests

Liver function tests

Your liver is an organ in the upper right side of your

abdomen. It does many important jobs, such as

remove toxins from your blood. Liver function tests

assess for chemicals that are made or processed by

the liver. Levels that are too high or low may signal

that the cancer has spread to distant sites. One such

chemical is ALP (




hosphatase). High levels

of ALP may mean that the cancer has spread to your

liver or bones.

Imaging tests

Imaging tests make pictures (images) of the insides

of your body. They can show which sites have cancer.

This information helps your doctors stage the cancer.

Your treatment team will tell you how to prepare

for these tests. You may need to stop taking some

medicines and stop eating and drinking for a few

hours before the scan. Tell your doctors if you get

nervous when in small spaces. You may be given a

sedative to help you relax.

Bilateral diagnostic mammogram

A mammogram is a picture of the insides of your

breast. The pictures are made using x-rays.

Mammograms that are used for breast cancer

screening are often made from two x-rays of each

breast. A computer combines the x-rays to make

detailed pictures.

See Figure 2.1

for more information.

Many women diagnosed with breast cancer have

already had a bilateral diagnostic mammogram. If

you haven’t had this test, it is advised. A bilateral

mammogram is a picture of each breast. Diagnostic

mammograms are made with more x-rays from

different angles than screening mammograms. By

using more x-rays, the picture is clearer and can

better show the size and number of tumors.


Ultrasound is a test that uses sound waves to make

pictures. For this test, you will need to lie down on

a table. Next, a technician or doctor will hold the

ultrasound probe on top of your breast. The probe

may also be placed below your armpit to view your

lymph nodes.

Breast MRI

If the mammography and ultrasound images are

unclear, your doctors may want you to get a breast







maging). This test uses

a magnetic field and radio waves to make pictures

of the insides of your breasts. Before the test, a

contrast dye may be injected into your vein to make

the pictures clearer. The dye may cause you to feel

flushed or get hives. Rarely, serious allergic reactions

occur. Tell your doctor if you have had bad reactions


For breast MRI, you must remove your top and bra

and lie face down on a table. The table has padded

openings for your breasts. In the openings, there are

coils that help to make pictures. During breast MRI,

the table moves slowly through the tunnel of the MRI


Bone scan

A bone scan is recommended if you have bone pain

or if ALP levels are high. Before the pictures are

taken, a radiotracer will be injected into your vein.

The most common radiotracer used for bone scans

is technetium. You will need to wait about 3 hours for

the radiotracer to enter your bones. A special camera

is used to take pictures while you lie still on a table.

It takes 45 to 60 minutes to complete the pictures.

Areas of bone damage use more radiotracer than

healthy bone and thus appear as bright spots. Bone

damage can be caused by cancer as well as other

health problems.