Name the clinical question before ordering the test
Mammography, ultrasound, and contrast-enhanced breast MRI answer different questions. MRI is often part of high-risk screening and can evaluate disease extent or implants, but it can also find abnormalities that require additional imaging or biopsy. A lesion visible only on MRI may need MRI-guided biopsy.
CT and PET/CT are generally used for staging or evaluating specific symptoms in selected patients with known cancer; they are not substitutes for routine high-risk breast screening. “MR-guided surgery” is not one standard procedure—ask whether the team means MRI-guided biopsy, wire or seed localization based on imaging, intraoperative imaging, or another technique.
Make the radiology record portable
Collect the report and the actual images in the format requested by the reviewing center. A second radiology review may compare current and prior studies, evaluate whether imaging and pathology agree, and determine whether additional biopsy or localization is needed before surgery.
- Record BI-RADS assessment, breast density, lesion size and location, enhancement or calcification description, and recommended next step.
- Ask whether the biopsy clip is visible and correctly placed.
- Confirm whether pathology is concordant with imaging; discordance may require repeat sampling or excision.
Read the pathology in layers
The core report may include histologic type, invasive versus in situ disease, grade, ER, PR, HER2, and sometimes Ki-67. The surgical report adds tumor size, margins, lymph nodes, lymphovascular invasion, and final stage. ER-positive means tumor cells have estrogen receptors; ER-negative means they do not. PR and HER2 are separate biomarkers. Triple-negative breast cancer lacks ER and PR and has little or no HER2 expression.
Relevant blood tests depend on the procedure and treatment. A clinician may order a blood count, metabolic panel, pregnancy testing, coagulation studies, or treatment-specific monitoring, but there is no universal “all labs” panel for every BRCA carrier or breast operation.