Breast Biopsy
Diagnostic Methods And Procedures

Breast Cancer Guide

Mammotone Picture

Mammotome Procedure

Breast Biopsy

Contents

What Is A Breast Biopsy?
Fine Needle Aspiration (FNA)
Core Needle Biopsy
Mammotome
Stereotactic Biopsy
Incisional Surgery
Excisional Surgery
Important Guidelines
Aftercare
Sentinel Lymph Node Biopsy (SLNB)


Breast Biopsy Picture

Core Needle Biopsy

What Is A Breast Biopsy?

A biopsy of the breast involves taking a sample of tissue or cells for examination under a microscope. It is most commonly performed as a breast cancer diagnosis tool to investigate a tumor or mass detected during a clinical examination or mammogram. If a woman finds a lump herself during a breast self examination, a mammogram will need to be carried out before a biopsy is ordered. A biopsy is usually a straight forward procedure and in the United States only about 10 percent of women biopsied will be diagnosed with cancer. By contrast in Sweden the malignancy (cancer) diagnosis rate is 80 percent. This is because Swedish doctors apply much stricter criteria on when a biopsy should be carried out, primarily for cost reasons.

Overview of this section: Breast Cancer Guide.

Types Of Biopsies

Fine Needle Aspiration (FNA)

FNA is one of the least invasive biopsy methods and it can be carried out in a clinician’s office. A local anesthesia is injected into the breast first to numb it. The doctor then uses a hollow needle to remove a small sample of cells or fluid from the suspicious lump. If the lump is mobile and moves around several attempts may be necessary before enough of a sample is taken. If the lump turns out to be a fluid filled cyst (not cancer), it will often collapse once the fluid is withdrawn. If the lump does not collapse, or if the mass appears solid, a surgical biopsy is usually required. This is because FNA is not as accurate as surgery and has a higher risk of false negatives - that is it can suggest cancer where no cancer exists. The likely reason for this is that FNA can only take a tiny sample of cells for analysis, compared to other more invasive procedures.

Core Needle Biopsy

If a lump feels solid a doctor may perform a core needle biopsy as a sort of 'in-between' procedure. It does not require cutting the skin like surgery, but a larger needle than FNA, a sort of ‘cutting’ needle is used. This procedure allows the doctor to obtain small cylinders (cores) of skin tissue for the pathologist to test. It allows the pathologist not only to check the individual cells but also to see how they react and fit together. The needle is usually attached to a biopsy gun which instantly punches the needle in and out of the skin quickly. Usually between 3 and 6 cylinders of tissue samples are taken. It does not leave any scars.

Check: Signs of breast cancer

Mammotome

This is a vacuum-assisted breast biopsy, but is better known by its brand name Mammotome. It is a fairly new technology which allows surgeons or radiologists to remove a larger tissue sample without causing a big scar. And unlike core needle biopsy, it only has to be inserted once. During the procedure the woman is asked to face down on a special exam table which has openings for placing her breasts. An anesthetic is injected into the breast to numb it. An ultrasound scan may be use to locate the suspicious area and then the doctor makes a tiny cut in the skin. He then inserts a special probe with a high speed rotating cutter that is attached to a vacuum pump. As the cutter rotates the tissue sample is sucked through the probe into a collection area. As Mammotome is still a relatively new procedure, do check with your surgeon to make sure he is experienced in using the equipment.

Stereotactic Biopsy

What if the biopsy is ordered because a cluster of microcalcifications were spotted on a mammogram or MRI scan? In others words - there is no sign of a lump. Since there is nothing to feel or see, surgeons will need imaging equipment to help guide them to the correct spot for sampling. One common method for this is stereotactic guided needle biopsy. A mammogram, ultrasound or MRI is used to guide the needle towards the suspicious area for taking a sample. This procedure can be used in conjunction with FNA, core needle and Mammotome. In some cases a small metal clip is inserted into the biopsied site to mark the location in case another biopsy is required in the future. If no further testing is required, it can remain in the breast harmlessly.

Incisional Surgery

Also known as open biopsy, this procedure removes a sample of cells tissue for examination by the pathologist. It cuts into the tumor or mass of tissue and removes a wedge. It is one of the most accurate ways to establish an accurate diagnosis. It is performed as day surgery under local anesthesia. See also: Cancer Surgery.

Excisional Surgery

This is the most invasive and extensive of all the biopsy procedures. Performed as day surgery under local anesthesia, an excisional biopsy involves cutting out the lump or suspicious area of cell growth, as well as a margin of normal tissue. If the surgeon cannot see or feel a lump the area will need to be marked on the woman's skin before surgery with the use of ultrasound or mammography. Alternatively imaging techniques may be used to insert tiny wires and dye to mark the area (known as needle wire localization). In surgery, the surgeon tracks the wire and removes the marked area with a scalpel. Although excisional biopsy is more extensive than other methods, it may give a woman peace of mind knowing the lump has been removed. It may also be used for cases of breast cancer recurrence.

Important Guidelines

Medical experts believe that about 90 percent of all breast biopsies only require the needle method. Yet studies show that nearly 70 percent are carried out surgically. This means that most women are being over-treated and undergoing unnecessary surgery. It also means that those who are diagnosed will have to undergo yet more surgery. So, before agreeing to a procedure ask your doctor to show you your imaging result (mammogram and any other studies). Ask him to point out the area of concern. If he recommends a surgery biopsy, ask him if a needle one could also be performed. If he says no, ask why not.

Aftercare

Most clinicians will tell their patient how to care for any wound resulting from a biopsy, including information on activity restrictions. Even women who undergo FNA may experience some bruising and tenderness for a few days. Mild pain killers like Tylenol and paracetamol can help relieve any pain. Aspirin products should be avoided as they can sometimes cause bleeding. Before leaving the clinic ask your doctor when you can expect the results of your test, normally they take a few days and you will be asked to come back to receive them.

Sentinel Lymph Node Biopsy (SLNB)

If a woman is diagnosed with breast cancer, the surgeon will want to know if it is invasive or not. This will be confirmed by breast cancer staging. Cancer which spreads beyond the breast duct is known as invasive. It is particularly important to know if cancerous cells have found their way into the blood or lymph vessels, as this is the quickest way to cause it to spread to other parts of the body (metastasize). This determines a woman's breast cancer survival rate.

SLNB is a new technique which tests if cancer has spread to the lymph nodes under the arms (the most likely route if it is to spread). It was developed as an alternative to traditional axillary lymph node dissection which is associated with chronic complications such as pain, swelling (lymphedema) and numbness of the arm. With SLNB, only one lymph node (the sentinel node) under the arm is removed for biopsy, as opposed to all the lymph nodes with the traditional method. The procedure is based on scientific studies which show that the breast lymph ducts usually drain to the sentinel node first, before filtering to the others. A negative result for cancer in the sentinel node indicates with more than 95 percent certainty that the other axillary nodes are also free of cancer. More often than not SLNB is performed in combination with a lumpectomy or mastectomy procedure.

The advantages of SLNB are numerous. It does not require an overnight hospital stay, there is no need to keep drainage tubes in place for several weeks and the patient recuperates a lot faster than with the traditional alternative. That said, it has still not moved into mainstream practice, so it may be difficult to locate a surgeon who practices it. Also some experts remain worried about the 5 percent or so of cases where cancer skips the sentinel node and heads straight for the remaining ones.

How The Procedure Is Performed

On the morning of the operation, the woman will be seen by a nuclear medicine specialist. This is a physician trained specifically in injecting radioactive dye. Dye is injected into the tumor and/or around the nipple. The patient is returned to wait in her room for a few hours. Later some scans are taken of the area to track the pathway that the dye has taken as it leaves the breast. This helps the surgeon identify the sentinel node. The woman is then taken to operating theatre and given general anesthesia. The surgeon injects a blue dye and makes an incision in the armpit. Any nodes which have taken up the radioactive or blue dye are removed. This can be 1 to 3 nodes. These are then sent to a pathologist for examination.

Related Articles on Female Cancers

For more on the subject, see the following:

Cancer Guide: General guide to causes and treatment.
Inflammatory Breast Cancer: Spot the early signs.
How To Prevent Breast Cancer
Hormonal Therapy For Breast Cancer
Breast Reconstruction Surgery

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