Breast Biopsy Health Article

Definition

A breast biopsy is removal of breast tissue for examination by a pathologist. This can be accomplished surgically, or by withdrawing tissue through a needle.

Purpose

A biopsy is recommended when a significant abnormality is found, either on physical examination and/or by an imaging test. Examples of abnormality can include a breast lump felt during physical self examination or tissue changes noticed from a mammogram test. Before a biopsy is performed, it is important to make sure that the threat of cancer cannot be disproved or ruled out by a simpler, less invasive examination. A lump may be obviously harmless when examined by ultrasound. If this is not decisive, the presence of cancer or a variety of benign breast conditions can be determined using a biopsy.

Precautions

The type of biopsy recommended should be considered. This will depend on whether the area can be felt, how well it can be seen on mammogram or ultrasound, and how suspicious it feels or appears. Specialized equipment is needed for different types of biopsy and availability may vary. Generally, needle biopsy is less invasive than surgical biopsy. It is appropriate for most, but not all situations. However, some surgeons feel it is far less accurate.

Surgical biopsy

If an abnormality is not felt during a self examination, there are signs that indicate the need for medical attention. These include:

• severe breast pain
• changes in the size of a breast or the nipple
• changes in the shape of both breast or nipple
• pitting, dumpling or redness of the breast skin
• nipple redness, irritation, or inversion
• changes in the pattern of veins visible on the surface of the breast
• some types of nipple discharge

If the abnormality is not felt, a needle localization must be done before the actual surgery. After local anesthetic is administered, a fine wire is placed in the area of concern. Either x ray or ultrasound guidance is used. The patient is awake and usually sitting up.

There are two types of breast biopsy considered here, excisional and incisional. An excisional biopsy is a surgical procedure, where the entire area of concern and some surrounding tissue is removed. It is usually done as an outpatient procedure, in a hospital or free standing surgery center. The patient may be awake, and is sometimes given medication to make her drowsy. The area to be operated on is numbed with local anesthetic. Infrequently, general anesthesia is used.

An excisional biopsy itself usually takes under one hour. The total amount of time spent at the facility depends on the type of anesthesia used, whether a needle localization was done, and the extent of the surgery.

If a mass is very large, an incisional biopsy may be performed. In this case only a portion of the area is removed and sent for analysis. The procedure is the same as an excisional biopsy in other respects.

Needle biopsy

A needle biopsy removes part of the suspicious area for examination. There are two types, aspiration biopsy (using a fine needle), and large core needle biopsy. Either of these may be called a percutaneous needle biopsy. Per-cutaneous refers to a procedure done through the skin.

A fine needle aspiration biopsy uses a very thin needle to withdraw fluid and cells that can be studied. It can be done in a doctor's office, clinic, or hospital. Local anesthetic may be used, but is sometimes withheld, as it may be more painful than the biopsy needle. The area to place the needle may be located by touch. No specialized equipment is needed. However, using ultrasound guidance enables the physician to feel and see the lesion at the same time. The actual withdrawing of fluid and cells can be visualized as it occurs. This helps ensure that the specimen is taken from the right place.

A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue, about the size of a grain of rice. It can be done in a clinic or hospital that has the appropriate facilities. Local anesthetic is routinely

used. Ultrasound or x ray is used for guidance of a large core needle biopsy.

If the suspicious area is seen best with x ray, a stereo-tactic device is used. This means that x rays are taken from several angles. This information is fed into a computer, which analyzes the data and guides the needle to the correct place. The patient may be sitting up, or she may be lying on her stomach, with her breast positioned through an opening in the table. The breast is held firmly, but comfortably between a plastic paddle and a metal plate, similar to those used for mammograms (a set of x rays taken of the front and side of the breast). X rays may be taken before, during, and after the tissue is drawn into the needle, to confirm that the correct spot is biopsied. This procedure may also be referred to as a stereotactic core biopsy, or a mammotomy.

Ultrasound is used to guide needle placement for some lesions. The patient lies on her back or side. After the area is numbed, sterile gel is applied. The physician places a transducer, an instrument about the size of an electric shaver, over the skin. This produces an image from the reflection of sound waves. A special needle, usually in a spring loaded device, is used to obtain the tissue. The procedure is observed on a monitor as it is happening.