Surgeon doing a surgical breast biopsy
Several methods for a breast biopsy now exist. The most appropriate method of biopsy for a patient depends upon a variety of factors, including the size, location, appearance and characteristics of the abnormality.
Fine needle aspiration
Fine needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass.
Core needle biopsy
A core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle. For palpable (“able to be felt”) lesions, the physician fixes the lesion with one hand and performs a freehand needle biopsy with the other. In case of non-palpable lesions, stereotactic mammography, or ultrasound, or PEM guidance is used. With stereotactic mammography, it is possible to pinpoint the exact location of a mass based on images taken from two different angles of the x-ray machine. With ultrasound, the radiologist or surgeon can watch the needle on the ultrasound monitor to help guide it to the area of concern. With PEM (positron emission mammagraphy), the lesion is targeted in 3D based on a positron emission tomography (PET) image of the breast. The needle used during core needle biopsy is larger than the needle used with FNA. The core biopsy needle also has a special cutting edge allowing removal of a bigger sample of tissue. With core needle biopsy, a relatively large sample can be removed through a small single incision in the skin. Typically, the breast area is first locally anesthetized with a small amount of anesthetic fluid. Then, the needle is placed into the breast. As with FNA, the radiologist or surgeon will guide the needle into the area of concern by palpating the lump. If the lesion can’t be felt the core needle biopsy is performed under image-guidance using either stereotactic mammography, ultrasound or even magnetic resonance imaging (MRI). A core needle biopsy procedure takes a few minutes to perform and is almost painless.
Vacuum assisted biopsy
Vacuum assisted biopsy is a version of core needle biopsy using a vacuum technique to assist the collection of the tissue sample. The needle normally has a lateral ("from the side") opening and can be rotated allowing multiple samples to be collected through a single skin incision. The Vacuum assisted biopsy procedure is similar to normal core needle biopsy. The vacuum assisted biopsy category also includes automated rotational core devices.
Direct & frontal biopsy
Recent innovations in tissue acquisition for the human breast have led to the development of unique direct frontal systems. Efficacy is considered optimal if the diagnosis by transcutaneous biopsy is identical to the surgical specimen in case of malignancy or in line with clinical follow-up when benign.
Open surgical biopsy
Open surgical biopsy means that a large mass or lump is removed during a surgical procedure. Surgical biopsy requires an approximately 3 to 5 centimeters incision and is normally performed in an operating room in sterile conditions. Open surgical biopsy in some cases can be performed with local anesthesia but in most cases general anesthesia may be necessary. Ten years ago, most breast biopsies were open surgical procedures. Today most patients are candidates for less invasive biopsy procedures such as core needle biopsy. Depending on the location of the lesion to be biopsied, a radiologist will often perform needle localization beforehand to guide the surgeon to the site being biopsied.
- Coding Breast Diseases and Surgery
- Cornelis A, Verjans M, Van den Bosch T, Wouters K, Van Robaeys J, Janssens JP (August 2009). "Efficacy and safety of direct and frontal macrobiopsies in breast cancer". Eur. J. Cancer Prev. 18 (4): 280–4. doi:10.1097/CEJ.0b013e328329d885. PMID 19352188.
- High-Precision Direct and Frontal Breast Biopsy to Assure Adequate Surgical Margin Interpretation; Jaak Janssens, MD, PhD; Ruediger Schulz-Wendtland, MD, PhD; Luc Rotenberg, MD; John-Paul Bogers, MD, PhD
- European Journal of Cancer Prevention