Breast Biopsy:

1
Breast Biopsy

• What to Expect When a Lump Is Detected

2
What Is A Biopsy?

• A biopsy is a procedure that removes a sample of
  cells or tissue from the breast to be examined.
• The cells or tissue are then examined under a
  microscope to look for signs of cancer.
• Only 1 in 5 women who have biopsies will actually
  be diagnosed with cancer.

3
When a lump is found.

• When a lump is found, a biopsy is the first step
  in diagnosis and treatment.
• Although the primary purpose is to diagnose
  cancer, a biopsy can also be a surgical treatment
  to remove cancer.

4
Visiting the Doctor

• After a lump has been detected, the doctor will
  follow a step by step process.
• First, the doctor should begin by asking about
  your personal family history.
• Next, the doctor may order follow-up tests, such
  as diagnostic mammograms and ultrasound imaging,
  which can provide additional information about
  suspicious lumps.
• However, to make a definite diagnosis of breast
  cancer, a biopsy must be performed.

5
Types of Biopsies

• There are two main types of biopsies
• Needle Open Biopsy
• Your options for biopsy are determined by
  whether the lump is palpable (can be felt) or
  non-palpable (can not be felted), the location of
  the lump and the womans general health.

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Needle Biopsy

• A needle biopsy is a procedure that uses a needle
  to remove tissue or cells from the breast.
• There are two types of needle biopsies
• Fine Needle and Core Needle Biopsy

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Needle Biopsies

• Fine Needle A thin, hollow needle is used to
  remove a sample of tissue. The procedure is
  quick and can be done in a doctors office.
• Core Needle A larger needle is inserted through
  a small incision in the skin, and a small core of
  tissue is removed. This type of needle biopsy is
  done with the assistance of mammography or
  ultrasound imaging in a doctors office or
  hospital outpatient clinic.

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Advantages of Needle Biopsies

• Simple procedure does not require surgery
• Accurate
• Quick only takes a few minutes
• Not painful
• Inexpensive
• Quick results

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Disadvantages of Needle Biopsies

• Entire lump is not removed
• Open biopsy may be necessary
• For Fine Needle Only
• Specialist needed to read results
• In situ cancer not distinguishable from invasive
  cancer

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Open Biopsies

• An open biopsy is a surgical procedure that opens
  the breast to remove tissue.
• There are two types of open biopsies
• Incisional and Excisional

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Incisional Biopsy

• A surgical procedure where only a portion of a
  tumor is removed
• Generally reserved for lumps that are larger
• Performed under local anesthesia in a hospital or
  outpatient clinic

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Excisional Biopsy

• A surgical procedure that removes the entire
  suspected area plus some surrounding normal
  tissue.
• Standard procedure for lumps that are smaller
  than an inch or so in diameter
• Similar to a lumpectomy
• Performed under local anesthetic or general
  anesthesia in a hospital or outpatient clinic

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Advantages of Open Biopsies

• Quick takes only one hour
• More accurate than a needle biopsy
• Larger samples provide information for treatment
  plan
• Excisional Only
• Removes entire lump
• May be the only surgical treatment needed

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Disadvantages of Open Biopsies

• Surgical procedure
• Expensive
• Side effects such as infection or blood
  collection under the skin
• Excisional Only
• Removing tissue can change the look and feel of
  the breast

15
Imaging Techniques

• When a lump cannot be felt, the doctor must
  locate it with a special imaging technique.
• The doctor may use mammography (sometimes called
  stereotactic localization) or ultrasound imaging
• The lump is located by mammography or ultrasound
• The doctor inserts a needle to collect a sample
  of tissue

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Summary
17
Important Information to Know...
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Why is it necessary to have a clinical breast
exam once you have found a lump?

• A doctor can tell a lot about a lump from its
  size, texture, and the way it moves within the
  breast. Sometimes an abnormal lump may be a
  liquid-filled sac called a cyst. Doctors can
  collapse these cysts by inserting a very thin
  needle and drawing out the fluid.

19
How long is the procedure for a needle biopsy?

• A fine needle aspiration only takes a few
  minutes. A core needle biopsy takes under one
  hour.

20
Will an anesthetic be used during the biopsy?

• A local anesthetic is used in needle biopsies.
  A person can have either a local anesthetic
  and/or a sedating anesthesis in an open biopsy.

21
How much does a biopsy normally cost?

• Biopsies range in price depending upon the
  technique.

22
If a mammogram or clinical breast exam reveals
something suspicious and your physician suggests
a biopsy, you may want to ask the following
questions

• What type of biopsy will I have?
• How reliable is this particular biopsy?
• Are there any effects of a biopsy?
• How long will the biopsy take?
• Can I eat or drink before the biopsy?
• Will the biopsy leave a scar?
• When will I be able to return to my normal
  routine?
• How soon will I know if I have cancer?
• If I do have cancer, what other tests will need
  to be done?

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Is there anything that would affect the
diagnosis?

• Test results may not be accurate if the biopsy
  sample does not contain enough tissue to make a
  definite diagnosis.

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What happens if the biopsy results indicate
cancer?

• There are several things that may happen
•  
• There may be follow-up tests to determine
  treatment. Tests may be done to determine if the
  tumor is dependent on hormones (such as
  estrogen). These are called estrogen and
  progesterone receptor tests. If the tumor is
  dependent on hormones, treatment with a
  medication such as tamoxifen may be advised.
• 2. If the biopsy confirms cancer, follow-up
  tests, including radiographic tests, blood
  studies, and bone scans determine treatment.

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How long after diagnosis will treatment begin?

• If the biopsy confirms cancer, the doctor will
  talk to you about treatment options. Treatment
  for breast cancer usually begins within a couple
  of weeks after the biopsy. This gives you time
  to
• Learn about treatment options and breast
  reconstruction
• Get another medical opinion
• Have tests that tell if the cancer has spread to
  other parts of the body
• Prepare yourself emotionally
• Make personal and work arrangements
• A short delay between the biopsy and treatment
  will not reduce the chances that your treatment
  will be successful.

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Advanced Breast Biopsy Instrumentation (ABBI)

• The ABBI procedure is performed under local
  anesthesia and is a one-step biopsy procedure.
  This means that it combines needle localization
  with the removal of the lump.
• Using stereotactic techniques, a technician
  pinpoints the lump with the aid of the computer,
  which calculates the precise location of the
  lump. The area is numbed with a local anesthetic
  and a marking needle is inserted to tag the
  precise location. A narrow tube-like device is
  inserted into the breast to obtain a specimen.
  The small opening in the breast is closed with a
  few stitches.

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What are the advantages of the ABBI procedure?

• The results are available in 24-48 hours.
• The ABBI procedure takes less than one hour.
• The ABBI procedure is minimally invasive,
  therefore allowing the woman to experience less
  time in healing and recovery.
• The ABBI procedure may be an alternative to open
  biopsies for non-palpable lesions.
• The ABBI procedure is currently the only
  procedure other than the traditional open surgery
  method which has the capability to remove a lump
  or a cluster of microcalcifications in their
  entirety.

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What are the disadvantages of the ABBI procedure?

• A downside to the ABBI procedure is
  availability. It is a relatively new technique
  and many physicians may not be trained in the
  procedure or have the available equipment.

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Mammotone Minimally Invasive Breast Biopsy
(MIBB)

• The Mammotone and MIBB are very similar and are
  often called Large Core Needle Biopsies.
• The Mammotone and MIBB are different from the
  core needle biopsy in that a needle is inserted
  once and multiple specimens are removed through
  contiguous sampling. Core needle biopsies
  require the needle to be inserted multiple times.
  
• Both the Mammotone and MIBB biopsy utilize a
  vacuum system. A probe is inserted and samples of
  tissue are collected in a chamber. Tissue
  samples are removed by action of a gentle vacuum.
  By rotating a thumbwheel, the physician moves
  the sampling notch to the next desired position.

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Advantages of the Mammotone MIBB

• The sample of the lump is larger (up to 8X
  larger), the needle is inserted only once to
  obtain multiple samples, and the sampling is
  contiguous and selective.