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Breast Cancer Screening

Breast Biopsy

Vacuum-Assisted Biopsy: This is a minimally invasive procedure that uses a single insertion of a specimen probe to remove significantly more tissue than CNB or FNAB procedures. The procedure is performed under local anesthesia, usually in a doctor's office or clinic. Guided by ultrasound or stereotactic imaging, the probe is inserted into the abnormal tissue. A vacuum line draws the tissue into an opening in the side of the probe and a smaller inner sampling tool cuts 8 to 10 tissue samples in a pattern completely encircling the mass. The specimens are forwarded to a laboratory for analysis by a pathologist.

The insertion point is closed with a sterile bandage and no stitches are required. Some bruising and swelling may occur after the procedure.

Large core biopsy: In this procedure, the entire breast mass is removed in a single section, using stereotactic imaging and wire localization. The biopsy is done under local anesthesia, with the breast in compression. A narrow tube with a cutting device is inserted into the area containing the mass, using the wire as a guide. The mass is then removed with a looped wire and forwarded to a laboratory for analysis by a pathologist.

This procedure is usually done on an outpatient basis in a doctor's office or a clinic. Stitches are required to close the incision and several hours of recovery are recommended before the patient is released. This procedure is performed less commonly than other biopsies. The primary concerns expressed about the procedure are that an unnecessary amount of normal tissue is removed just to perform the biopsy. The margin of tissue around the mass cannot be definitively assessed by laboratory analysis.

Open surgical biopsy: For many years, open surgical biopsy was the only method of obtaining a tissue sample for analysis. The accuracy of diagnosis for open surgical biopsy is close to 100%, because the tissue sample is large: however, needle biopsies are less invasive and have fewer complications. It is important for women to thoroughly review the relative benefits and risks of all biopsy procedures with a physician so that an informed decision can be made based on each individual situation.

Open surgical biopsy is almost always done in a hospital, usually on an outpatient basis. General anesthesia is seldom used. An open surgical biopsy is usually performed under local anesthesia with IV sedation for the patient. If the mass cannot be palpated, wire localization is used to pinpoint the precise location of the abnormal area. The patient is then taken to the operating room, where a 1.5 to 2 inch incision is made. The mass is removed, along with a portion of tissue surrounding the mass. The specimen is forwarded to a laboratory for analysis by a pathologist.

The incision is closed with sutures and a sterile dressing is placed on the wound. An external scar is typical, and internal scar formation that may interfere with mammography may last several years.

Studies indicate that approximately 5% of all breast biopsies ordered actually require open surgical intervention; however, this method accounts for nearly 40% of annual breast biopsy procedures. Increased awareness of minimally invasive procedures would help to decrease the incidence of unnecessary open surgical biopsies.

There are some rare complications associated with open surgical biopsy, including:

  • Abnormal bleeding
  • Infection
  • Difficult wound healing