In a breast biopsy or mammogram, tissue is taken from the breast and examined under the microscope in order to determine whether or not cancer is present. There are different breast biopsy techniques. These include: Fine needle aspiration, also known as FNA, image-guided core needle biopsy, and excisional biopsy.
FNA
Fine needle aspiration, which is also known as FNA, is among the least invasive breast biopsy techniques. It is often used when the doctor suspects a cyst or to biopsy a lymph node. A problem with FNA is if malignant cells are seen, the pathologist may not be ale to tell if the cancer is invasive or non invasive. This distinction is very important because it guides treatment decisions. If cancer is diagnosed on FNA, additional biopsies may be essential.
Core Needle Biopsy
This technique is used when an abnormality is seen on breast imaging such as mammogram, ultrasound or MRI. If mammogram is used to guide the biopsy, it’s called a stereotactic biopsy. Otherwise it is called an ultrasound-guided core needle biopsy or MRI-guided core needle biopsy. This procedure is typically done by a radiologist but it can also be performed by a surgeon.
The skin is cleansed and the area is usually anesthetized with local anesthetic. A small incision is made in the skin with a scalpel. Then a needle is inserted into the area of concern and several very small cores of tissue are removed. The doctor will take 3 cores or as many as necessary to be confident about the pathology results.
A small titanium tissue marker (clip or chip) is placed in the area of the breast where the tissue was removed from. A mammogram is taken after the biopsy to document that the clip is in the correct position. Clip location should be recorded in the procedure note. The pathology report must be interpreted along with the procedure note.
The procedure note is only complete when the doctor who performed the biopsy has reviewed the pathology report. When results are concordant, the findings and recommendations are taken at face value. Findings are discordant when the imaging and pathology don’t fit.
Excisional Biopsy
This may also be referred to as an open surgical biopsy. An excisional biopsy / open surgical biopsy can be performed with or without localization. Breast lesions that cannot be felt (palpated) on physical/clinical examination but are only seen on imaging need wire-localization.
A thin guide-wire is passed through the skin and into area of concern. An incision is made in the skin, the wire is followed to the mass or calcifications and the tissue is removed. Most of the time, the specimen is X-rayed to be sure the correct spot was removed. Then the tissue is sent to the pathologist.
In cases where a breast mass is easy to feel, it can be surgically removed without localization. An incision is made and the mass is removed using special scissors or a similar device. The tissue is sent to the pathologist for results.
Excisional biopsy is very similar to lumpectomy / partial mastectomy. The difference is that in lumpectomy / partial mastectomy, the surgeon’s goal is to remove the lesion with a rim of surrounding normal tissue. In an excisional biopsy, the focus is to remove the lesion only.
Breast Health Institute Austin
If you are worried about your breasts and want them to be healthy or have additional questions regarding breast biopsy techniques, Dr. Miltenburg and the Breast Health Institute of Austin is the place for you. Contact us today to schedule a consultation.