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					     Breast Biopsy:
What to Expect When a Lump Is
          Detected
                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.
          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.
                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.
              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 woman’s general
health.
                   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
                   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 doctor’s 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 doctor’s office
  or hospital outpatient clinic.
        Advantages of Needle Biopsies

•   Simple procedure – does not require surgery
•   Accurate
•   Quick – only takes a few minutes
•   Not painful
•   Inexpensive
•   Quick results
     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
                   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
                 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
                 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
        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
      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
                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
                             Summary
Breast cancer is often suspected when a lump is felt
  during a breast-self exam or clinical breast exam
and/or an abnormal area is found on a mammogram.


                  After a lump has been detected,
             the doctor will follow a step by step process.


                             The doctor will ask you about
                                 your medical history.


                                      The doctor may order follow-up
                                          tests and/or a biospy.


                                     Your options for biopsy are determined by whther
                                  the lump is palpable or non-palpable, the location of the
                                          lump, and the woman's general health.


                                           Remember, only 1 in 5 women who have biopsies
                                               will actually be diagnosed with cancer.
Important Information to Know...
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.
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.
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.
How much does a biopsy normally cost?

 Biopsies range in price depending upon the technique.
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?
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.
What happens if the biopsy results
indicate cancer?
There are several things that may happen:

1.   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.
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.
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.
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.
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.
     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.
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.