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.