Written by Dr. Olga Bednarek
Category: Procedures
Published: February 2, 2017
Breast Biopsy
If you have a noticeable breast mass or an abnormal mammogram, the next step is to obtain a tissue sample, known as a biopsy. There are several different types of biopsies available for different circumstances.
- Core Needle Biopsy
- Core needle biopsies are performed with local anesthetic. This means that you will be awake, and your doctor will inject some medication to numb just the area where they are taking the sample from.
- A small cut is made in the skin of the breast, through which the biopsy needle is inserted. The needle is designed to remove small slivers of tissue from the area of concern. Mammography or ultrasound are often used to help guide the needle to the correct area. The needle will be passed several times to ensure there is an adequate sample for study.
- Excisional Biopsy
- Excisional biopsy involves surgical removal of the lesion in your breast. It is used when a core needle biopsy is not possible (due to location of the lesion) or if the results of the core needle biopsy does not provide enough information to make a diagnosis. An excisional biopsy may be performed under local or general anesthesia.
- A wire is used to guide the surgeon to the location of the lesion. The wire is placed using mammogram or ultrasound for guidance.
- It is important to note that an excisional biopsy is used for the purpose of diagnosis only. If the diagnosis is known to be breast cancer, one of the treatment options in lumpectomy.
- Lumpectomy
- Lumpectomy is similar to excisional biopsy; however, it involves surgical removal of a known breast cancer, as opposed to sampling some tissue to obtain a diagnosis. Lumpectomy may also be performed with local or general anesthesia, and may also use a wire to guide the surgeon to the cancer. The goal of a lumpectomy is to remove all of the cancer.
- Mastectomy
- Mastectomy refers to the complete removal of your breast. Whether you have a lumpectomy or mastectomy depends on tumour size and the extent of the cancer. Some patients may choose to have a mastectomy instead of a lumpectomy for a variety of reasons. Patients who have a strong family history of breast cancer or who have certain genetic mutations (for example, BRCA1 or BRCA2) may choose to have a preventative mastectomy in order to reduce their risk of future cancer.
- Mastectomy is performed under general anesthesia. An incision will be made along the length of your breast. The tissue will be removed and the skin closed with sutures. Your surgeon may leave a drain in to help remove fluid that can accumulate where the tumour was. The drain will be removed in a follow up appointment.
- It may be possible to have breast reconstruction performed immediately after mastectomy. Talk to your surgeon about whether this is a good option for you.
- Sentinel Lymph Node Biopsy
- Lymph nodes are a part of your body’s immune system. Lymph fluid is a fluid in your body that helps nourish your cells and fight off infections. It is transported around your body by lymph vessels, and harmful substances are filtered out of it by lymph nodes. If cancer has spread enough to enter the lymphatic system in your body, cancer cells will be collected by the lymph nodes. A sentinel lymph node biopsy is done during surgery to determine how far a cancer has spread.
- The sentinel lymph node is the first node (or nodes) in the system that the cancer could possibly spread to. Your doctor will determine which node this is by injecting a blue dye or a special radioactive marker into the tissue around the tumour. This node will be removed and sent to a pathologist, who will examine it for cancer while you are in surgery. Depending on what the pathologist finds, your surgeon may remove more nodes in order to determine how far the disease has spread.
Sources: UpToDate: Breast biopsy; Sentinel lymph node biopsy in breast cancer: Techniques; Overview of sentinel lymph node biopsy in breast cancer; Mastectomy: indications, types, and concurrent axillary lymph node management
http://www.cancer.org/cancer/cancerbasics/lymph-nodes-and-cancer
http://www.breastcancer.org/treatment/surgery/mastectomy/expectations