Type of Surgery
Information
Last updated: 02/17/2009
The type of biopsy recommended will depend on whether the area can be felt, how well it can be seen on mammogram or ultrasound, and how suspicious it feels or appears. Specialized equipment is needed for different types of biopsy and availability may...
vary.
Surgical biopsy
There are two major types of surgical breast biopsy: excisional and incisional. An excisional biopsy is a surgical procedure where the entire area of concern and some surrounding tissue is removed. It is usually done as an outpatient procedure in a hospital or freestanding surgery center. The patient may be awake and is sometimes given medication to make her drowsy. The area to be operated on is numbed with local anesthetic. Infrequently, general anesthesia is used. An excisional biopsy itself usually takes under one hour to perform. The total amount of time spent at the facility depends on the type of anesthesia used, whether a needle localization was done, and the extent of the surgery.
If a mass is very large, an incisional biopsy may be performed. In this case, only a portion of the area is removed and sent for analysis. The procedure is the same as an excisional biopsy in other respects.
Needle biopsy
A needle biopsy removes part of the suspicious area for examination. There are two types: aspiration biopsy (using a fine needle) and large-core needle biopsy. Either of these may be called a percutaneous needle biopsy. Percutaneous refers to a procedure done through the skin.
A fine-needle aspiration biopsy uses a very thin needle to withdraw fluid and cells that can be studied. It can be done in a doctor's office, clinic, or hospital. Local anesthetic may be used, but is sometimes withheld, as its administration may be more painful than the biopsy needle. The area to place the needle may be located by touch without using specialized equipment. However, ultrasound guidance enables the physician to feel and see the lesion at the same time. The actual withdrawal of fluid and cells can be visualized as it occurs. This helps ensure that the specimen is taken from the right place.
A large-core needle biopsy uses a larger diameter needle to remove small pieces of tissue, usually about the size of a grain of rice. It can be done in a clinic or hospital that has the appropriate facilities. Local anesthetic is routinely used. Ultrasound or x ray is used for guidance of a large-core needle biopsy.
If the suspicious area is seen best with x ray, a stereotactic device is used. This means that x rays are taken from several angles. The information is fed into a computer that analyzes the data and guides the needle to the correct place. The patient may be sitting up, or she may be lying on her stomach, with her breast positioned through an opening in the table. The breast is held firmly but comfortably between a plastic paddle and a metal plate, similar to those used for mammograms. X rays may be taken before, during, and after the tissue is drawn into the needle to confirm that the correct spot is biopsied. This procedure may also be referred to as a stereotactic core biopsy, or a mammotomy.
Ultrasound is used to guide needle placement for some lesions. The patient lies on her back or side. After the area is numbed, sterile gel is applied. The physician places a transducer, an instrument about the size of an electric shaver, over the skin. This produces an image from the reflection of sound waves. A special needle, usually in a spring-loaded device, is used to obtain the tissue. The procedure is observed on a monitor as it is happening.
An abnormal pathology report indicates a cancer is present. If a fine-needle aspiration biopsy was performed, the pathologist has viewed individual cells under a microscope to see if they appear cancerous. Large-core needle biopsy and surgical biopsy will be able to give more information. This includes the type of cancer, whether or not it has invaded surrounding tissue, and how likely it is to spread quickly. There are some conditions that are not malignant but indicate high risk for future development of breast cancer. If these are identified, more frequent monitoring of the area may be recommended.
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Other Information
A biopsy (in Greek: Ī²ĪÆĪæĻ life and ĻĻĪ· look/appearance) is a medical test involving the removal of cells or tissues for examination. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically. When an entire lump or suspicious area is removed, the procedure is called an excisional biopsy. When only a sample of tissue is removed with preservation of the histological architecture of the tissue's cells, the procedure is called an incisional biopsy or core biopsy. When a sample of tissue or fluid is removed with a needle in such a way that cells are removed without preserving the histological architecture of the tissue cells, the procedure is called a needle aspiration biopsy.
Several methods for breast biopsy now exist. The most appropriate method of biopsy for a patient depends upon a variety of factors, including the size, location, appearance and characteristics of the abnormality.
ā¢ Fine Needle Aspiration
(FNA) Fine needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass. With FNA, the cellular material taken from the breast is usually sent to the pathology laboratory for analysis. A technique similar to FNA can also be used by the radiologist or surgeon to drain fluid from a benign cyst. This procedure is called cyst aspiration. A Fine Needle Aspiration procedure is generally almost painless and takes only a few minutes to perform.
ā¢ Core Needle Biopsy
A core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle. For palpable (āable to be feltā) lesions, the physician is fixing the lesion with one hand and performing a freehand needle biopsy with the other. In case of non-palpable lesions stereotactic mammography or ultrasound guidance is used. With stereotactic mammography it is possible to pinpoint the exact location of a mass based on images taken from two different angles of the x-ray machine. With ultrasound, the radiologist or surgeon can watch the needle on the ultrasound monitor to help guide it to the area of concern. The needle used during core needle biopsy is larger than the needle used with FNA. The core biopsy needle also has a special cutting edge allowing removal of a bigger sample of tissue. With Core Needle Biopsy a relatively large sample can be removed through a small single incision in the skin. Typically, the breast area is first locally anesthetized with a small amount of anesthetic fluid. Then, the needle is placed into the breast. As with FNA, the radiologist or surgeon will guide the needle into the area of concern by palpating the lump. If the lesion canāt be felt the core needle biopsy is performed under image-guidance using either stereotactic mammography, ultrasound or even magnetic resonance imaging (MRI). A core needle biopsy procedure takes a few minutes to perform and is almost painless.
ā¢ Vacuum Assisted Biopsy
Vacuum Assisted Biopsy is a version of Core Needle Biopsy using a vacuum technique to assist the collection of the tissue sample. The needle normally has a lateral (āfrom the sideā) opening and can be rotated allowing multiple samples to be collected through a single skin incision. The Vacuum Assisted Biopsy procedure is similar to normal Core Needle Biopsy.
ā¢ Open Surgical Biopsy
Open Surgical Biopsy means that a large mass or lump is removed during a surgical procedure. Surgical biopsy requires an approximately 3 to 5 centimeters incision and is normally performed in an operating room in sterile conditions. Open surgical biopsy in some cases can be performed with local anesthesia but in most cases general anesthesia may be necessary. Ten years ago, most breast biopsies were open surgical procedures. Today most patients are candidates for less invasive biopsy procedures such as core needle biopsy. Depending on the location of the lesion to be biopsied, a radiologist will often perform needle localization beforehand to guide the surgeon to the site being biopsied.
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