The only certain way to learn whether a breast lump or mammographic abnormality is cancerous is by having a biopsy, a procedure in which tissue is removed by a surgeon or other specialist and examined under a microscope by a pathologist. A pathologist is a doctor who specializes in identifying tissue changes that are characteristic of disease, including cancer.
Tissue samples for biopsy can be obtained by either surgery or needle. The doctor's choice of biopsy technique depends on such things as the nature and location of the lump, as well as the woman's general health.
- Redness or swelling around the incision
- Warmth around the incision
- Drainage from the incision
What Is The Purpose Of A Breast Biopsy ?
The basic aim of a breast biopsy is to determine whether or not a worrisome lump is cancer and, if it is cancer, what type it is. When no cancer is detected, the diagnosis of a benign or harmless lump is reassuring.
The patient lies prone on the stereotactic table with the breast suspended through a hole in the table The breast is then placed in compression. Images are then obtained using digital x-rays. These x-rays use much less radiation than traditional mammograms. Images are taken at two 15-degree angles from the center. The images are viewed on a computer monitor, and the physician can identify the lesion in three dimensions.
The computer can then then help guide a biopsy needle to the exact coordinates of the lesion. The breast tissue can be removed in one of two ways. A large bore needle can be used to remove cores of tissue. This is called the Mammotome procedure.
It removes cores of breast tissue via a small incision (2-3mm). Multiple cores are taken (usually 6-10). The major advantage of the Mammotome procedure is that there is virtually no scar. The other type of stereotactic breast biopsy is called the ABBI procedure. This device removes a larger core of tissue (5-20mm).
In this fashion, the entire lesion can be removed. This can sometimes provide a more accurate diagnosis. Both types of stereotactic breast biopsies are performed under local anasthesia. Patients have minimal discomfort during or after the procedure. Patients can usually resume normal activities by the following day. Stereotactic biopsies have been shown to be very accurate. They are as accurate as an open surgical biopsy.
Benefits of the procedure include less patient discomfort, quicker recovery, decreased scarring, and decreased cost. Traditional mammographic directed biopsies require that the lesion be seen on two views, but with stereotactic techniques abnormalities that are seen on one view can be removed. There are certain mammographic lesions that cannot be biopsied stereotactically. These include areas that are vague on the mammogram and might not show up on the digital screen as well as some areas of diffuse calcifications. Technical problems are sometimes seen in patients with small breasts or in lesions that are up against the chest wall.
The decision as to whether a lesion can be removed stereotactically is usually made by the surgeon and the radiologist. As the procedure of stereotactic breast biopsy becomes more popular, more hospitals are obtaining the necessary equipment. Thus the technique is becoming available to the majority of patients with mammographically detectable lesions.
- There is a slight chance of infection at the injection or incision site.
- Excessive bleeding is rare, but may require draining or re-bandaging. Bruising is common.
- There will be a scar. Depending on the amount of tissue removed and how the breast heals, the appearance of the breast may be affected.
- Depending on the results of the biopsy, further surgery or treatment may be needed.
Other Benign Breast Conditions
- Mastitis : - Mastitis is a breast infection that most often affects women who are breast-feeding. The breast may become red, warm, or painful. Mastitis is treated with antibiotics. But if the mastitis does not get better when you take antibiotics, it is important that you let the doctor know right away. Some breast cancers can look like infections.
- Fat Necrosis : - Fat necrosis sometimes happens when an injury to the breast heals and leaves scar tissue that can feel like a lump. A biopsy can tell if it is cancer or not. Sometimes when the breast is injured, an oil cyst (fluid-filled area) forms instead of scar tissue during healing. Oil cysts can be diagnosed and treated by taking out (aspirating) the fluid.
- Duct Ectasia : - Duct ectasia is common and most often affects women in their 40s and 50s. Its symptoms are usually a green, black, thick, or sticky discharge from the nipple, and tenderness or redness of the nipple and area around the nipple. Duct ectasia can also cause a hard lump, which is usually biopsied to be sure it is not cancer. Redness that does not improve may need to be biopsied to be sure it is not cancer.
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