BIOPSYBIOPSYBreast BiopsyBreast Biopsycompiled Bycompiled By

Dr. Dr. Sunil Vishwakarmaunil VishwakarmaRSO SurgeryRSO Surgery

G. R. Medical College, GwaliorG. R. Medical College, Gwalior

WHAT IS BIOPSY?WHAT IS BIOPSY? Indicates removal of tissue from a living body for Indicates removal of tissue from a living body for

microscopic diagnostic examination microscopic diagnostic examination Most precise and accurate Most precise and accurate Primary purpose: determine the diagnosis Primary purpose: determine the diagnosis

precisely for proper treatment precisely for proper treatment Should always be used to verify presence and Should always be used to verify presence and

nature of neoplastic diseasenature of neoplastic disease More likely to rule out malignancy than to More likely to rule out malignancy than to

diagnose cancer diagnose cancer

TECHNIQUES OF BIOPSYTECHNIQUES OF BIOPSY

EXCISIONAL BIOPSYEXCISIONAL BIOPSY Removal of lesion in its entirety Removal of lesion in its entirety For discrete lesions For discrete lesions Includes 2-3 mm perimeter of normal tissueIncludes 2-3 mm perimeter of normal tissue Certainly benign lesionsCertainly benign lesions

EXCISION BIOPSYEXCISION BIOPSY

METHOD:METHOD: Administer local anesthetic (should not be closer Administer local anesthetic (should not be closer

than 2cm from the site to avoid “waterlogging”)than 2cm from the site to avoid “waterlogging”) Stabilize lesion ; Apply tractionStabilize lesion ; Apply traction Incise skin or mucosa around the base of the lesion in Incise skin or mucosa around the base of the lesion in

an elliptical shapean elliptical shape Detach lesionDetach lesion Place specimen in Place specimen in

BottleBottle Suture woundSuture wound

INCISIONAL BIOPSYINCISIONAL BIOPSY

Removes only a portion of the lesionRemoves only a portion of the lesion Removal of a wedge of tissue including normal Removal of a wedge of tissue including normal

tissue, also known as WEDGE BIOPSYtissue, also known as WEDGE BIOPSY For lesions >1 cm diameterFor lesions >1 cm diameter Includes normal and abnormal tissuesIncludes normal and abnormal tissues May risk shedding malignant cellsMay risk shedding malignant cells Should not be done on pigmented or vascular Should not be done on pigmented or vascular

lesionslesions Record position, size, shape of lesionRecord position, size, shape of lesion

INCISIONAL BIOPSYINCISIONAL BIOPSY

Narrow, deep Broad, shallow

INCISIONAL BIOPSYINCISIONAL BIOPSY METHOD:METHOD:

Administer local anestheticAdminister local anesthetic Identify junction between normal tissue and the Identify junction between normal tissue and the

lesionlesion Stabilize then dissect the specimenStabilize then dissect the specimen Place specimen Place specimen

in bottlein bottle Suture woundSuture wound

ASPIRATION BIOPSYASPIRATION BIOPSY

Performed with needle and syringe on any fluid-Performed with needle and syringe on any fluid-filled lesion, except mucocele filled lesion, except mucocele

2 main types: 2 main types: Explore whether a lesion contains fluidExplore whether a lesion contains fluid Used to actually aspirate cells for pathologic Used to actually aspirate cells for pathologic

diagnosis (fine needle aspiration)diagnosis (fine needle aspiration) To avoid scar or when adjacent anatomic structures pose To avoid scar or when adjacent anatomic structures pose

a risk. e.g. neck masses a risk. e.g. neck masses

ASPIRATION BIOPSYASPIRATION BIOPSY

METHOD:METHOD: Clean the tissueClean the tissue Inject anesthetic OVER; not INTO the lesionInject anesthetic OVER; not INTO the lesion Select a wide bore needle and 10mL/20mL syringeSelect a wide bore needle and 10mL/20mL syringe Penetrate tissue and aspirate fluidPenetrate tissue and aspirate fluid Transfer to bottleTransfer to bottle Needle tip may have to be repositioned repeatedly Needle tip may have to be repositioned repeatedly

on an effort to locate a suitable fluid-containing on an effort to locate a suitable fluid-containing cavitationcavitation

ASPIRATION BIOPSYASPIRATION BIOPSY

The needle is then moved in a to and fro fashion within the mass

Needle tip may have to be repositioned repeatedly on an effort to locate a suitable fluid-containing cavitation

PUNCH BIOPSYPUNCH BIOPSY Inserted into the center of a lesion and Inserted into the center of a lesion and

a small plug of tissue removed a small plug of tissue removed

BREAST BIOPSYBREAST BIOPSY

A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders. Several different types of biopsy may be done.

INDICATIONSINDICATIONS

Any suspicious lump/lesion in the breast Any suspicious lump/lesion in the breast warrants for the biopsy.warrants for the biopsy.

When a lump is found, a biopsy is the first step When a lump is found, a biopsy is the first step in diagnosis and treatment.in diagnosis and treatment.

Although the primary purpose is to diagnose Although the primary purpose is to diagnose cancer, a biopsy can also be a surgical treatment cancer, a biopsy can also be a surgical treatment to remove cancer.to remove cancer.

MOST COMMON CAUSES OF MOST COMMON CAUSES OF BREAST LUMPBREAST LUMP

FibroadenomaFibroadenoma FibroadenosisFibroadenosis Breast abscessBreast abscess BreastcystBreastcyst Breast cancerBreast cancer

TYPES OF BREAST BIOPSIESTYPES OF BREAST BIOPSIES

There are two main types of biopsies:There are two main types of biopsies:Needle BiopsyNeedle BiopsyOpen BiopsyOpen Biopsy

Your options for biopsy are determined by Your options for biopsy are determined by whether the lump is palpable (can be felt) or non-whether the lump is palpable (can be felt) or non-palpable (can not be felted), the location of the palpable (can not be felted), the location of the lump and the woman’s general health.lump and the woman’s general health.

NEEDLE BIOPSYNEEDLE BIOPSY

A needle biopsy is a procedure that uses a A needle biopsy is a procedure that uses a needle to remove tissue or cells from the needle to remove tissue or cells from the breast.breast.

There are two types of needle biopsies:There are two types of needle biopsies:

Fine Needle and Core Needle BiopsyFine Needle and Core Needle Biopsy

NEEDLE BIOPSIESNEEDLE BIOPSIES

Fine Needle Fine Needle – A thin, hollow needle is used to – A thin, hollow needle is used to remove a sample of tissue. The procedure is remove a sample of tissue. The procedure is quick and can be done in a doctor’s office.quick and can be done in a doctor’s office.

Core NeedleCore Needle – A larger needle is inserted – A larger needle is inserted through a small incision in the skin, and a small through a small incision in the skin, and a small core of tissue is removed. This type of needle core of tissue is removed. This type of needle biopsy is done with the assistance of biopsy is done with the assistance of mammography or ultrasound imaging in a mammography or ultrasound imaging in a doctor’s office or hospital outpatient clinic.doctor’s office or hospital outpatient clinic.

ADVANTAGES OF NEEDLE ADVANTAGES OF NEEDLE BIOPSIESBIOPSIES

Simple procedure – does not require surgerySimple procedure – does not require surgery AccurateAccurate Quick – only takes a few minutesQuick – only takes a few minutes Not painfulNot painful InexpensiveInexpensive Quick resultsQuick results

DISADVANTAGES OF DISADVANTAGES OF NEEDLE BIOPSIESNEEDLE BIOPSIES

Entire lump is not removedEntire lump is not removed Open biopsy may be necessaryOpen biopsy may be necessary

For Fine Needle Only:For Fine Needle Only: Specialist needed to read resultsSpecialist needed to read results In situ cancer not distinguishable from invasive In situ cancer not distinguishable from invasive

cancercancer

OPEN BIOPSIESOPEN BIOPSIES

An open biopsy is a surgical procedure that An open biopsy is a surgical procedure that opens the breast to remove tissue.opens the breast to remove tissue.

There are two types of open biopsies:There are two types of open biopsies:

Incisional and ExcisionalIncisional and Excisional

ADVANTAGES OF OPEN ADVANTAGES OF OPEN BIOPSIESBIOPSIES

Quick – takes only one hourQuick – takes only one hour More accurate than a needle biopsyMore accurate than a needle biopsy Larger samples provide information for Larger samples provide information for

treatment plantreatment plan

Excisional Only:Excisional Only: Removes entire lumpRemoves entire lump May be the only surgical treatment neededMay be the only surgical treatment needed

DISADVANTAGES OF OPEN DISADVANTAGES OF OPEN BIOPSIESBIOPSIES

Surgical procedureSurgical procedure ExpensiveExpensive Side effects such as infection or blood collection Side effects such as infection or blood collection

under the skinunder the skin

Excisional Only:Excisional Only: Removing tissue can change the look and feel of Removing tissue can change the look and feel of

the breastthe breast

IMAGING TECHNIQUESIMAGING TECHNIQUES

When a lump cannot be felt, the doctor must When a lump cannot be felt, the doctor must locate it with a special imaging technique.locate it with a special imaging technique.

The doctor may use mammography (sometimes The doctor may use mammography (sometimes called stereotactic localization) or ultrasound called stereotactic localization) or ultrasound imagingimaging

The lump is located by mammography or The lump is located by mammography or ultrasoundultrasound

The doctor inserts a needle to collect a sample The doctor inserts a needle to collect a sample of tissueof tissue

Female breastFemale breast

The female breast is either of two mammary glands (organs of milk secretion) on the chest.

Needle biopsy of the breastNeedle biopsy of the breastA needle biopsy is performed under local anesthesia. Simple aspirations are performed with a small gauge needle to attempt to draw fluid from lumps that are thought to be cysts. Fine needle biopsy uses a larger needle to make multiple passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present.

Open biopsy of the breastOpen biopsy of the breast

An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

LumpectomyLumpectomy

Lumpectomy is a surgical procedure performed on a solid breast mass to determine if it is malignant. The suspicious lump and some surrounding tissue is excised and analyzed.

Advanced Breast Biopsy Instrumentation Advanced Breast Biopsy Instrumentation (ABBI)(ABBI)

The ABBI procedure is performed under local anesthesia and is The ABBI procedure is performed under local anesthesia and is a one-step biopsy procedure. This means that it combines a one-step biopsy procedure. This means that it combines needle localization with the removal of the lump. needle localization with the removal of the lump.

Using stereotactic techniques, a technician pinpoints the lump Using stereotactic techniques, a technician pinpoints the lump with the aid of the computer, which calculates the precise with the aid of the computer, which calculates the precise location of the lump. The area is numbed with a local anesthetic location of the lump. The area is numbed with a local anesthetic and a marking needle is inserted to “tag” the precise location. A and a marking needle is inserted to “tag” the precise location. A narrow tube-like device is inserted into the breast to obtain 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 specimen. The small opening in the breast is closed with a few

stitches.stitches.

What are the advantages of the ABBI What are the advantages of the ABBI

procedure?procedure? The results are available in 24-48 hours.The results are available in 24-48 hours. The ABBI procedure takes less than one hour.The ABBI procedure takes less than one hour. The ABBI procedure is minimally invasive, therefore allowing The ABBI procedure is minimally invasive, therefore allowing

the woman to experience less time in healing and recovery.the woman to experience less time in healing and recovery. The ABBI procedure may be an alternative to open biopsies for The ABBI procedure may be an alternative to open biopsies for

non-palpable lesions. non-palpable lesions. The ABBI procedure is currently the only procedure other than The ABBI procedure is currently the only procedure other than

the traditional open surgery method which has the capability to the traditional open surgery method which has the capability to remove a lump or a cluster of microcalcifications in their remove a lump or a cluster of microcalcifications in their entirety. entirety.

What are the disadvantages of the ABBI What are the disadvantages of the ABBI

procedure?procedure? A downside to the ABBI procedure is availability. It is a A downside to the ABBI procedure is availability. It is a relatively new technique and many physicians may not be trained relatively new technique and many physicians may not be trained in the procedure or have the available equipmentin the procedure or have the available equipment. .

Mammotone & Minimally Invasive Mammotone & Minimally Invasive Breast Biopsy (MIBB)Breast Biopsy (MIBB)

The Mammotone and MIBB are very similar and are often called The Mammotone and MIBB are very similar and are often called Large Core Needle Biopsies. Large Core Needle Biopsies.

The Mammotone and MIBB are different from the core needle The Mammotone and MIBB are different from the core needle biopsy in that a needle is inserted once and multiple specimens are biopsy in that a needle is inserted once and multiple specimens are removed through contiguous sampling. Core needle biopsies require removed through contiguous sampling. Core needle biopsies require the needle to be inserted multiple times. the needle to be inserted multiple times.

Both the Mammotone and MIBB biopsy utilize a vacuum system. A Both the Mammotone and MIBB biopsy utilize a vacuum system. A probe is inserted and samples of tissue are collected in a chamber. probe is inserted and samples of tissue are collected in a chamber. Tissue samples are removed by action of a gentle vacuum. By Tissue samples are removed by action of a gentle vacuum. By rotating a thumbwheel, the physician moves the sampling notch to rotating a thumbwheel, the physician moves the sampling notch to the next desired position. the next desired position.

Advantages of the Mammotone & MIBBAdvantages of the Mammotone & MIBB

The sample of the lump is larger (up to 8X larger), the needle is The sample of the lump is larger (up to 8X larger), the needle is inserted only once to obtain multiple samples, and the sampling inserted only once to obtain multiple samples, and the sampling is contiguous and selectiveis contiguous and selective..

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