CYTOLOGY
If a suspicious mass is detected during imaging then a tissue sample must be taken to be examined under a microscope and determine the nature of the mass.
FINE NEEDLE ASPIRATION
This technique is used when the lump is palpable. During the procedure a 21-gauge needle is inserted into the lump and fluid together with cells are taken to be examined under a microscope. The cytological characteristics of the tissue sample are evaluated and classified in the following categories:
C1: Inadequate for diagnosis
C2: Definitely benign
C3: Suspicious, probably benign
C4: Suspicious probably malignant
C5: definitely malignant
The C1 classification is not uncommon and occurs in20% of cases because inadequate material has been obtained. Finally a C3 or C4 classification will need to be further investigated
NEEDLE CORE BIOPSY
When the fine needle aspiration is inconclusive or the results are classified as suspicious a needle core biopsy is taken. Furthermore for solid lumps the core biopsy must be carried out under image guidance (mammography or ultrasound) to ensure that a suitable sample of the suspicious lump is obtained.
After localization of the suspicious lump an incision is made into the skin above the lump and a narrow biopsy needle is pushed into the lump by a biopsy gun. Usually up to five cores of tissue about 3mm wide and 10-15mm long are obtained. Then the core biopsies are X-rayed to make sure that sufficient samples of the calcification are obtained. Finally the tissue is processed to be observed under the microscope and classified in the following categories;
B1: Normal breast tissue. In this case no significant abnormalities are present and no further investigation is required
B2: Benign breast tissue. In this case the lump will be removed or monitored (e.g. fibroadenoma)
B3: Equivocal – Possibly/potentially malignant. In this case diagnostic or therapeutic surgery is mandatory
B4: Suspicious (e.g. atypical ductal hyperplasia)
B5: Malignant mass
SURGICAL BIOPSY
During this procedure an incision is made on the breast and tissue is removed surgically to be examined in the pathology lab under a microscope as mentioned above. In excisional biopsy the entire lump and part of the surrounding tissue is removed. In cases when the lump is very large and full removal could result to disfigurement of the breast an incisional biopsy is more likely to be performed. During this procedure only a small part of the lump is removed.
STEREOTACTIC CORE-NEEDLE BIOPSY
A new biopsy devise can be used in some cases to avoid surgical biopsy. During this technique mutable angle X-rays are taken with a mammogram machine to locate the exact position of and a computer controlled biopsy device performs a core needle biopsy as described above.
FINE WIRE LOCALIZATION DIRECTED BIOPSY
In case when imaging techniques and core needle biopsy are not conclusive and a surgical biopsy must be taken from a non-palpable lump this technique can help localize the suspicious mass before surgery. A lump is located by a mammogram machine and a thin hollow needle is guided into the lump through multiple mammogram slights. A very thin thin wire which is hooked at the end is then placed on the lump through the hollow needle. Finally the needle is removed leaving the wire in as a guide for the surgeon and the patient is then transferred to an operating room for a surgical biopsy.
If a suspicious mass is detected during imaging then a tissue sample must be taken to be examined under a microscope and determine the nature of the mass.
FINE NEEDLE ASPIRATION
This technique is used when the lump is palpable. During the procedure a 21-gauge needle is inserted into the lump and fluid together with cells are taken to be examined under a microscope. The cytological characteristics of the tissue sample are evaluated and classified in the following categories:
C1: Inadequate for diagnosis
C2: Definitely benign
C3: Suspicious, probably benign
C4: Suspicious probably malignant
C5: definitely malignant
The C1 classification is not uncommon and occurs in20% of cases because inadequate material has been obtained. Finally a C3 or C4 classification will need to be further investigated
NEEDLE CORE BIOPSY
When the fine needle aspiration is inconclusive or the results are classified as suspicious a needle core biopsy is taken. Furthermore for solid lumps the core biopsy must be carried out under image guidance (mammography or ultrasound) to ensure that a suitable sample of the suspicious lump is obtained.
After localization of the suspicious lump an incision is made into the skin above the lump and a narrow biopsy needle is pushed into the lump by a biopsy gun. Usually up to five cores of tissue about 3mm wide and 10-15mm long are obtained. Then the core biopsies are X-rayed to make sure that sufficient samples of the calcification are obtained. Finally the tissue is processed to be observed under the microscope and classified in the following categories;
B1: Normal breast tissue. In this case no significant abnormalities are present and no further investigation is required
B2: Benign breast tissue. In this case the lump will be removed or monitored (e.g. fibroadenoma)
B3: Equivocal – Possibly/potentially malignant. In this case diagnostic or therapeutic surgery is mandatory
B4: Suspicious (e.g. atypical ductal hyperplasia)
B5: Malignant mass
SURGICAL BIOPSY
During this procedure an incision is made on the breast and tissue is removed surgically to be examined in the pathology lab under a microscope as mentioned above. In excisional biopsy the entire lump and part of the surrounding tissue is removed. In cases when the lump is very large and full removal could result to disfigurement of the breast an incisional biopsy is more likely to be performed. During this procedure only a small part of the lump is removed.
STEREOTACTIC CORE-NEEDLE BIOPSY
A new biopsy devise can be used in some cases to avoid surgical biopsy. During this technique mutable angle X-rays are taken with a mammogram machine to locate the exact position of and a computer controlled biopsy device performs a core needle biopsy as described above.
FINE WIRE LOCALIZATION DIRECTED BIOPSY
In case when imaging techniques and core needle biopsy are not conclusive and a surgical biopsy must be taken from a non-palpable lump this technique can help localize the suspicious mass before surgery. A lump is located by a mammogram machine and a thin hollow needle is guided into the lump through multiple mammogram slights. A very thin thin wire which is hooked at the end is then placed on the lump through the hollow needle. Finally the needle is removed leaving the wire in as a guide for the surgeon and the patient is then transferred to an operating room for a surgical biopsy.