Breast biopsy-estimated 700,000 breast biopsies per year in the U.S.
Biopsies are required to confirm histology and assess tumor biology.
Biopsy should evaluate ER, PR, HER2 and consider BRCA mutation status, PD-L1 status in triple negative breast cancers, and phosphatidylinositol-4,5 bisphosphonate 3-kinase catalytic subunit alpha in ER/PR positive, HER2 negative metastatic breast cancer. genomic profiling on tumor tissue and circulating tumor DNA may also be carried out to alter treatment approaches.
1 in 4 positive for cancer.
Revealing proliferative lesions without atypia have a 1.5 to 2 fold greater breast cancer risk compared with women with nonproliferative lesions.
Women with atypical hyperplasia have a 3 to 5 fold higher risk of breast cancer than women with nonproliferative lesions.
Percutaneous tissue acquisition techniques include fine-needle aspiration, large-core biopsy and vacuum-assisted core biopsy.
False negative rate of fine-needle biopsy is high.
False positive cytology on fine-needle biopsy approximately 1-2%.
A diagnosis made on fine-needle biopsy is adequate for lumpectomy and axillary staging, but is not sufficient to proceed with mastectomy.
Stereotactic core needle biopsy is the diagnostic procedure of choice for most mammographic abnormalities.
Minimally invasive techniques, needle aspiration and core needle biopsies are the standard procedures for the diagnosis in the management of breast cancer and premalignant breast lesions.
There are four main types of breast biopsies that may be performed.
A fine-needle aspiration biopsy is usually ordered when the doctor is almost certain that the lump is a cyst.
This test is generally performed in conjunction with an ultrasound which is helpful in guiding the needle into a small or hard to find lump.
The procedure is painless and it consists in inserting a thin needle into the breast tissue while the lump is palpated.
The core-needle biopsy is normally performed under local anesthesia and in a physician’s office.
The needle used in this procedure is slightly larger than the one used for a fine-needle biopsy because the procedure is intended to remove a small cylinder of tissue that will be sent to the laboratory for further examination.
Stereotactic biopsy relies on a three-dimensional X-ray to guide the needle biopsy of non-palpable mass.
The biopsy is performed in a similar manner, by using a needle to remove tissue sample but locating the specific area of the breast is done by X-raying the breast by two different angle.
Surgical biopsy is a procedure performed to remove the entire lump or a part of it for laboratory analyzing.
Benefits of minimal invasive procedures include: ability to diagnose lesions with a small tissue sample, improves surgical planning, reduces the number of surgical procedures, avoids operation for benign lesions and avoids scarring lesions.
A minimum of four core biopsies specimens are recommended when performing ultrasound guided needle biopsy.
Multiple cores should be extracted to demonstrate the invasive nature of the lesion.
Specimen radiography of all microcalcifications and surgically excised masses should be part of the workup for all mammographically detected abnormalities. Two views are preferred to evaluate the radiologic adequacy of excision margins.
Median times between a benign result and cancer are 100, 124, and 92 months for women with nonproliferative lesions, proliferative lesions without atypia and atypical hyperplasia, respectively.
Surgeons should present the pathologist with an oriented specimen with inked margins.
The width of margins for invasive and in situ disease should be measured to the nearest millimeter.
Whenever possible the tumor size should be measured to the nearest millimeter and invasive and noninvasive components should be measured separately.
Must retrieve a substantial volume of tissue for HER-2-neu and hormone receptor status evaluations.
Small hematomas occur in as many as 60% of stereotactic guided breast biopsies, with 1% of such lesions becoming clinically problematic.