Breast cancer biopsy procedure: stereotactic, needle, puncture and surgical

Medically reviewed: 20, January 2024

What is Breast Cancer Biopsy?

Breast cancer biopsy is a method of diagnostic sampling of atypical breast tissue samples for the purpose of their morphological identification.

• Breast biopsy is performed to exclude or confirm breast cancer in the presence of palpable densification;
• nepalpiruemogo nodal education according to mammography or ultrasound of the mammary glands;
• changes (crust, peeling, ulcers) or discharge from the nipple.

Fetal tissue collection is performed by a mammologist or surgeon in one of the ways taking into account the location and size of the tumor: fine needle aspiration biopsy, needle, stereotaxic needle, incisional (surgical) biopsy, using ultrasound or MRI, etc.

Only a biopsy with a cytological or histomorphological examination of the samples of the obtained material allows one to refute or confirm the malignancy of the process in the mammary gland.

When planning a biopsy, the psychological aspect of the procedure should be considered: the stress experienced by a woman, ignorance, fear of pain. It is important to remember that in 80% of cases as a result of a biopsy the diagnosis of breast cancer is not confirmed.

Before carrying out a breast cancer biopsy with the help of sonography or mammography, the location, depth and prevalence of the tumor focus is determined. With deep-lying non-palpable tumors, a breast biopsy is performed under X-ray, ultrasound or tomographic guidance. In the process of biopsy, the collection of cellular samples of suspicious breast tissue or the entire tumor is performed.

Indications for conduction of breast cancer biopsy

The clinical grounds for a biopsy of the breast are established by a mammalogist or an oncologist mammalogist. Breast biopsy can be prescribed if palpable seals are detected, suspicious areas on mammograms or with ultrasound of the breast, changes in the skin of the breast or near-sucking region (crusts, ulcers, peeling), bleeding from the nipple.

Before a biopsy of the mammary gland, an allergic anamnesis and the condition of the coagulation system is determined (a coagulogram is prescribed), anticoagulants are canceled. If a biopsy is associated with an MRI of the breast, implantable electronic devices are revealed.

In the case of pregnancy, the use of MRI and mammography during breast biopsy is not recommended. Before biopsy, the marking of the puncture point of the mammary gland by the marker is carried out.

Currently, mammology uses two methods of breast biopsy: minimally invasive transcutaneous and surgical. The optimal biopsy method is chosen in each individual case.

Methods of breast cancer biopsy

Needle breast cancer biopsy

The least traumatic of all methods of breast biopsy is fine needle aspiration. In the process of aspiration biopsy of the breast, it is possible to obtain a liquid or cell samples from the tumor for a cytological study. Fine needle biopsy is suitable for the study of palpable breast formations.

It is performed under local tissue infiltration with an anesthetic solution in the patient’s position, lying on the back. Under palpation control, the doctor inserts into the thickness of the gland tissues a thin long needle connected to the syringe. After the needle has entered the tumor, when the piston is pulled, a small amount of liquid or glandular material enters the syringe. In the case of puncturing the cyst, a sufficient amount of liquid contents can enter the syringe, after which the cystic cavity collapses.

With a small amount of cellular material, verification of the diagnosis can be difficult, which will require additional methods of breast biopsy.

The technique of needle breast cancer biopsy of the breast is similar to aspiration, with the difference that in this case a thicker needle is used. Needle biopsy of the mammary gland is performed with non-palpable tumors under the control of ultrasound, mammography, MRI. In the process of needle biopsy, it is possible to obtain a tissue sample the size of rice grain.

Breast stereobiopsy

Stereotactic breast biopsy is performed under the control of X-ray stereometry. The patient is placed on the study table on the abdomen, while the breast is tightly fixed in a special window with a compression plate. In this position, mammograms are performed at different angles to form a three-dimensional image. An automatic calculation of the parameters of the breast biopsy is performed: the entry points, trajectories of the biopsy needle and the site to be biopsy with an accuracy of 1 mm.

When stereotactic biopsy is used needle-pistol with a notch, allowing to receive a column of tissues for immunohistochemical, histological, molecular biological research.

Surgical breast cancer biopsy

Surgical methods involve the removal of a fragment (incisional biopsy) or the entire breast tumor (excisional biopsy) for histological verification.

The disadvantage of incisional breast biopsy can be a false-negative result in the heterogeneous nature of the tumor under investigation, in the structure of which both normal and atypical cells are contained.

To conduct excisional biopsy, a special marker conductor is used, which, under the control of the targeted mammography, is established within the defined formation. During the subsequent mini-operation, a conductor and the surrounding tissue are excised through a 3-5-cm incision, and seams are applied. Surgical excision biopsy is the most accurate, although the most traumatic method of examining the breast.

At the end of a breast biopsy, the area of ​​the puncture or incision is covered by a bandage; For an hour, compression and cooling of the breast area is performed to avoid the formation of a hematoma. On the day of breast biopsy, it is recommended to wear a bra and restrict physical activity.

What are the possible risks?

After a breast biopsy, pain may persist, swelling and bruising may occur at the site of the puncture; rarely – bleeding or infection occurs. In case of skin redness, local hyperthermia, discharge from the biopsy area, fever should immediately consult a doctor.

After incisional or excisional biopsy of the breast, deformity of the breast, formation of coarse scars is possible.

The accuracy of different types of breast biopsy in the definition of malignancy or benignness of the process is variable, therefore, it is not excluded that false negative results are obtained. When determining cancer cells in the biopsy, further (surgical, radiation, hormonal) treatment will be required.

Puncture breast cancer biopsy

Puncture biopsy of a non-palpable formation under the control of ultrasound is a procedure of targeted sampling of suspicious breast tissue for the purpose of preoperative cytomorphologic verification of the diagnosis. Ultrasound-control ensures that the biopsy needle is accurately hit by a puncture formation that can not be determined palpably.

This procedure is carried out in the X-ray room under local anesthesia immediately after the performance of the targeted mammography in various projections necessary for the precise localization of pathological formation.

Puncture breast cancer biopsy of axillary lymph nodes under the control of ultrasound is a diagnostic puncture of lymph nodes in the axillary region, aimed at elucidating the specificity of the pathological process, including at the level of the lymph nodes.

The indication for biopsy is the presence of an ultrasound picture of enlarged or structurally altered lymph nodes, especially in patients with newly diagnosed or treated breast cancer. Puncture biopsy of lymph nodes allows us to clarify the nature of the reactive process in the lymph nodes (metastatic, inflammatory), to determine the stage of the tumor, and ultrasound guidance provides tracking of the path of the biopsy needle.

Breast cancer trepanobiopsy

Trepanobiopsy of the breast – a minimally invasive technique for obtaining a histological material – a column of breast tissue weighing 0.1-0.3 g with a special needle for guillotine biopsy.

Trepanobiopsy of the breast can be performed mechanically or automatically (using a biopsy gun) and allows the pre-operative stage not only to investigate the morphological structure of the tissue sample, but also to determine the immunohistochemical profile of the tumor. Conducting trepanobiopsy of the mammary gland is indicated in case of noninformativity of a double fine needle biopsy. The efficacy of trepanobiopsy reaches 95-96%.

Breast Cancer Biopsy: Interpreting Results

A breast cancer diagnosis can be overwhelming, leaving patients anxious for answers and eager to explore available courses of action. One common diagnostic tool employed in identifying malignant cells within suspicious breast masses involves performing a biopsy.

Once samples have been extracted, histopathologic assessment plays a significant role in confirming whether neoplastic activity exists. While terms found within resulting reports may appear intimidating, familiarizing yourself with prevalent vocabulary translates complex data into comprehensible insights guiding informed decision-making.

Various approaches characterize breast cancer biopsies—each serving distinct clinical indications tailored to radiographic features and patient circumstances. Common methodologies comprise:

• Fine Needle Aspirate (FNA),
• Core Needle Biopsy (CNB),
• Ultrasound Guided Core Needle Biopsy (UG-CNB),
• Stereotactic Guided Core Needle Biopsy (SG-CNB),
• Magnetic Resonance Imaging Guided Core Needle Biopsy (MRIG-CNB),
• Open Surgical Biopsy.

Each strategy procures representative specimen(s) amidst precision imaging modalities offering accurate depictions of targeted regions. Upon collection, sample tissues undergo rigorous examination revealing fundamental cellular architectures poised for interpretation by trained pathologists.

Comprehending breast cancer biopsy findings relies heavily upon discerning the language used by expert analysts. Decoding terminology empowers readers to appreciate nuanced differences among diverse benign and malignant entities, establish therapeutic strategies accordingly, and monitor response patterns across longitudinal surveillance periods.

Benign Lesions

Benign lesions refer to harmless growth devoid of invasive characteristics. Examples incorporating but not limited to fibroadenomas, intraductal papillomas, sclerosing adenoses, radial scars, phyllodes tumors, and granular cell tumors.

Clinicians rely on excision whenever ambiguity arises between indolent versus potentially aggressive processes promoting ongoing observation or definitive therapy.

Fibroadenoma

Encountered frequently within young women, fibroadenomas represent benign stromal-epithelial tumors composed of uniform ductules encapsulated within dense connective framework. Classified into three categories namely Simple, Complex, and Juvenile based on cytological morphology and structural configurations observed under high power magnification. Routine monitoring suffices unless voluminous expansions ensue requiring prompt removal.

Intraductal Papilloma

Originating centrally within major laciferous ducts, intraductal papillomas present as solitary nodules featuring frond-like formations anchoring fibrovascular stalks lined with double layers of epithelium containing luminal columnar cells and basal myoepithelial counterparts.

Associations linking papillary carcinogenesis remain tenuous demanding vigilant scrutiny particularly when nipple discharge accompanies presentation.

Premalignant Conditions

Premalignant conditions denote aberrancies carrying increased susceptibilities towards future carcinomatous transformation requiring rigorous preventative oversight. Noteworthy instances consist of atypical hyperplasia types ranging from usual ductal hyperplasia (UDH) and lobular carcinoma in situ (LCIS) providing essential context pertinent to deciding suitable follow-up plans.

UDH vs LCIS

Distinguishing between typical and atypical ductal hyperplasia primarily depends upon quantitative metrics relating cellular density, arrangement irregularity, nuclear pleomorphism, mitotic frequency, and stratification severity detected exclusively within confined spaces spanning involved terminal ductulo-lobular units (TDLUs).

Comparably, LCIS embodies monomorphic population dispersed diffusely inhabiting entire acini frequently exhibiting discohesion lacking decisive polarization aligned alongside basement membranes. Prognostic ramifications diverge considerably underscoring necessity distinguishing variants predictive adverse sequelae.

Malignancy Characteristics

When confronted with established malignant phenomena, breaching traditional barriers engenders widespread dissemination compelling prompt attention. Salient markers highlighting:

• invasion incorporate tubule formation,
• loss of polarity,
• nuclear pleomorphism,
• mitotic activity,
• absence myoepithelial layer,
• angiolymphatic invasion,
• hormone receptor profiling indicating endocrine sensitivity.

Employing immunohistochemistry techniques, laboratorians identify differential antigen expressions driving additional molecular assays further clarifying genomic portraits streamlining multidisciplinary treatments.

Invasive Ductal Carcinoma (IDC)

Representing approximately eighty percentages breast malignancies, IDC initiates as single foci originating primary sites situated centrally within large collecting vessels extending exuberantly into adjacent adipocytes disrupting neighboring compartments propagating destructive cascades.

Conclusion

Navigating a breast cancer diagnosis can be distressing, however understanding each step provides comfort and clarity. After initial screening and diagnostic imaging, obtaining a definite answer frequently calls for a biopsy — a minimally invasive technique utilized to collect and analyze cells directly from the suspect mass. Various forms of biopsies cater to different clinical settings, all sharing an ultimate goal of confirmation, grading, staging, and typing the nature of suspected cancer for apt and timely commencement of treatment.

Histologically confirmed diagnoses arm patients and healthcare teams with paramount information influencing treatment trajectories. Identifying luminal A, luminal B, HER2-enriched, triple negative, or even rarer subtypes guides prognosis predictions, counselling discussions, and multi-modality management strategies. Equipped with tumor grade, hormonal receptor status, human epidermal growth factor receptor 2 (HER2)/neu protein overexpression, and Ki-67 labelling index, bespoke care plan designs integrate evidence-based protocols along adjuvant chemo-, radio-, hormonal-, or immuno-therapy interventions targeting residual micrometastasis thereby augmenting overall survival probabilities.