Breast Biopsy Types

What is a Breast Biopsy?

A breast biopsy is a diagnostic procedure where tissue from a suspect area within the breast is removed and examined under a microscope to determine if it is cancerous or benign. This is an essential step in diagnosing various breast conditions, particularly when earlier tests such as mammograms or ultrasounds suggest abnormalities.


Types of Breast Biopsy

  • Fine Needle Aspiration Biopsy (FNAB)
  • Core Needle Biopsy
  • Vacuum-Assisted Biopsy


Selection Criteria for Breast Biopsy Types

The choice of biopsy technique depends on several factors, including the nature and location of the breast abnormality, the number of lesions, patient health and preferences, and the equipment available. The objective is to obtain sufficient tissue for diagnosis with the least discomfort and scarring.


Risks and Considerations of Breast Biopsy

While breast biopsies are generally safe, they do carry some risks, such as infection, bruising, and, in rare cases, bleeding. Patients might also experience pain at the biopsy site. Another important consideration is the accuracy of the biopsy, as there is a small chance of a false-negative result where cancer is present but not detected by the biopsy.


Fine Needle Aspiration

Fine Needle Aspiration Biopsy (FNAB) is a minimally invasive diagnostic procedure used to evaluate suspicious masses within the breast. It involves using a thin, hollow needle to extract cells from a lump or abnormal growth in the breast. The procedure is often guided by palpation (feeling with the fingers) or imaging techniques such as ultrasound to locate the area of concern accurately.


Who is Suitable for FNAB?

FNAB is particularly suitable for evaluating cystic lesions (fluid-filled lumps) and can also be used to determine the nature of solid lumps. It's typically chosen when the abnormality is easily accessible and palpable or when the aim is to confirm the presence of a benign condition without more invasive procedures.


Fine Needle Aspiration Biopsy Procedure

The procedure for FNAB is relatively straightforward:

  • Preparation: The skin over the lump is cleaned, and a local anaesthetic may be applied to numb the area. However, it's not always necessary since the procedure is generally not very painful.
  • Needle Insertion: Under guidance, either by palpation or imaging, a fine needle attached to a syringe is inserted into the lump.
  • Sample Collection: The physician aspirates (draws out) cells and fluid by pulling back on the syringe plunger. This process may be repeated several times from different parts of the lump to collect enough cells for analysis.
  • Post-Procedure: After the needle is removed, pressure is applied to the biopsy site to stop any bleeding. Bandaging is typically minimal, and stitches are not required.


Advantages of Fine Needle Aspiration Biopsy

  • Minimally Invasive: FNAB is less invasive than other biopsies, resulting in less pain and scarring.
  • Quick Procedure: The entire process usually takes only a few minutes.
  • No Scarring: Since the needle is very fine, it leaves no scar.
  • Immediate Recovery: Patients can resume their normal activities immediately after the procedure.


Limitations of Fine Needle Aspiration Biopsy

  • Diagnostic Limitations: FNAB can sometimes yield insufficient tissue for a definitive diagnosis, requiring further testing with more invasive procedures like a core needle biopsy or an excisional biopsy.
  • Accuracy: There is a risk of false-negative results, where cancerous cells are present but not sampled by the needle. False positives are less common but can occur.
  • Cyst Rupture: If the needle punctures a cyst, it may cause the cyst to rupture, which is usually harmless but might cause discomfort.


Core Biopsy

A core needle biopsy (CNB) is a crucial diagnostic tool used in the evaluation of breast abnormalities, especially when imaging studies like mammograms or ultrasounds show areas of concern that cannot be conclusively identified as benign or malignant. This type of biopsy provides a more comprehensive tissue sample than fine needle aspiration (FNA), allowing for a detailed histological analysis that can confirm or rule out the presence of cancer.


Who is Suitable for CNB?

Core needle biopsy is often recommended when:

  • An abnormality that requires further examination is detected on a mammogram, ultrasound, or MRI.
  • There is a palpable lump in the breast that needs histological diagnosis.
  • Previous FNA results were inconclusive or non-diagnostic.
  • There is a need to distinguish between different types of breast cancer or to identify benign conditions.


Core Needle Biopsy Procedure

The core needle biopsy procedure is performed using a larger, hollow needle capable of removing cylindrical breast tissue samples. Here's how it typically proceeds:

  • Preparation: The area of the breast to be biopsied is cleaned, and local anaesthesia is administered to minimise discomfort.
  • Guidance: The procedure is often guided by imaging techniques such as ultrasound, MRI, or mammography (stereotactic biopsy) to accurately target the area of concern.
  • Needle Insertion: The biopsy needle is inserted into the breast through a small incision. Several cores of tissue (usually between three to six samples) are collected from different parts of the lesion.
  • Sample Collection: Each insertion collects a small cylinder of breast tissue, about 1/16 inch in diameter and 1/2 inch long.
  • Post-Procedure Care: After the needle is withdrawn, pressure is applied to the biopsy site to stop bleeding, followed by a sterile dressing. Stitches are not usually required.


Advantages of Core Needle Biopsy

  • Diagnostic Accuracy: Provides more tissue for examination than FNA, leading to a higher diagnostic accuracy.
  • Minimally Invasive: Less invasive than surgical biopsy, with a lower risk of scarring and complications.
  • Quick Recovery: Most patients can resume normal activities shortly after the procedure.


Risks and Considerations for Core Needle Biopsy

  • Bleeding and Bruising: Some patients may experience bleeding or bruising at the biopsy site.
  • Infection: There's a small risk of infection at the puncture site.
  • Pain: Due to local anaesthesia, the procedure is generally well-tolerated, but some discomfort or pain may occur during or after the biopsy.
  • False Negatives: Although less common than with FNA, there is still a risk of a false-negative result, where cancerous changes are missed.


Vacuum Biopsy

A vacuum-assisted biopsy (VAB) is an advanced form of breast biopsy that uses a vacuum-powered instrument to remove multiple tissue samples through a single needle insertion. This method is particularly useful for obtaining tissue from microcalcifications (tiny calcium deposits) and other small abnormalities detected during breast imaging exams, such as mammograms or MRIs.


Who is Suitable for Vacuum Biopsy?

Vacuum-assisted biopsy is indicated in several scenarios:

  • When imaging tests such as mammograms, ultrasound, or MRI reveal suspicious areas that are small, difficult to access, or would benefit from more extensive sampling.
  • For lesions that previous biopsy attempts have inadequately sampled.
  • When a larger sample size is needed to make a definitive diagnosis without resorting to surgical biopsy.


Vacuum Biopsy Procedure

The vacuum-assisted biopsy procedure is typically performed using local anaesthesia and guided by imaging technology:

  • Preparation: The skin over the biopsy site is cleaned, and local anaesthesia is administered to numb the area.
  • Guidance: To ensure precise lesion targeting, the procedure is often guided by ultrasound, stereotactic mammography, or MRI.
  • Insertion and Sampling: A small incision is made in the skin, and the biopsy needle is inserted. The vacuum device gently pulls tissue into the needle aperture without having to remove and reinsert the needle. Several samples can be collected by rotating the needle or repositioning the device through this single insertion.
  • Collection of Samples: The vacuum pulls the tissue into the needle, which is then cut and suctioned into a collection chamber. This process is repeated several times to ensure enough samples are gathered.
  • Closure: After the procedure, pressure is applied to minimise bleeding, and a bandage is placed over the site. Stitches are generally not necessary.


Advantages of Vacuum Biopsy

  • Efficient Sampling: This technique allows for multiple tissue samples through a single needle insertion, reducing the procedure time and discomfort.
  • Comprehensive: Capable of removing a larger amount of tissue, increasing the likelihood of an accurate diagnosis.
  • Minimally Invasive: Less invasive than a surgical biopsy, with minimal scarring and recovery time.
  • Precise: Imaging guidance allows for accurately targeting areas of concern, minimising damage to surrounding tissues.


Risks and Considerations for Vacuum Biopsy

  • Bleeding and Bruising: Some patients may experience minor bleeding or bruising at the biopsy site.
  • Infection: As with any procedure that breaks the skin, there is a risk of infection, though it is typically low.
  • Pain: Some discomfort may be experienced during or after the procedure, although local anaesthesia generally makes the procedure tolerable.
  • Tissue Damage: There's a slight risk of damage to the surrounding breast tissue or structures, although serious complications are rare.
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