Biopsy options available to detect cancer

Lisa F. Baron, M.D., Chief of Mammography, Hollings Mammography Center

The number of newly diagnosed breast cancers among American women continues to rise. Nearly 185,000 women will be diagnosed this year.

In 1998 breast cancer will be the most frequently diagnosed cancer in women, due partly to early detection, but also to the growing age of the population. Yet, when detected early, breast cancer patients can lead normal and productive lives.

A combination of routine mammography and physical examination is critical in the early detection of breast cancer. Mammography is often able to detect the cancer when it is too small to be felt. Ironically, a lump may be felt within the breast, and may be difficult to see on the mammogram. This is why the combination of mammography and breast examination is important.

Fortunately, most abnormalities discovered by physical examination, or on the mammogram are benign (not cancerous). However, a sample of tissue is often needed for confirmation.

If the abnormal mammographic finding is felt (palpable), it often can be biopsied without any additional imaging assistance. When the abnormality is too small to be felt additional methods are needed to obtain a tissue sample. This selection depends on a variety of factors.

Historically, the most common method used to localize an abnormality was a needle localized biopsy. This technique is still the best method of biopsy for some patients. The procedure is performed in the Mammography Department prior to the surgical biopsy.

A thin wire is placed into the suspicious area within the breast and left in place as a marker for the surgeon. Once the wire is in place, the patient is taken to the operating room, and the surgeon removes the sample of tissue along with the wire. The specimen is then reviewed by the pathologist under the microscope to determine if cancer is present.

Many breast abnormalities now can be biosied without having to go to the operating room. Two methods are commonly used. First is the Stereotactic Breast Core Biopsy, which uses a special computer to locate the abnormality in the breast. MUSC has performed this procedure since 1992 and was the first institution in Charleston to be accredited by the American College of Radiology.

The method does not involve an operation. Instead a small needle is guided to the abnormality in the breast using a computer. A small sample of tissue is removed and analyzed under the microscope. Only a small skin incision is made, which usually heals without scarring and the patient does not require stitches. Most patients tolerate the biopsy well and can resume their normal activities immediately after the procedure.

The second type of core biopsy is performed with guidance from an ultrasound machine. If the lesion is able to be seen with the ultrasound machine, then a needle can be maneuvered to the abnormality and a biopsy taken. Local anesthesia is given so the procedure usually does not hurt. Because only a small skin incision is made, stitches are not needed. The samples of tissue are then reviewed by the pathologist and the findings are reported to the doctor. The decision on the type of biopsy depends on the size and location of the lesion, patient considerations and if the lesion is a mass or contains calcifications. It is important to remember that most biopsy results are not cancer, but a tissue sample is needed for confirmation.

The need for a biopsy is no reason to panic. Talk to your health care provider. Ask questions. Call the Hollings Mammography Center at (843)-792-1999 for further information.

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