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Specialized Needle Biopsies

Computer Aided Detection (CAD)

Multi-Specialty Breast Care

Specialized Needle Biopsies

Breast Biopsy Techniques

Stereotactic Biopsy Many women go through the anxiety provoking experience of being called back to their breast center when an area of concern is found on their screening mammogram. If this area persists on the mammogram and/or ultrasound, the radiologist may recommend a biopsy. The biopsy will provide the pathologist with material so that a definitive diagnosis can be made. Please remember that 70 – 90% of all biopsies will be negative/benign, or not cancer.

Traditionally, when an abnormality presented itself, an excisional, or open surgical biopsy was performed. In this modern era, most breast biopsies are done under local anesthetic with some form of needle, in the doctor’s office, or breast center. There are, however, certain occasions when surgical biopsy will still be indicated and performed. Needle biopsy offers less disfigurement, immediate recovery, no general anesthetic with its side effects, and lower cost. Following is a fairly comprehensive list of the different types of needle biopsies.

FNA/ FINE NEEDLE ASPIRATION:

This procedure is usually guided by ultrasound, or by palpation/feel of a mass. A very narrow needle is placed into the lesion, through the anesthetized skin. Some cells are retrieved and then sent to the pathologist to be evaluated.

CORE NEEDLE BIOPSY:

Core Biopsy A small nick is made in the skin after the anesthetic has been administered. A larger needle is inserted into the suspicious area one or more times. This is usually a spring- loaded device for quick advancement and sampling. The benefit over FNA is that more cells and their background tissue are obtained, giving the pathologist more information from which a diagnosis can be made.

Core needle biopsy can be guided by ultrasound, by palpation/ feel, or by stereotactic guidance.

STEREOTACTIC NEEDLE BIOPSY:

Stereotactic Biopsy Table There are two scenarios currently available. One is an upright unit where the patient sits up in a chair, and her breast is compressed in a traditional mammogram unit. The second type is a prone table. In this model, the patient lies on her tummy, and the affected breast extends through a hole in the table, and is compressed below by a “mini-mammogram unit.” This second style reduces the incidence of patient motion, helps to prevent the occasional light-headed person from fainting, and takes advantage of the natural force of gravity to help sample tissues deep within the breast, closer to the chest wall.

Digital stereo x-rays are used to guide the needle or probe to the exact location of the lesion. A dedicated computer is used to increase the speed, precision, and ease of the procedure. Multiple samples are then obtained. The devices most commonly used with stereo biopsies are core needles, and vacuum assisted probes.

VACUUM ASSISTED PROBE BIOPSIES:

Vacuum Assisted Probe These can be the same size as the more traditional spring-loaded core needles, or slightly larger. Preparation is the same as for a core needle biopsy. It differs from the core needle in that the probe does not need to be removed and replaced into the breast with each sampling. It is inserted once, and remains in the breast throughout the procedure. It rotates and collects samples as it goes, using a vacuum to pull the suspicious tissue into it. This device can collect more tissue in less time than core needles. Another advantage is that it can deploy a tiny surgical clip into the biopsy cavity, thus allowing a surgeon to locate the area at a future time, if needed for treatment.

RADIO FREQUENCY INTRODUCERS IN CONJUNCTION WITH HAND HELD BREAST BIOPSY SYSTEMS:

This is the implementation of an electro surgical device that uses radio frequency to cut tissue in order to reach a lesion. All of these core and probe devices must traverse breast tissue from the skin to the actual suspicious area. Sometimes this breast tissue can be very tough, and require much force to get to the desired area, and occasionally the lesion itself is tough or rubbery and can deflect the biopsy needle. The radio frequency device can facilitate a biopsy by making it easier to get from the skin into the lesion.

CRYO-ASSISTED ROTATIONAL CUTTING DEVICES/PROBES:

CassiTM Rotational Core Biopsy Device Another name for this device is “Stick-Freeze” technology. This is a modification of a core needle biopsy. Again, a small nick is made in the anesthetized skin. A rather small securing needle is placed within the suspicious lesion. The surrounding tissue is frozen directly to this needle; it “sticks” to the needle. A cutting canula, (outer round sheath), rotates and automatically advances over the securing needle, cutting and obtaining the tissue that is on the securing needle. This process is fully automated, hand held, and obtains large tissue samples with fewer passes, or insertions than many spring loaded core biopsies. Ultrasound is used to guide this type of biopsy.

The availability of all of these modern, less invasive options have facilitated the diagnosis of breast disease, making it easier, faster, and less painful. Now, for the most part, surgery can be reserved for cancer, or precancerous lesions.

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