Generality
Breast biopsy is a procedure that allows histological analysis of breast tissue, performed on small portions of tissue taken from a nodule or from a suspected area.
Breast biopsy is performed under ultrasound or mammographic guidance, introducing a cutting needle into the breast or making an incision, until reaching the suspicious formation from which the sample to be subjected to analysis is collected. Based on the outcome of the histological examination, the specialist doctor will decide whether to proceed with further investigations and / or establish the most appropriate therapeutic path for the case.
What is that?
Breast biopsy consists of the removal of breast tissue material in the form of small cylindrical frustules taken from the area of the breast where an abnormality or suspected neoplastic formation has been detected. The material thus collected is then subjected to histological examination (optical microscope study of the characteristics of a tissue) or to other laboratory tests.
Usually, breast biopsy is performed after a non-diagnostic cytologic sampling (inadequate or unrepresentative) or in case of discrepancy between the report from the pathological anatomy specialist and that of the radiologist or surgeon.
The purpose of this procedure is, in fact, to define with greater precision and reliability the nature and the histopathological characteristics of the tissue under examination, excluding or confirming the diagnosis of malignant breast cancer .
The breast biopsy allows, therefore, to indicate the most appropriate therapeutic approaches for each individual case and, if an intervention is necessary, it allows to better program the type of surgical operation to be performed to have access to the neoplasm.
What is it for?
Breast biopsy is a method frequently used in oncology, in order to exclude any diagnostic doubts and obtain a more precise response as possible.
Usually, this procedure is indicated in cases where a lump, thickening or area of breast tissue suspected of palpation and interpretation of the mammography or ultrasound picture is found, and in cases where the cytological examination (needle aspiration) does not provide sufficiently reliable information on the nature of this anomaly.
The removal of breast tissue allows to distinguish a benign alteration (as in the case of cysts and fibroadenomas) from a lesion of a malignant nature (carcinoma or other tumors), establishing the pathology in progress. In addition to histological evaluation, breast biopsy also allows defining the functional characteristics of the lesion (such as biological activity and possible invasiveness).
Breast biopsy may also be indicated in the presence of: serous or blood secretions from the nipples; unusual changes in the skin and areola of one or both breasts (dimples, orange peel skin, swelling, redness or sensation of heat) and unjustified pain in the breast or armpit.
In most cases, the sampling is carried out under ultrasound guidance (ie with the use of ultrasound) or radiographic (in the case of mammography), to better locate the suspected lesion and reach the target exactly.
Types of biopsy
Breast biopsy can be performed with different procedures. The choice of the breast tissue sampling technique is made by the specialist doctor on the basis of various factors, such as the characteristics, the size or the location of the lesion to be analyzed.
In any case, the purpose of these procedures is to clarify a diagnostic doubt related to structural alterations evidenced by previous diagnostic tests (mammography, ultrasound or magnetic resonance). The tissue sample is then analyzed under a microscope to determine whether it is tumor or not.
The main techniques available today include:
- Breast needle biopsy: it allows to take a small portion of tissue (frustule) with a cutting needle of caliber slightly higher than that of a syringe used for normal injections. Once inserted in the breast and reached the area to be examined, this instrument allows to collect portions of breast tissue to be subjected to subsequent analysis under a microscope. The examination is generally carried out under local anesthesia and, in most cases, under ultrasound guidance.
- Macro-needle biopsy : through a 1-2 mm incision, a needle is introduced into the suspected area with a groove in which a cutting blade slides, which allows a tissue to be removed. Usually, no stitches are needed. The macro-biopsy uses needles of greater caliber than the previous technique. During the procedure, more samples are taken, each of the size of a grain of rice.
- Surgical biopsy (excisional or incisional) : involves the removal, through an incision on the breast, of a portion of the mass (incisional biopsy) or of the entire nodule, and of a small part of surrounding tissue (excisional biopsy) to be submitted, then, for histological examination.
The excisional biopsy is the most accurate method to make a diagnosis, but it is also the most invasive (for this reason, it is not usually the technique of first choice).
The surgical biopsy is performed in the operating room: through a 2-3 cm incision in the skin, the surgeon isolates the lump from the rest of the gland and removes it. The piece is then sent to the pathological anatomy laboratory to be studied. In the event that the nodular formation or the suspected mass were not palpable, the site of the lesion is marked before the operation, which must be removed by the surgeon (preoperative centering). For this purpose, the introduction of a thin needle can be provided, by which a metal wire (which will be removed later during surgery) can be placed or a few drops of a radioactive tracer can be injected.
How to do it
Breast biopsy consists in taking tissue samples with the placement of a special cutting needle, commanded by a spring mechanism, or a repeater to guide the surgical removal of alterations that generate suspicion.
To better locate the nodule or area, breast biopsy is performed with the support of mammography, ultrasound or magnetic resonance: the operator identifies the precise target of the collection thanks to the observation in real time on a screen of the images processed from the different imaging tools.
The time required for the survey varies according to the type of withdrawals made and their number; in general, the duration of breast biopsy varies between 15 and 60 minutes.
The patient is made to lie down in a supine position on a couch, with her arms turned upwards and the breast area uncovered; in some cases, it may be required to lie on your side.
The skin is carefully disinfected and, in the area of collection, a local anesthetic is administered percutaneously.
The area from which to collect a small fraction of tissue is reached through a cutting needle of a few millimeters in diameter or, if necessary, a small skin incision is made (2-3 mm) with the tip of a scalpel, to allow sampling of fabric in the indicated part (generally take 3 or 4 frustules).
At the end of the exam, the risk of bleeding is limited by a slight compression for a few minutes and a bag of dry ice is applied to accelerate the absorption of possible hematomas and relieve the painful sensation. In most cases, it is not necessary to suture the skin. The patient can return immediately to her home and a rest period of a few hours is recommended. The dressing can be removed the next day.
The collected material is sent to the laboratory and studied under the microscope by the pathological anatomy specialist, who will provide for the complete evaluation of the histotype, the degree of differentiation of the lesion and, if necessary, of the functional characteristics by antigen-antibody reactions with methods of immunohistochemistry.
In some cases, the tissues can be the subject of a molecular study using specific techniques.
Interpretation of results
B1 = Inadequate / Not representative
Indicates a technically non-optimal (inadequate) or non-representative withdrawal for the formulation of the diagnosis. This means that the histological features found do not justify the clinical-radiological picture and that the doctor must re-evaluate the case.
B2 = Benigno finding
The sample is adequate and referable to lesions of an absolutely benign nature.
B3 = Atypia in lesion probably benign
The analysis of the material found cytological and / or structural characteristics different from those of a frankly benign lesion. In this case, the training is considered "probably benign" or identified as a "risk factor" for carcinoma. Therefore, depending on the characteristics found, further investigations may be indicated for the correct definition of the pathological condition.
B4 = Suspected of malignancy
Breast biopsy shows a sample with characteristics that suggest the probable presence of a carcinoma. These cases are subjected to surgery, which will allow an adequate definition of the lesion.
B5 = Malignant artifact
The cytological analysis of the material indicates the presence of a frank carcinoma, in situ or infiltrating the stroma. This means that they were found in the sample of cells with unequivocal characters of malignancy. The finding identifies the cases to be subjected to surgery: the histological examination of the entire removed area will allow a more complete and accurate diagnosis.
Preparation for the exam
Before the breast biopsy, it is advisable that the person who has to undergo it inform the reference senologist if he suffers from any allergies.
Another important foresight consists in temporarily suspending (or reducing), after consulting with your doctor or specialist who will carry out the procedure, the anticoagulant- based therapies for the 48 hours prior to the exam (to reduce the risk of bleeding). It is not necessary to interrupt, however, other possible pharmacological treatments in progress (for example, for hypertension or diabetes).
Risks and Complications
Breast biopsy generally causes minimal and acceptable pain during the examination, as it is performed under local anesthesia . However, it is an invasive and traumatic procedure for the breast: it is possible, therefore, that a painful manifestation appears at the site of the extraction in the following hours.
In these cases, on the advice of the doctor, it is possible to take common painkillers (usually paracetamol) and apply cold packs in the days following the breast biopsy. Even wearing a bra that provides good support can help relieve pain.
In the following days bruises may appear in the area, which coincide with the small spread of blood in the tissues surrounding the point of collection.
Other risks associated with a breast biopsy include:
- Hemorrhages and blood effusions of modest size;
- Sense of skin tension and swelling of the breast;
- Infections of the mammary gland (rare, since all the rules for operating in sterile conditions are respected);
- Bleeding at the biopsy site (more frequent in areas where the breast is richer in superficial venous plexuses);
- Possible breast deformities, depending on how much tissue is removed;
- Accidental puncture of the pleura and passage of air in the pleural cavity (pneumothorax);
- Further surgery or other treatments, depending on the results of the biopsy.
In the event that a fever occurs, the area affected by the investigation becomes red and hot or an unusual secretion appears at the site of collection, it is advisable to consult your doctor. After a breast biopsy, these manifestations may indicate, in fact, the onset of an infection, which may require immediate treatment.
