Breast biopsy

There are many reasons why a doctor may order a breast biopsy. == Fine-needle aspiration ==

Fine-needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass. FNA can be done to aspirate the contents of a cyst, which may relieve any pain that the cyst caused, or can be used to aspirate a suspicious lesion in conjunction with cytology (cellular analysis). == Core needle biopsy ==

Core needle biopsy (CNB) is another percutaneous ("through the skin") method of breast biopsy that became more popular than FNA in the 1990s due to the larger sample of tissue CNB provides. This method is usually done under ultrasound guidance and involves using two needles, one inner "puncture" needle that is inserted into the mass, and a wider gauge needle with an open "gap" or "trough" on one side that allows for tissue to enter. A spring-loaded sheath is then triggered by the technician that covers the trough in the needle to allow sample tissue to be separated and removed for analysis. Typically, four tissue samples are removed to minimize sample error. To prevent the need to pierce the breast repeatedly, a coaxial needle is left in place on top of the mass as a guide. CNB has a higher sensitivity for cancer than FNA, has lower false negatives, and has proven more successful in finding rare breast diseases like lobular carcinoma. However, this method still has relatively high rates of false negatives compared to surgical or vacuum-assisted methods due to the overall low volume of tissue removed. Also, because breast tissue can be difficult to target on ultrasound, as many as 5–10% of suspicious lesions are missed by the needle and may result in a high rate of false negatives, or the need for additional biopsies. == Stereotactic biopsy ==

Stereotactic biopsy is done with the help of a specialized device, which provides mammographic guidance. For a stereotactic biopsy, morbid obesity is a relative contraindication due to the weight limitations of the devices. Pregnancy and breast compression size may also be contraindications, depending on the modality being used. == Vacuum-assisted breast biopsy ==

Vacuum-assisted breast biopsy (VABB) is a more recent version of core needle biopsy using a vacuum technique to assist the collection of the tissue sample. Similarly to core needle biopsy, the needle has a lateral ("from the side") opening and can be rotated, allowing multiple samples to be collected through a single skin incision. This method has become more popular than FNA, CNB, and surgical biopsies due to the benefits of low invasiveness while still obtaining a larger tissue sample. The vacuum-assisted biopsy category also includes automated rotational core devices. == Direct and frontal biopsy ==

The direct and frontal biopsy systems can even be considered relatively painless. The quality of the sample is sufficient for research on molecular biology. == Excisional (surgical) biopsy ==

Excisional biopsy involves surgically removing the suspicious area of the breast to examine it under the microscope for diagnosis. One method is wire-guided (or wire-localized) excisional biopsy, where a wire is inserted into the breast and repeatedly imaged using breast ultrasound or mammography until the technician sees that the tip is located in the suspicious area. The suspicious area is then removed entirely in one block by the surgeon with the help of the wire. When the tissue is removed, it is processed by a pathologist, who describes the tissue as it appears by eye and inks the sides to help orient the tissue under the microscope after it is sliced. == Adverse effects ==

Adverse effects of breast biopsies tend to vary depending on the type of biopsy performed. The more invasive, such as surgery, tend to have more severe types of adverse incidents, whereas less invasive techniques, such as FNA or CNB, tend to have less severe adverse incidents. For vacuum-assisted biopsies, some complications of the procedure can include bleeding, post-operative pain, and hematoma formation. Bleeding into the site of the suspicious lesion caused by the biopsy procedure can appear to look like a complex cyst on ultrasound, which could lead to additional unnecessary management. The false negative rate of the results of a breast biopsy is approximately 1%. == References ==