What is a breast biopsy?

Dr. LaRaja: A biopsy is a procedure performed if you have a lump (lesion) in your breast. This lesion may be felt or seen only on a mammogram. During a biopsy procedure, breast tissue is removed for study under a microscope to determine if it is benign (non-cancerous) or malignant (cancerous). There are several different biopsy procedures, ranging from the insertion of a very fine needle into the tissue growth to collect a few cells to the removal of the entire abnormality. Recently, we’ve begun using a minimally invasive biopsy called the ABBI* procedure. This method uses special x-ray technology to guide physicians right to the lesion. Surgeons can then remove a sample of this tissue in a single pass, with minimum damage to surrounding tissue.

Is there any alternative to a breast biopsy?

Dr. LaRaja: If your doctor suspects cancer or is not really sure of the diagnosis based on the mammogram, the next step should always be a biopsy. It is the only way to be completely sure if the tissue in question is cancerous or not. Of course, if there is a cancer, we want to remove it as early as possible. The cure rate is better than 90 percent if the cancer is caught early enough. Also, with early detection, there is a greater likelihood that we can remove the cancer without disfiguring the breast.

I examine my breasts carefully once a month. If I find a lump, will it still be early enough to put me in that high-survival category?

Dr. LaRaja: Usually this is true. Self-examination can detect breast cancers while they are still in the early stages. However, you cannot always feel the lesion, and, many times, the abnormal tissue can be seen only on x-rays (mammograms) of the breast. That is why mammograms are so important. If you can feel a lump, the chances are 10 to 15 percent that it will prove to be cancerous. If an abnormality shows up on a mammogram but can’t be felt, the chances of it being cancer are generally about 15 percent; but the advantage is that the lesion has definitely been found at an early stage.

Can I skip self-examination and rely on a regular mammogram?

Dr. La Raja: No. Some lumps don’t show up on a mammogram. Also, some cancers may grow large enough to be felt between mammograms. Therefore, we want to use all the safeguards that are currently available in modern medicine to catch a cancer as early as possible. Self-examination remains one of these methods. The regular combination of self-examination and mammography gives you the best chance of catching a cancer early and, therefore, being cured.

How effective is mammography?

Dr. LaRaja Mammography is about 80 to 90 percent accurate in detecting breast cancers. In most cases, a mammogram will detect an abnormality before it’s large enough to be felt. A slow-growing cancer can take years to develop into a lump that’s big enough for you to feel. Also, a lump deep in the breast may be undetectable to the touch. At Cabrini Medical Center, we supplement mammography with ultrasound, a procedure that uses sound waves to detect abnormalities in the breast. The decision of whether to use sonography as an additional tool is best left to the surgeon’s judgment. In terms of accuracy, however, sonography is now approaching mammography, according to some radiologists. Therefore, combining mammography, ultrasound, self-examination and examination by a surgeon greatly reduces the chances that a cancerous growth will escape detection.

If a lump or other warning signs are detected, what choices do I have?

Dr. LaRaja: Your doctor will meet with you to discuss the choices available. However, if there is any suspicion of cancer, the next step should always be a biopsy. As a general rule any mass that you can feel should be removed entirely (lumpectomy).

Do I have any say in what kind of biopsy is performed?

Dr. LaRaja: When it comes to breast biopsies, there are a number of choices. The surgeon may recommend a fine needle aspiration or core needle biopsy. In these procedures, the doctor numbs your breast with a local anesthetic, inserts a needle into the abnormality and removes a tiny tissue sample. If a cyst is suspected, the doctor can use a very thin needle attached to a syringe to drain the fluid out. This can be done in the doctor’s office. Some lesions are nothing more than cysts containing fluid. If the lesion cannot be felt, the surgeon can use three-dimensional x-ray techniques to pinpoint the lesion and ensure that the needle is inserted in the right place. These procedures are relatively simple, but the surgeon may have to insert the needle several times to ensure that an adequate sample of the suspicious tissue is taken. It is our preference to use the ABBI* procedure. It has proven to be a simple, very accurate approach that removes a sample of suspicious tissue in a single pass.

How does the ABBI* procedure work?

Dr. LaRaja: In the ABBI* procedure, the surgeon uses special x-ray technology to pinpoint the lesion. After a local injection of an anesthetic, the surgeon makes a small incision in the skin and inserts a special instrument to remove a specimen. Because the entire procedure is performed under local anesthesia, the patient can return home shortly after its completion. Another advantage of the procedure is that it does not involve the use of an operating room, an advantage that greatly reduces the cost and relieves the patient of unnecessary anxiety.

What if I have a lesion and want it removed, regardless?

Dr. LaRaja: It is natural to want to have a lesion removed. Removing small lesions used to be a two-step procedure. Patients first had to go to the x-ray department where a radiologist inserted a needle in the breast to mark the location of the lesion. The patient was then taken to the operating room and placed under general anesthesia. There a surgeon removed the tissue around the tip of the needle and, to be sure the entire lesion was removed, a margin of normal tissue. Nowadays, we prefer to start with the ABBI* procedure, which lets us find out what we are dealing with before deciding if further action is required. In 97 to 98 percent of cases diagnosed in this manner, therapy does not involve removal of the breast.

Can the ABBI* procedure be used to biopsy very large lumps?

Dr. LaRaja: This is possible but is not usually done. In the case of a lesion that is large enough to be felt, the surgeon will usually recommend its entire removal. In the case of very large lumps, your surgeon may recommend that you first have a portion of the lump removed for microscopic examination (incisional biopsy). Further treatment, if needed, will depend on the findings in the laboratory.

How painful is a breast biopsy?

Dr. LaRaja: During the procedure, there is little or no pain because anesthesia is used. Our experience has shown that there is virtually no pain with the ABBI*, fine-needle or core-needle procedures.

What about scars or disfigurement?

Dr. LaRaja: There are no significant scars with the fine-needle or core-needle procedures. Though it is a simple procedure, the ABBI* procedure does amount to minor surgery. There is a small opening in the skin, which is closed in a plastic-surgery manner, thus making the scar almost invisible with no noticeable indentation in the skin. Usually, the needle localization (excisional) method leaves a larger scar and results in a greater loss of tissue. You should talk with your doctor before undergoing these surgical procedures, so that you understand how extensive the surgery will be and how much post-biopsy scarring, if any, you can anticipate.

How long does a biopsy take?

Dr. LaRaja: An ABBI* procedure usually takes about an hour from your arrival to your departure, as do the fine-needle and the core-needle biopsies. The needle localization (excisional) method usually takes about three hours to perform, since the patient must first go to the x-ray suite and then be taken to the operating room. Since general anesthesia is usually used, a significant amount of additional time is required for the patient to recover in the postoperative unit.

Is early detection all I can do to protect myself?

Dr. LaRaja: Breast cancer is increasing at an alarming rate, and we aren’t sure of all the causes. The best advice we can give is based on our general knowledge of cancer. At the present time, there is no substitute for early detection. However, some studies indicate there may be a link to cigarette smoking and certain foods that are high in fat content. Also, a small percentage of women have a genetic disposition toward developing breast cancer. Therefore, if any member of your family has had breast cancer, it is important that you consult your doctor about appropriate monitoring. The good news is that we’re getting much better at detecting cancer in its early stages and are bringing about cures in an increasing number of cases with minimal disfiguring of the breast.