Breast Cancer Procedures

For almost all findings found by imaging (mammography, sonography, or MRI) a needle biopsy is the preferred next step. Firstly, most of the findings (nodules and calcifications) which we identify are benign, so surgery can be avoided. Sometimes we are quite certain that the finding is malignant but still a needle biopsy is performed so that the surgeon performs surgery knowing what s/he is going after. For example, if the surgery is removal of a biopsy-proven cancer (lumpectomy) then they should remove larger margins. In this day and age it is fairly unusual to go to surgery to remove a nodule that the surgeon does not know what it is. Furthermore, if the diagnosis of cancer has been established in advance, then the surgeon will do the evaluation of axillary lymph nodes (sentinal node biopsy) at the time of the initial surgery (a one-step procedure). Also, they will be planning for the best cosmetic result.

When a lump is felt, but no abnormality is identified on imaging studies, a surgeon may still opt to remove it. In that scenario s/he does not know what they will find at surgery. A needle biopsy may or may not be done first. If a needle biopsy is being done, it is based on the palpable finding (feeling the lump) this would be done by the surgeon, not the radiologist.