Minimally-invasive Needle Biopsy

First, and foremost, most diagnoses can and should be made via a needle/core biopsy. With rare exception, one should only go to the operating room AFTER a diagnosis is made and with a plan of what needs and will be done.

In a core biopsy, the needle has a sampling tray and a there is a cutting blade or cannula that passes over this to take the sample. In a vaccum assisted core biopsy, the vacuum pulls tissue down into the sampling tray improving the quality and size of the specimen retrieved. The vacuum may also be used to pull the tissue out of the needle readying the sample tray for the next tissue acquisition (rather than removing and re-inserting the entire needle/device). In the case of a benign but palpable lesion (i.e. fibroadenoma), with enought samples, most or all of the lesion can be removed with a vacuum assisted device rendering it no longer palpable. First, and foremost, most diagnoses can and should be made via a needle/core biopsy. With rare exception, one should only go to the operating room AFTER a diagnosis is made and with a plan of what needs and will be done.

In a core biopsy, the needle has a sampling tray and a there is a cutting blade or cannula that passes over this to take the sample. In a vaccum assisted core biopsy, the vacuum pulls tissue down into the sampling tray improving the quality and size of the specimen retrieved. The vacuum may also be used to pull the tissue out of the needle readying the sample tray for the next tissue acquisition (rather than removing and re-inserting the entire needle/device). In the case of a benign but palpable lesion (i.e. fibroadenoma), with enought samples, most or all of the lesion can be removed with a vacuum assisted device rendering it no longer palpable.

Over the past 20 years, the standard of care for sampling suspicious lesions in the breast has evolved from open surgical biopsies to the modern standard of minimally-invasive needle biopsy. Over many years, studies have confirmed that needle biopsies are as accurate as surgical biopsies in diagnosing breast cancer, and the needle has advantages: no operating room visit, less invasive, minimal if any scarring, no stitches, fewer complications, less expensive, quicker to perform. In addition, if cancer is diagnosed with a needle biopsy, the patient will have a greater chance of having just one surgery. (If the cancer is diagnosed on a surgical biopsy, the patient usually has to return to the operating room a second time to get all of the cancer out, and to sample the lymph nodes under the arm.) Although most biopsies can be performed with a needle, approximately 10% of biopsies must be performed surgically. The reasons include: living in a region where there are no specialists trained to perform the needle biopsy; the location of the lesion might be in a part of the breast that the needle cannot safely reach; patient inability to cooperate with positioning for the needle biopsy; medical conditions that make direct control of bleeding in the operating room necessary; a breast that is too small or large to allow for the biopsy to be performed with a needle; the presence of an implant, which might not allow for a needle biopsy without a high risk of rupturing the implant. Over the past 20 years, the standard of care for sampling suspicious lesions in the breast has evolved from open surgical biopsies to the modern standard of minimally-invasive needle biopsy. Over many years, studies have confirmed that needle biopsies are as accurate as surgical biopsies in diagnosing breast cancer, and the needle has advantages: no operating room visit, less invasive, minimal if any scarring, no stitches, fewer complications, less expensive, quicker to perform. In addition, if cancer is diagnosed with a needle biopsy, the patient will have a greater chance of having just one surgery. (If the cancer is diagnosed on a surgical biopsy, the patient usually has to return to the operating room a second time to get all of the cancer out, and to sample the lymph nodes under the arm.) Although most biopsies can be performed with a needle, approximately 10% of biopsies must be performed surgically. The reasons include: living in a region where there are no specialists trained to perform the needle biopsy; the location of the lesion might be in a part of the breast that the needle cannot safely reach; patient inability to cooperate with positioning for the needle biopsy; medical conditions that make direct control of bleeding in the operating room necessary; a breast that is too small or large to allow for the biopsy to be performed with a needle; the presence of an implant, which might not allow for a needle biopsy without a high risk of rupturing the implant.