When you have an abnormality in your breast, either something that you are able to feel or a lesion seen on mammogram or ultrasound, a biopsy may be recommended. Traditioinally, the term biopsy referred to what we now call “surgical or excisional biopsy”, or the total removal of an abnormality. This is no longer recommended in the majority of patients as the first approach to a lesion. It was found that over 85% of surgical biopsies resulted in a benign (non-cancerous) diagnosis. This means that a substantial number of women were taken to surgery when they did not need an operation – we just didn’t have a way of determining what the lesion was. In addition, patients that were found to have cancer were more likely to require a second operation if the surgeon did not know the diagnosis prior to the procedure.
Currently the standard of care is for a diagnosis to be established prior to surgery if at all possible. This is most commonly performed by a minimally-invasive stereotactic or ultrasound-guided core biopsy. Stereotactic biopsy is performed when the abnormality is seen on mammogram, and ultrasound-guided core biopsy is performed when the abnormality is best seen on ultrasound. At times, MRI-guided biopsy is also appropriate. All of these biopsy procedures are performed while you are awake, using local anesthesia. They are performed in an office or outpatient setting, and recovery is usually quick. The tissue samples that are removed are analyzed by a pathologist, and results are generally available within 2-4 days.
Dr. Attai performs ultrasound-guided core biopsies in her office and she is certified by the American Society of Breast Surgeons for the performance of breast ultrasound and ultrasound-guided biopsies. If the biopsy shows benign changes, Dr. Attai will discuss your options going forward – often resuming routine follow up is recommended. If the biopsy shows abnormal cells (atypical hyperplasia), surgery is generally indicated as a small percentage of patients with atypia may have an associated cancer. If the biopsy shows cancer, additional testing and workup may be recommended prior to planning surgery. Using this approach, the operating room is reserved for actual treatment of a problem, not simply to make a diagnosis, and the likelihood of requiring a 2nd surgery is decreased.
A small percentage of patients will require surgery as the initial procedure; for various reasons a minimally invasive biopsy may not be able to be performed. However, in the majority of patients, a minimally-invasive core biopsy is the preferred first step.
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