Breast biopsy is performed by the physician to determine whether a mass detected on mammography, ultrasound or MRI is cancer or not. Many biopsy techniques can be used in the breast, but the most common technique is cutting needle biopsy. This biopsy, also known as trucut or core biopsy, is performed with a special needle placed into the mass under ultrasound, mammography or MRI guidance. When the button of the needle is released, a stripe-shaped tissue piece of 1-2 mm thickness is cut out. Usually 2-4 pieces are obtained from each breast mass and these samples are taken into a liquid called formaldehyde and sent to the pathology.
The trucut needle is the standard biopsy method used today in the breast and has a very high diagnostic rate. The old needle biopsy that was once performed by surgeons in the past with simple injectors should be completely abandoned. This biopsy method has the following important drawbacks:
1. Since the trucut (core) biopsy is performed by imaging devices such as ultrasound, mammography and MRI, it can be assured that the needle is inserted into the mass and biopsy has been taken from the right place. In contrast, old needle biopsy is performed by trying to feel the mass by hand without seeing it on ultrasound. Therefore, one can never make sure that the samples have been taken from the appropriate place.
2. With the trucut biopsy needle, original tissue fragments are obtained from the suspicious mass. With the old technique, only the cell clusters can be taken, and thus, the diagnostic value is low. Therefore, cancer may be missed in many patients with this type of needle biopsy.
3. With the old needle biopsy, the pathologist can only say whether the tumor is cancer or not, and further information can not be provided. With the trucut technique, the pathologist may give additional information such as the type of cancer, the rate of growth, whether it is spread to the vessels and nerves, and the amount of hormone receptors, which may change treatment decision.
For these reasons, if the breast biopsy is to be performed, imaging-guided cutting needle biopsy should be used and simple needle biopsy should be abandoned.
Video information "How to make a needle needle biopsy in the breast?"
In some cases, it may be preferable to take all or a large portion of the suspicious mass in the breast. Or sometimes, the suspicious area may not be as sharply limited as a mass, it may be a wide region with unclear boundaries and it may be necessary to take the entire region. The classical method applied in such cases is the removal of the suspicious area or mass by surgery. To do this, the suspicious mass or area is usually marked with a wire first, and then the surgeon takes out this area through a large incision by following the wire. Although widely used, this surgical method has some disadvantages:
1. Two procedures (first wire marking and then surgery) are often required to remove the mass.
2. If the suspicious mass proves benign, which is generally the case, the patient is operated unnecessarily. The scar tissue of the incision site may cause confusion during the regular follow up by mimicing cancer on ultrasound and mammography controls.
3. If the mass proves cancerous, a second surgery may be required and results of the armpit sentinel lymph node biopsy may be impaired due to previous surgery.
For these reasons, methods that may be an alternative to surgical biopsy have been developed in cases where the whole tumor or a large tissue must be removed in the breast.
These methods are known as BLES and vacuum biopsy. In BLES or Breast Lesion Excision System, a 4-5mm thick needle is inserted from the skin and when the tumor is reached under ultrasound guidance and the device is activated, special wires come out from the tip of the needle. These wires heat and cut the surrounding tissue with radiofrequency energy and grasp the mass like a scoop. The mass is then taken out through a 4-5 mm incision in one intact piece.
Vacuum biopsy is also performed under local anesthesia and ultrasound guidance. Through a 3-4 mm incision at the skin, the vacuum biopsy needle is inserted and placed behind the mass. When the device is switched on, the vacuum biopsy needle sucks the tissue towards itself and cuts it into strips with cutter blades, and collects these pieces into a small chamber.
Video information "How is the breast vacuum biopsy applied?"
Both BLES and vacuum biopsy have unique advantages and disadvantages. Since BLES heats the tissue, bleeding is very small and the mass is taken as a single piece. However, only the masses less than 2.5cm in diameter can be removed with this method. Vacuum biopsy does not have a diameter limit, but since the mass is removed in pieces the bleeding is slightly higher. Both methods are used successfully in the treatment of benign tumors such as fibroadenoma in the breast, besides for biopsy purposes.
Video information: "Nonsurgical treatment of breast masses with vacuum biopsy and BLES"
Interventional oncology in cancer management
Prof Saim Yilmaz, MD