The development and widespread use of image-guided breast biopsies has revolutionised the way breast lesions are managed and has expanded the role of breast imaging. The safety, accuracy, and cost effectiveness of these biopsies have led to the replacement of the surgical biopsy for most breast lesions requiring a tissue diagnosis.
Excision biopsy or surgical biopsy has been done routinely over the years for breasts lesions however big or small. The disadvantages of this procedure include hospitalisation, use of general anaesthesia, scars on the breast, high rates of infection, and higher costs owing to associated hospitalisation.
Another main disadvantage of doing an excision biopsy of a breast lesion is that if the final pathology report, which normally takes a week or so, says the lesion is malignant, the patient in all likelihood will have to undergo a more extensive revision surgery.
Today, minimally invasive procedures on the breast under image guidance have significantly changed the way in which breast lesions are managed and followed up.
FINE-NEEDLE ASPIRATION CYTOLOGY (FNAC)
· Fine-needle aspiration cytology is a procedure where a small, fine needle, with a syringe connected to it is used to take a sample of breast cells from the lump.
This sample is then sent to the laboratory and is examined under a microscope for cancer cells.
· There are limitations to FNAC with this procedure in terms of under diagnosing cancer and not being able to categorically distinguish between certain types of cancer from non-cancer lesions.
ULTRASOUND GUIDED CORE NEEDLE BIOPSIES (CNB)
· An ultrasound guided core biopsy of the breast is a procedure in which a small sample of tissue is removed from the breast using a specialised biopsy needle, so that it can be examined under a microscope.
· An ultrasound machine is used to identify the area of the breast that requires examination and to guide the biopsy needle to the correct position for the procedure to take place.
· The procedure should last no longer than 20 minutes and is carried out in an ultrasound room under the effect of local anaesthesia.
· Core biopsy removes more material than FNAC and is more likely to give a definite diagnosis.
· Core biopsies are performed by radiologists specially trained to perform these tests.
· During the procedure the local anaesthetic may cause some stinging sensation for a few seconds before it numbs the breast. During the procedure some pressure may be felt but the patient does not normally feel any pain.
· The procedure is repeated several times (usually 3–5 times) through the same point until enough tissue has been collected.
· Post procedure compression dressing is applied on the site with no need for stitches.
STEREOTACTIC BREAST BIOPSY
· Many a time early breast cancer may just present itself as small specks of microcalcifications.
· These are submillimeter sizes and can only be imaged on mammograms; hence a biopsy of such calcifications is carried out under mammogram guidance and is called stereotactic biopsies.
· They help target not only microcalcifications but also small areas of scarring or distortion in the breasts which are seen only on mammograms.
VACUUM ASSISTED BREAST BIOPSY
Stereotactic Core and Vacuum Assisted Biopsies are performed by radiologists and trained female radiographers who competently assist in these procedures.
· It is a specialised type of core biopsy. These procedures remove lots of small pieces of tissue from the breast.
· They are similar to a standard core needle biopsy, but use specialised needles with suction to secure the sample from the breast.
· Therefore, this modality can be used to therapeutically to remove small non-cancerous lesions on an OPD basis in the radiology department.
· Fibroadenoma is a benign tumour of the breast and is the most common tumour in women under 30 years of age.
· The incidence of fibroadenoma has also been increasing in postmenopausal women due to hormone replacement therapy.
· Vacuum assisted biopsies can be used to therapeutically remove these lesions completely without the need for surgical excision.
· Young women with benign lesions benefit from vacuum assisted removal of lesions because they are unwilling to undergo surgery for cosmetic reasons.
· The procedure also benefits elderly patients with a solid lump that is non-malignant based on imaging features.
· Other advantages of VAB include lack of general anaesthesia and hospitalisation, need for stitches, and almost negligible pain.
· Vacuum assisted biopsies can be performed both under mammogram and under ultrasound.
· More than 80% patients report no pain during and after lesion removal. A small fraction of patients report minor pain post procedure.
· Vacuum assisted biopsies can be used to completely remove lesions in the range of 3-4 cms.
With breast cancer cases on the rise, imaging guided breast interventions have made a huge difference to how breast lesions are now approached and treated.
No longer does a woman need to undergo invasive surgical procedures to determine the nature of a breast lesion. All the above-mentioned procedures are done on an outpatient basis with almost negligible complications.