Biopsy

1. Fine-needle aspiration (FNA)

2. Core needle biopsy (CNB)

3. Surgical biopsy

a procedure in which a thin, hollow needle is repeatedly inserted into a suspicious lesion to collect cell samples for analysis

• Preferred tool for assessing a breast mass with a low probability of being malignant

• —> Even if a palpable breast mass does not appear suspicious on radiographic imaging, a biopsy is performed if the mass is symptomatic or to reassure the patient and definitively rule out a malignant process.

• May also be used for follow-up and assessment of response to treatment

• Simple and fast technique

• Minimally invasive

• Especially suited for lesions close to the skin

• No anesthesia required

• Low risk of complications

• Small sample are associated with a high false-positive rate.

• Cannot be used to distinguish between noninvasive and invasive carcinoma

• If cytology results indicate a potential for malignancy, a core needle biopsy is required to confirm the diagnosis.

a type of biopsy performed with a larger needle under image guidance using sonography, mammography, or MRI

—> Stereotactic vacuum-assisted CNB is suitable for evaluating microcalcifications and masses < 1 cm.

preferred tool for assessing a suspicious breast mass on ultrasound or mammography

• Can be used to confirm the diagnosis (preferred test)

• Used to distinguish between noninvasive and invasive carcinoma based on histology (see “Pathology” below)

• Allows testing for receptor status

• Invasive procedure

• Local anesthesia required

• Higher risk of complications (e.g., hematoma, pain) compared to FNA

• Incisional biopsy: surgical removal of a part of the suspicious mass

• Excisional biopsy: The entire mass and potentially a safety margin with healthy tissue is surgically removed.

• Should only be used if CNB is not feasible or results of CNB are inconclusive

• Full-thickness skin biopsy (punch biopsy) should be performed if inflammatory breast cancer or Paget disease of the breast is suspected.

• Provides a larger tissue sample for a more accurate diagnosis

• Immediate resection of the tumor is possible.

• Highly invasive procedure

• General anesthesia required

• Highest risk of complications (e.g., bleeding, surgical site infection) compared to FNA or CNB