Breast biopsy

Introduction

Mammography and ultrasonography are the common examinations for the investigation of breast pathology. In addition, mammography is a successful worldwide screening test concerning the investigation and the early diagnosis and of breast neoplastic diseases. However, in many cases because of differential diagnosis, breast biopsy is needed to resolve the diagnostic dilemma. The common way to perform breast biopsy is by:
• Fine Needle Aspiration (FNA)
• Core Biopsy
• Open Biopsy
The FNA is actually a cytological examination of the suspicious cystic or solid masses of the breast. FNA is commonly used for the aspiration of the breast cystic tumor. On the other hand, core biopsy or open biopsy is used for the histological documentation of breast pathology, however more often for the solid suspicious masses.
The open biopsy offers the advantage of the complete extraction of the tumor, however under anesthesia, especially for patients with deep breast tumor. In case of more superficial masses, local anesthesia could be used as well. Furthermore, in case of gross breast with deep and small tumors, guide wire (KOPANS) might be necessary for the precise and complete excision of the breast neoplasia (Figure 1).

μαστος-εικ 1
Figure 1. Open biopsy of the breast, with preoperative insertion of guide wire (KOPANS)

Indications

The most common indications for breast biopsy are:
• Ductal papilloma
• Phyilloides breast tumor (cystosarcoma)
• Tumors with:
Lobular margins
Radial borders
Mixed (solid-cystic) ultrasound vision
Acoustic shadow
Transversal orientation of the tumor in relation to the breast’s skin
• Suspicious calcifications
• Suspicious masses (BIRADS 4 & 5)
BIRADS is a classification system of the characteristics of breast tumors. The system is commonly used in mammography, ultrasound and MRI of the breast, offering a common terminology between the medical staff that follows the breast pathology.

Complications

The most common complications after breast’s biopsy and especially after open biopsy with tumor extraction are:
• Hematoma
• Wound infection
Postoperative soft pressure of the surgical wound with bandage for 24 hours and the perioperative use of antibiotic prophylaxis may eliminate the former complications.

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Kalogiannidis doctor

IOANNIS Α. KALOGIANNIDIS MD, PhD

Associate Professor
Obstetrics Gynecology -
Gynecologic Oncology

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