BIOPSY TYPES FOR BREAST LESIONS
Breast is the organ with the most biopsy diversity. For example, if there are 20 biopsies in medicine, 20 are used in the breast. Fine needle aspiration biopsy (FNAB), Core biopsy (Tru-cut biopsy), vacuum biopsy, surgical biopsies (excisional breast biopsy, incisional biopsy: removal of a small sample from inoperable tumor), marked biopsis (wire-located breast biopsy, ROLL: radio-guided occult lesion localization), cytology nipple discharge, ductal lavage examination, surgery of the breast ducts (sub-areola exploration, micronodectomy, etc.) and many more methods.
A patient’s biopsy recommendations can vary greatly amongst physicians. Of course, with so much variety, patients are perplexed. Of course, the final decision is up to the patient, both in terms of doctor selection and procedure selection, but I recommend that you consider the practical opinions stated below:
The biopsy decision is belongs to the breast surgeon when the breast lesion is palpable and belongs to experienced radiologist when the lesions are non-palpable (discovered on radiological images).
Tru-cut or core biopsy is most suitable type of biopsy after the completion of radiological work-up. Ultrasonography-guided core needle biopsy under local anaesthesia is highly preferable. It does not necessitate general anesthesia. The all palpable BIRADS3, nonpalpable BIRADS4 and BIRADS5 lesions require biopsy. Surgical excision of localized lesions requires surgeon-radiologist collaboration. In summary, the radiologist located the lesion with a specific wire, the surgeon removes the lesions with the wire and confirmed excised lesion with specimen radiograms.
Experience is crucial in a wire-located biopsy. Both the surgeon and the radiologist have to be experienced. Because the inappropriate localization of the lesion can lead to inadequate surgery. The removal of all lesions, especially in cases of microcalcification, must be confirmed by a specimen radiograms. Otherwise, incomplete removal of the lesion requires re-localization and re-excision. Unfortunately, repeated excisions may lead to breast deformity. I personally don’t prefer vacuum biopsy for non-palpable lesions. Because when it comes to cancer diagnosis, surgical-margin problems can be seen in small, stellate-shape tumors.
I prefer frosen section pathological examination in my all breast surgery procedures even for wire located breast biopsy. Because, more accurate cancer diagnosis and safe surgical margin able to confirmed by experienced pathologist at same time period and also sentinel lymph nodes are evaluated at same surgery session.
I suggest you go to a general surgeon without losing time in the presence of a spontaneously discharge from nipple. It may be finding of early breast cancer. Different diagnostic and biopsy techniques are used in these conditions.