This document provides information about breast biopsy procedures. It defines a biopsy as the removal of breast tissue to examine for signs of breast cancer or other disorders. There are two main types of biopsies - needle biopsies, which use needles of varying sizes to extract tissue samples, and open biopsies, which are surgical procedures that open the breast. The document describes different biopsy techniques and their advantages and disadvantages in determining diagnoses for breast lumps and abnormalities.

1. BIOPSY
BIOPSY
Breast Biopsy
Breast Biopsy
compiled By
compiled By
Dr.
Dr. Sunil Vishwakarma
unil Vishwakarma
RSO Surgery
RSO Surgery
G. R. Medical College, Gwalior
G. R. Medical College, Gwalior

2. WHAT IS BIOPSY?
WHAT IS BIOPSY?
 Indicates removal of tissue from a living body for
Indicates removal of tissue from a living body for
microscopic diagnostic examination
microscopic diagnostic examination
 Most precise and accurate
Most precise and accurate
 Primary purpose: determine the diagnosis
Primary purpose: determine the diagnosis
precisely for proper treatment
precisely for proper treatment
 Should always be used to verify presence and
Should always be used to verify presence and
nature of neoplastic disease
nature of neoplastic disease
 More likely to rule out malignancy than to
More likely to rule out malignancy than to
diagnose cancer
diagnose cancer

3. TECHNIQUES OF BIOPSY
TECHNIQUES OF BIOPSY

4. EXCISIONAL BIOPSY
EXCISIONAL BIOPSY
 Removal of lesion in its entirety
Removal of lesion in its entirety
 For discrete lesions
For discrete lesions
 Includes 2-3 mm perimeter of normal tissue
Includes 2-3 mm perimeter of normal tissue
 Certainly benign lesions
Certainly benign lesions

5. EXCISION BIOPSY
EXCISION BIOPSY
 METHOD:
METHOD:
 Administer local anesthetic (should not be closer
Administer local anesthetic (should not be closer
than 2cm from the site to avoid “waterlogging”)
than 2cm from the site to avoid “waterlogging”)
 Stabilize lesion ; Apply traction
Stabilize lesion ; Apply traction
 Incise skin or mucosa around the base of the lesion in
Incise skin or mucosa around the base of the lesion in
an elliptical shape
an elliptical shape
 Detach lesion
Detach lesion
 Place specimen in
Place specimen in
Bottle
Bottle
 Suture wound
Suture wound

6. INCISIONAL BIOPSY
INCISIONAL BIOPSY
 Removes only a portion of the lesion
Removes only a portion of the lesion
 Removal of a wedge of tissue including normal
Removal of a wedge of tissue including normal
tissue, also known as WEDGE BIOPSY
tissue, also known as WEDGE BIOPSY
 For lesions >1 cm diameter
For lesions >1 cm diameter
 Includes normal and abnormal tissues
Includes normal and abnormal tissues
 May risk shedding malignant cells
May risk shedding malignant cells
 Should not be done on pigmented or vascular
Should not be done on pigmented or vascular
lesions
lesions
 Record position, size, shape of lesion
Record position, size, shape of lesion

7. INCISIONAL BIOPSY
INCISIONAL BIOPSY
 Narrow, deep
 Broad, shallow

8. INCISIONAL BIOPSY
INCISIONAL BIOPSY
 METHOD:
METHOD:
 Administer local anesthetic
Administer local anesthetic
 Identify junction between normal tissue and the
Identify junction between normal tissue and the
lesion
lesion
 Stabilize then dissect the specimen
Stabilize then dissect the specimen
 Place specimen
Place specimen
in bottle
in bottle
 Suture wound
Suture wound

9. ASPIRATION BIOPSY
ASPIRATION BIOPSY
 Performed with needle and syringe on any fluid-
Performed with needle and syringe on any fluid-
filled lesion, except mucocele
filled lesion, except mucocele
 2 main types:
2 main types:
 Explore whether a lesion contains fluid
Explore whether a lesion contains fluid
 Used to actually aspirate cells for pathologic
Used to actually aspirate cells for pathologic
diagnosis (fine needle aspiration)
diagnosis (fine needle aspiration)
 To avoid scar or when adjacent anatomic structures pose
To avoid scar or when adjacent anatomic structures pose
a risk. e.g. neck masses
a risk. e.g. neck masses

10. ASPIRATION BIOPSY
ASPIRATION BIOPSY
 METHOD:
METHOD:
 Clean the tissue
Clean the tissue
 Inject anesthetic OVER; not INTO the lesion
Inject anesthetic OVER; not INTO the lesion
 Select a wide bore needle and 10mL/20mL syringe
Select a wide bore needle and 10mL/20mL syringe
 Penetrate tissue and aspirate fluid
Penetrate tissue and aspirate fluid
 Transfer to bottle
Transfer to bottle
 Needle tip may have to be repositioned repeatedly
Needle tip may have to be repositioned repeatedly
on an effort to locate a suitable fluid-containing
on an effort to locate a suitable fluid-containing
cavitation
cavitation

11. ASPIRATION BIOPSY
ASPIRATION BIOPSY
The needle is then moved in a to and
fro fashion within the mass
Needle tip may have to be
repositioned repeatedly on
an effort to locate a suitable
fluid-containing cavitation

12. PUNCH BIOPSY
PUNCH BIOPSY
 Inserted into the center of a lesion and
Inserted into the center of a lesion and
a small plug of tissue removed
a small plug of tissue removed

13. BREAST BIOPSY
BREAST BIOPSY
A breast biopsy is the removal of breast tissue to
examine it for signs of breast cancer or other
disorders. Several different types of biopsy may be
done.

14. INDICATIONS
INDICATIONS
 Any suspicious lump/lesion in the breast
Any suspicious lump/lesion in the breast
warrants for the biopsy.
warrants for the biopsy.
 When a lump is found, a biopsy is the first step
When a lump is found, a biopsy is the first step
in diagnosis and treatment.
in diagnosis and treatment.
 Although the primary purpose is to diagnose
Although the primary purpose is to diagnose
cancer, a biopsy can also be a surgical treatment
cancer, a biopsy can also be a surgical treatment
to remove cancer.
to remove cancer.

15. MOST COMMON CAUSES OF
MOST COMMON CAUSES OF
BREAST LUMP
BREAST LUMP
 Fibroadenoma
Fibroadenoma
 Fibroadenosis
Fibroadenosis
 Breast abscess
Breast abscess
 Breastcyst
Breastcyst
 Breast cancer
Breast cancer

16. TYPES OF BREAST BIOPSIES
TYPES OF BREAST BIOPSIES
There are two main types of biopsies:
There are two main types of biopsies:
Needle Biopsy
Needle Biopsy
Open Biopsy
Open Biopsy
Your options for biopsy are determined by
Your options for biopsy are determined by
whether the lump is palpable (can be felt) or non-
whether the lump is palpable (can be felt) or non-
palpable (can not be felted), the location of the
palpable (can not be felted), the location of the
lump and the woman’s general health.
lump and the woman’s general health.

17. NEEDLE BIOPSY
NEEDLE BIOPSY
 A needle biopsy is a procedure that uses a
A needle biopsy is a procedure that uses a
needle to remove tissue or cells from the
needle to remove tissue or cells from the
breast.
breast.
There are two types of needle biopsies:
There are two types of needle biopsies:
Fine Needle and Core Needle Biopsy
Fine Needle and Core Needle Biopsy

18. NEEDLE BIOPSIES
NEEDLE BIOPSIES
 Fine Needle
Fine Needle – A thin, hollow needle is used to
– A thin, hollow needle is used to
remove a sample of tissue. The procedure is
remove a sample of tissue. The procedure is
quick and can be done in a doctor’s office.
quick and can be done in a doctor’s office.
 Core Needle
Core Needle – A larger needle is inserted
– A larger needle is inserted
through a small incision in the skin, and a small
through a small incision in the skin, and a small
core of tissue is removed. This type of needle
core of tissue is removed. This type of needle
biopsy is done with the assistance of
biopsy is done with the assistance of
mammography or ultrasound imaging in a
mammography or ultrasound imaging in a
doctor’s office or hospital outpatient clinic.
doctor’s office or hospital outpatient clinic.

19. ADVANTAGES OF NEEDLE
ADVANTAGES OF NEEDLE
BIOPSIES
BIOPSIES
 Simple procedure – does not require surgery
Simple procedure – does not require surgery
 Accurate
Accurate
 Quick – only takes a few minutes
Quick – only takes a few minutes
 Not painful
Not painful
 Inexpensive
Inexpensive
 Quick results
Quick results

20. DISADVANTAGES OF
DISADVANTAGES OF
NEEDLE BIOPSIES
NEEDLE BIOPSIES
 Entire lump is not removed
Entire lump is not removed
 Open biopsy may be necessary
Open biopsy may be necessary
For Fine Needle Only:
For Fine Needle Only:
 Specialist needed to read results
Specialist needed to read results
 In situ cancer not distinguishable from invasive
In situ cancer not distinguishable from invasive
cancer
cancer

21. OPEN BIOPSIES
OPEN BIOPSIES
 An open biopsy is a surgical procedure that
An open biopsy is a surgical procedure that
opens the breast to remove tissue.
opens the breast to remove tissue.
There are two types of open biopsies:
There are two types of open biopsies:
Incisional and Excisional
Incisional and Excisional

22. ADVANTAGES OF OPEN
ADVANTAGES OF OPEN
BIOPSIES
BIOPSIES
 Quick – takes only one hour
Quick – takes only one hour
 More accurate than a needle biopsy
More accurate than a needle biopsy
 Larger samples provide information for
Larger samples provide information for
treatment plan
treatment plan
Excisional Only:
Excisional Only:
 Removes entire lump
Removes entire lump
 May be the only surgical treatment needed
May be the only surgical treatment needed

23. DISADVANTAGES OF OPEN
DISADVANTAGES OF OPEN
BIOPSIES
BIOPSIES
 Surgical procedure
Surgical procedure
 Expensive
Expensive
 Side effects such as infection or blood collection
Side effects such as infection or blood collection
under the skin
under the skin
Excisional Only:
Excisional Only:
 Removing tissue can change the look and feel of
Removing tissue can change the look and feel of
the breast
the breast

24. IMAGING TECHNIQUES
IMAGING TECHNIQUES
When a lump cannot be felt, the doctor must
When a lump cannot be felt, the doctor must
locate it with a special imaging technique.
locate it with a special imaging technique.
 The doctor may use mammography (sometimes
The doctor may use mammography (sometimes
called stereotactic localization) or ultrasound
called stereotactic localization) or ultrasound
imaging
imaging
 The lump is located by mammography or
The lump is located by mammography or
ultrasound
ultrasound
 The doctor inserts a needle to collect a sample
The doctor inserts a needle to collect a sample
of tissue
of tissue

25. Female breast
Female breast
The female breast
is either of two
mammary glands
(organs of milk
secretion) on the
chest.

26. Needle biopsy of the breast
Needle biopsy of the breast
A needle biopsy is performed
under local anesthesia. Simple
aspirations are performed
with a small gauge needle to
attempt to draw fluid from
lumps that are thought to be
cysts. Fine needle biopsy uses
a larger needle to make
multiple passes through a
lump, drawing out tissue and
fluid. Withdrawn fluid and
tissue is further evaluated to
determine if there are
cancerous cells present.

27. Open biopsy of the breast
Open biopsy of the breast
An open biopsy can be
performed under local
or general anesthesia
and will leave a small
scar. Prior to surgery, a
radiologist often first
marks the lump with a
wire, making it easier for
the surgeon to find.

28. Lumpectomy
Lumpectomy
Lumpectomy is a surgical
procedure performed on a
solid breast mass to
determine if it is malignant.
The suspicious lump and
some surrounding tissue is
excised and analyzed.

29. Advanced Breast Biopsy Instrumentation
Advanced Breast Biopsy Instrumentation
(ABBI)
(ABBI)
The ABBI procedure is performed under local anesthesia and is
The ABBI procedure is performed under local anesthesia and is
a one-step biopsy procedure. This means that it combines
a one-step biopsy procedure. This means that it combines
needle localization with the removal of the lump.
needle localization with the removal of the lump.
Using stereotactic techniques, a technician pinpoints the lump
Using stereotactic techniques, a technician pinpoints the lump
with the aid of the computer, which calculates the precise
with the aid of the computer, which calculates the precise
location of the lump. The area is numbed with a local anesthetic
location of the lump. The area is numbed with a local anesthetic
and a marking needle is inserted to “tag” the precise location. A
and a marking needle is inserted to “tag” the precise location. A
narrow tube-like device is inserted into the breast to obtain a
narrow tube-like device is inserted into the breast to obtain a
specimen. The small opening in the breast is closed with a few
specimen. The small opening in the breast is closed with a few
stitches.
stitches.

30. What are the advantages of the ABBI
What are the advantages of the ABBI
procedure?
procedure?
 The results are available in 24-48 hours.
The results are available in 24-48 hours.
 The ABBI procedure takes less than one hour.
The ABBI procedure takes less than one hour.
 The ABBI procedure is minimally invasive, therefore allowing
The ABBI procedure is minimally invasive, therefore allowing
the woman to experience less time in healing and recovery.
the woman to experience less time in healing and recovery.
 The ABBI procedure may be an alternative to open biopsies for
The ABBI procedure may be an alternative to open biopsies for
non-palpable lesions.
non-palpable lesions.
 The ABBI procedure is currently the only procedure other than
The ABBI procedure is currently the only procedure other than
the traditional open surgery method which has the capability to
the traditional open surgery method which has the capability to
remove a lump or a cluster of microcalcifications in their
remove a lump or a cluster of microcalcifications in their
entirety.
entirety.

31. What are the disadvantages of the ABBI
What are the disadvantages of the ABBI
procedure?
procedure?
A downside to the ABBI procedure is availability. It is a
A downside to the ABBI procedure is availability. It is a
relatively new technique and many physicians may not be trained
relatively new technique and many physicians may not be trained
in the procedure or have the available equipment
in the procedure or have the available equipment.
.

32. Mammotone & Minimally Invasive
Mammotone & Minimally Invasive
Breast Biopsy (MIBB)
Breast Biopsy (MIBB)
The Mammotone and MIBB are very similar and are often called
The Mammotone and MIBB are very similar and are often called
Large Core Needle Biopsies.
Large Core Needle Biopsies.
The Mammotone and MIBB are different from the core needle
The Mammotone and MIBB are different from the core needle
biopsy in that a needle is inserted once and multiple specimens are
biopsy in that a needle is inserted once and multiple specimens are
removed through contiguous sampling. Core needle biopsies require
removed through contiguous sampling. Core needle biopsies require
the needle to be inserted multiple times.
the needle to be inserted multiple times.
Both the Mammotone and MIBB biopsy utilize a vacuum system. A
Both the Mammotone and MIBB biopsy utilize a vacuum system. A
probe is inserted and samples of tissue are collected in a chamber.
probe is inserted and samples of tissue are collected in a chamber.
Tissue samples are removed by action of a gentle vacuum. By
Tissue samples are removed by action of a gentle vacuum. By
rotating a thumbwheel, the physician moves the sampling notch to
rotating a thumbwheel, the physician moves the sampling notch to
the next desired position.
the next desired position.

33. Advantages of the Mammotone & MIBB
Advantages of the Mammotone & MIBB
The sample of the lump is larger (up to 8X larger), the needle is
The sample of the lump is larger (up to 8X larger), the needle is
inserted only once to obtain multiple samples, and the sampling
inserted only once to obtain multiple samples, and the sampling
is contiguous and selective
is contiguous and selective.
.

34. Thank You
Thank You