This document provides information about different types of biopsies. It discusses: - Biopsy is the removal of tissue from the body for examination to make a diagnosis. The main types are excisional, incisional, and aspiration biopsies. - Excisional biopsy removes the entire lesion. Incisional biopsy removes only a portion. Aspiration biopsy uses a needle to remove fluid. - Breast biopsies include needle biopsies like fine needle and core needle, and open biopsies like incisional and excisional. Imaging helps locate non-palpable lumps. - New techniques like ABBI and Mammotone aim to obtain

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compiled By
Dr. Sunil Vishwakarma
RSO Surgery
G. R. Medical College, Gwalior

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

3. TECHNIQUES OF BIOPSY

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

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

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

7. INCISIONAL BIOPSY
✓Narrow, deep
✗
Broad, shallow

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

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

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

11. 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
■ Inserted into the center of a lesion and
a small plug of tissue removed

13. 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
■ Any suspicious lump/lesion in the breast
warrants for the biopsy.
■ When a lump is found, a biopsy is the first step
in diagnosis and treatment.
■ Although the primary purpose is to diagnose
cancer, a biopsy can also be a surgical treatment
to remove cancer.

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

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

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

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

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

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

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

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

23. DISADVANTAGES OF OPEN
BIOPSIES
■ Surgical procedure
■ Expensive
■ Sideeffects suchasinfectionorbloodcollection
under the skin
Excisional Only:
■ Removing tissue can change the look and feel of
the breast

24. IMAGING TECHNIQUES
When alump cannot be felt, the doctor must
locate it with a special imaging technique.
■ The doctor may use mammography (sometimes
calledstereotacticlocalization)orultrasound
imaging
■ The lump is located by mammography or
ultrasound
■ The doctor inserts aneedle to collect asample
of tissue

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

26. 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
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 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
(ABBI)
The ABBI procedure is performed under local anesthesia and is
a one-step biopsy procedure. This means that it combines
needle localization with the removal of the lump.
Using stereotactic techniques, a technician pinpoints the lump
with the aid of the computer, which calculates the precise
location of the lump. The area is numbed with a local anesthetic
and a marking needle is inserted to “tag” the precise location. 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
stitches.

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

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

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

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

34. Thank You