Breast Biopsy Techniques Fine Needle Aspiration Description Use of a thin needle to extract cells of fluid from a breast lump or an abnormal area. Often used when a lump can be felt during the exam. Value Limitation Rapid Simple bedside procedure. May yield limited tissue sample -> potentially affect accuracy. Useful for evaluating a palpable lump Not ideal for non-palpable lesions Usually, no anaesthesia is required. The rate of non-diagnostic samples is higher than that of core needle biopsy. Low risk of complications. Well suited for lesions close to the skin. Core Needle Biopsy Description Type of biopsy used in which a large needle is guided by sonography, fluoroscopy or MRI. Use to collect a tissue sample for analysis. Value Limitation More invasive than fine needle biopsy. Local or general anaesthesia is generally needed. Yields larger tissue fragments. Preferred methods for assessing a suspicious breast mass on ultrasound or mammography Higher risk of complications than fine needle aspiration such as: Hematoma Can distinguish between non-invasive and invasive carcinoma. Pain Allows for testing receptor status in patients with breast cancer. Bleeding Suitable for both palpable and non-palpable masses. Infections Provides more tissue analysis than fine needle aspiration. But complications are still rare but higher than fine needle aspiration. Slight discomfort during procedure. Surgical biopsy Description Incisional -> surgical removal of a part of a suspicious mass. Excisional -> entire mass removal with or without a margin of healthy tissue is surgically removed. Value Limitation INCISIONAL INCISIONAL Useful for large lesions Doesn’t remove the entire lesion Allows for adequate sampling May miss critical areas. Provides diagnostic evaluation. EXCISIONAL EXCISIONAL Surgical procedure with associated risks. Both diagnostic and therapeutic Scar formation. Complete removal of small lesions. Imaging assisted biopsy including hook wire and mammotomy Description Hook wire localisation biopsy: a radiologist will use imaging to place a hook wire into a breast lesion before surgery. Mammotomy biopsy: a vacuum assisted core needle biopsy performed under imaging guidance usually under ultrasound. Value Limitation HOOK WIRE LOCALISATION BIOPSY Two step processes: Initial localisation (ultrasound or mammography) HOOK WIRE LOCALISATION BIOPSY Subsequent surgical excision. Precise localisation. Patient discomfort Minimally invasive Risk of wire migration Non-ionising radiation. Effective for suspicious lesions on imaging. Rarely the wire may shift slightly between localisation and surgery. MAMMOTOMY Cost considerations Life saving Workflow considerations Early cancer detection MAMMOTOMY Avoiding mastectomy Small amount of radiation use Over diagnosis False positives Drawback