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{{Breast lumps}}
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==Overview==
The only certain method to approve the presence of breast [[malignancy]] is [[breast lump]] [[biopsy]].The three types of biopsies are core-needle biopsy, open surgical biopsy, and fine needle biopsy. Core-needle biopsy has different types such as ultrasound guided-core needle biopsy, stereotactic-guided core-needle biopsy, MRI-guided core-needle biopsy, and freehand core-needle biopsy. Core-needle biopsy has high [[sensitivity]] and [[specificity]]. [[Triple test]] score is used by surgeons for assessment of palpable [[breast lumps]]. Classic type of triple test includes clinical breast examination, [[FNA]], and [[mammography]] and modified version includes clinical breast examination, core-needle biopsy and [[ultrasound]].
 
== Other Diagnostic Studies==
== Other Diagnostic Studies==
[[Biopsy]]:
===Biopsy===


The only certain method to approve the presence of breast malignancy is [[breast lump]] [[biopsy]] <ref name=":0">John M. Eisenberg Center for Clinical Decisions and Communications Science. Having a Breast Biopsy: A Review of the Research for Women and Their Families. 2016 May 26. In: Comparative Effectiveness Review Summary Guides for Consumers [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK368364/ </ref>
The only certain method to approve the presence of breast malignancy is [[breast lump]] [[biopsy|biopsy.]]<ref name=":0">John M. Eisenberg Center for Clinical Decisions and Communications Science. Having a Breast Biopsy: A Review of the Research for Women and Their Families. 2016 May 26. In: Comparative Effectiveness Review Summary Guides for Consumers [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK368364/ </ref>


There are three types of biopsy:
There are three types of biopsy:
*[[Core-needle biopsy]]
*Core-needle biopsy
*[[Open surgical biopsy]]
*Open surgical biopsy
*[[Fine needle biopsy]] <ref name=":1">Casaubon JT, Regan JP. Breast Masses, Fine Needle Aspiration. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470268/</ref>
*Fine needle biopsy<ref name=":1">Casaubon JT, Regan JP. Breast Masses, Fine Needle Aspiration. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470268/</ref>


Core-needle biopsy<ref name=":0" />
'''Core-needle biopsy:'''<ref name=":0" />
*Ultrasound guided-core needle biopsy<ref name="pmid11698631">{{cite journal| author=Yeow KM, Lo YF, Wang CS, Chang HK, Tsai CS, Hsueh C| title=Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses. | journal=J Vasc Interv Radiol | year= 2001 | volume= 12 | issue= 11 | pages= 1313-7 | pmid=11698631 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11698631  }} </ref>
*[[Ultrasound]] guided-core needle biopsy:<ref name="pmid11698631">{{cite journal| author=Yeow KM, Lo YF, Wang CS, Chang HK, Tsai CS, Hsueh C| title=Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses. | journal=J Vasc Interv Radiol | year= 2001 | volume= 12 | issue= 11 | pages= 1313-7 | pmid=11698631 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11698631  }} </ref>
**The needle is guided by use of ultrasound and patient lies on back or side
**The needle is guided by use of [[ultrasound]] and patient lies on back or side
** Highly sensitivity and specificity
** Highly [[sensitivity]] and [[specificity]]
**Choice method for breast tissue sampling
**Choice method for breast tissue sampling
*Stereotactic-guided core-needle biopsy
*Stereotactic-guided core-needle biopsy
**The needle is guided by use of x-ray and computer and patient lie on stomach
**The needle is guided by use of [[x-ray]] and computer and patient lie on [[stomach]].
**Choice method for mammograohically suspicious breast lumps which are occult in ultrasound<ref name="pmid20074953">{{cite journal| author=Ward ST, Shepherd JA, Khalil H| title=Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic. | journal=Breast | year= 2010 | volume= 19 | issue= 2 | pages= 105-8 | pmid=20074953 | doi=10.1016/j.breast.2009.12.003 | pmc= | url=htps://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20074953  }} </ref>
**Choice method for mammograohically suspicious [[breast lumps]] which are occult in [[ultrasound|ultrasound.]]<ref name="pmid20074953">{{cite journal| author=Ward ST, Shepherd JA, Khalil H| title=Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic. | journal=Breast | year= 2010 | volume= 19 | issue= 2 | pages= 105-8 | pmid=20074953 | doi=10.1016/j.breast.2009.12.003 | pmc= | url=htps://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20074953  }} </ref>
*MRI-guided core-needle biopsy
*MRI-guided core-needle biopsy
**The needle is guided by Magnetic resonance imaging
**The needle is guided by [[Magnetic resonance imaging]].
*Freehand core-needle biopsy
*Freehand core-needle biopsy
**Usually used for breast lumps which can be felt by hand on breast tissue
**Usually used for [[breast lumps]] which can be felt by hand on breast tissue.
Core-needle biopsy has lower risk of complications such as bleeding, bruising and infection
Core-needle biopsy has lower risk of [[complications]] such as [[bleeding]], [[bruising]] and [[infection]]


Open surgical biopsy<ref name=":0" />
'''Open surgical biopsy:'''<ref name=":0" />
*Perform under general anesthesia
*Perform under [[general anesthesia]]
*If core-needle biopsy is unavailable due to location of breast lump, open surgical biopsy is required
*If core-needle biopsy is unavailable due to location of breast lump, open surgical biopsy is required
*In patients with high risk of cancer is recommended
*In patients with high risk of [[cancer]] is recommended
*1-2 inch cut on breast tissue for breast lump removal
*1-2 inch cut on breast tissue for breast lump removal
*Higher risk of complications (bruising, bleeding and infection)
*Higher risk of [[complications]] ([[bruising]], [[bleeding]], [[pain]] and [[infection]])
Fine needle biopsy (FNA)<ref name=":1" />
Fine needle biopsy ([[FNA]]):<ref name=":1" />
*Performed by small needle (21-25 gauge)
*Performed by small needle (21-25 gauge)
*Regarding to small amount of breast tissue, FNA is considered as controversial method for breast lump diagnosis
*Regarding to small amount of breast tissue, [[FNA]] is considered as controversial method for breast lump diagnosis
*Performed for large and symptomatic breast cysts or imaginary abnormalities
*Performed for large and symptomatic breast [[cysts]] or imaginary abnormalities
*Complications of [[FNA]] include [[bruising]], [[bleeding]], [[pain]], [[infection]] and [[pneumothorax]]; if needle goes deep inside the chest)
*Due to inadequate tissue or nondiagnostic results, [[FNA]] has lower rate of diagnosis rather than core-needle biopsy
*[[FNA]] advantages:
**[[Cost-effectiveness]]
**Less [[invasive]] method
**Suitable for patient under [[anticoagulant therapy]]
**Appropriate to sample axillary tissue
*[[FNA]] follow-up:
**Non-bloody fluid/resolved [[cyst]]
*** [[Ultrasound]] follow-up to reassure the [[cyst]] has been resolved
***No more follow-up
**Bloody fluid/ persistent [[cyst]]
***Refer to a surgeon for open surgical [[biopsy]]
 
[[Triple test]] score is used by surgeons for assessment of palpable [[breast lumps]]:<ref>Morris KT, Pommier RF, Morris A, et al. Usefulness of the Triple Test Score for Palpable Breast Masses. Arch Surg. 2001;136(9):1008–1013. doi:10.1001/archsurg.136.9.1008</ref><ref name="pmid23104707">{{cite journal| author=Wai CJ, Al-Mubarak G, Homer MJ, Goldkamp A, Samenfeld-Specht M, Lee Y et al.| title=A modified triple test for palpable breast masses: the value of ultrasound and core needle biopsy. | journal=Ann Surg Oncol | year= 2013 | volume= 20 | issue= 3 | pages= 850-5 | pmid=23104707 | doi=10.1245/s10434-012-2710-y | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23104707  }} </ref>


*Classic [[triple test]]:
**Clinical breast examination, [[FNA]] and [[mammography]]
*Modified version of [[triple test]]
**Clinical breast examination, Core-needle biopsy and [[ultrasound]]
*[[Palpation]], [[mammography]] and [[biopsy]] are required for women aged > 35 years<ref>Santen RJ. Benign Breast Disease in Women. [Updated 2018 May 25]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278994/</ref>
**If [[mammography]] is negative, [[biopsy]] is needed to rule out [[malignancy]] especially [[Lobular carcinoma in situ|lobular carcinoma]]
*[[Palpation]], [[ultrasound]] and [[biopsy]] are suggested for women <35 years
**Surgeons may omit [[biopsy]] for [[fibroadenoma]] features on [[ultrasound]] and prefer 6 month follow-up for 2 years
**Some surgeons recommend core-needle biopsy or [[FNA]] for all [[fibroadenomas]]
***Particularly in carriers of [[BRCA]] [[mutation]]
*** Reduce the need for serial [[ultrasound]]


==References==
==References==
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

The only certain method to approve the presence of breast malignancy is breast lump biopsy.The three types of biopsies are core-needle biopsy, open surgical biopsy, and fine needle biopsy. Core-needle biopsy has different types such as ultrasound guided-core needle biopsy, stereotactic-guided core-needle biopsy, MRI-guided core-needle biopsy, and freehand core-needle biopsy. Core-needle biopsy has high sensitivity and specificity. Triple test score is used by surgeons for assessment of palpable breast lumps. Classic type of triple test includes clinical breast examination, FNA, and mammography and modified version includes clinical breast examination, core-needle biopsy and ultrasound.

Other Diagnostic Studies

Biopsy

The only certain method to approve the presence of breast malignancy is breast lump biopsy.[1]

There are three types of biopsy:

  • Core-needle biopsy
  • Open surgical biopsy
  • Fine needle biopsy[2]

Core-needle biopsy:[1]

Core-needle biopsy has lower risk of complications such as bleeding, bruising and infection

Open surgical biopsy:[1]

Fine needle biopsy (FNA):[2]

  • Performed by small needle (21-25 gauge)
  • Regarding to small amount of breast tissue, FNA is considered as controversial method for breast lump diagnosis
  • Performed for large and symptomatic breast cysts or imaginary abnormalities
  • Complications of FNA include bruising, bleeding, pain, infection and pneumothorax; if needle goes deep inside the chest)
  • Due to inadequate tissue or nondiagnostic results, FNA has lower rate of diagnosis rather than core-needle biopsy
  • FNA advantages:
  • FNA follow-up:
    • Non-bloody fluid/resolved cyst
      • Ultrasound follow-up to reassure the cyst has been resolved
      • No more follow-up
    • Bloody fluid/ persistent cyst
      • Refer to a surgeon for open surgical biopsy

Triple test score is used by surgeons for assessment of palpable breast lumps:[5][6]

References

  1. ↑ 1.0 1.1 1.2 John M. Eisenberg Center for Clinical Decisions and Communications Science. Having a Breast Biopsy: A Review of the Research for Women and Their Families. 2016 May 26. In: Comparative Effectiveness Review Summary Guides for Consumers [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2005-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK368364/
  2. ↑ 2.0 2.1 Casaubon JT, Regan JP. Breast Masses, Fine Needle Aspiration. [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470268/
  3. ↑ Yeow KM, Lo YF, Wang CS, Chang HK, Tsai CS, Hsueh C (2001). "Ultrasound-guided core needle biopsy as an initial diagnostic test for palpable breast masses". J Vasc Interv Radiol. 12 (11): 1313–7. PMID 11698631.
  4. ↑ Ward ST, Shepherd JA, Khalil H (2010). [htps://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20074953 "Freehand versus ultrasound-guided core biopsies of the breast: reducing the burden of repeat biopsies in patients presenting to the breast clinic"]. Breast. 19 (2): 105–8. doi:10.1016/j.breast.2009.12.003. PMID 20074953.
  5. ↑ Morris KT, Pommier RF, Morris A, et al. Usefulness of the Triple Test Score for Palpable Breast Masses. Arch Surg. 2001;136(9):1008–1013. doi:10.1001/archsurg.136.9.1008
  6. ↑ Wai CJ, Al-Mubarak G, Homer MJ, Goldkamp A, Samenfeld-Specht M, Lee Y; et al. (2013). "A modified triple test for palpable breast masses: the value of ultrasound and core needle biopsy". Ann Surg Oncol. 20 (3): 850–5. doi:10.1245/s10434-012-2710-y. PMID 23104707.
  7. ↑ Santen RJ. Benign Breast Disease in Women. [Updated 2018 May 25]. In: De Groot LJ, Chrousos G, Dungan K, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278994/


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