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==Overview==
==Overview==
The only certain method to approve the presence of breast malignancy is [[breast lump]] [[biopsy]].The three types of biopsy are core-needle biopsy, open surgical biopsy, and fine needle biopsy.
== 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]]<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, pain 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)
*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
*Due to inadequate tissue or nondiagnostic results, [[FNA]] has lower rate of diagnosis rather than core-needle biopsy
*FNA advantages
*[[FNA]] advantages
**Cost-effectiveness
**[[Cost-effectiveness]]
**Less invasive method
**Less [[invasive]] method
**Suitable for patient under anticoagulant therapy
**Suitable for patient under [[anticoagulant therapy]]
**Appropriate to sample axillary tissue
**Appropriate to sample axillary tissue
*FNA follow-up
*[[FNA]] follow-up:
**Non-bloody fluid/resolved cyst
**Non-bloody fluid/resolved [[cyst]]
*** Ultrasound follow-up to reassure the cyst has been resolved
*** [[Ultrasound]] follow-up to reassure the [[cyst]] has been resolved
***No more follow-up
***No more follow-up
**Bloody fluid/ persistent cyst
**Bloody fluid/ persistent [[cyst]]
***Refer to a surgeon for open surgical biopsy
***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>
[[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:
*Classic [[triple test]]:
**Clinical breast examination, FNA and mammography
**Clinical breast examination, [[FNA]] and [[mammography]]
*Modified version of triple test
*Modified version of [[triple test]]
**Clinical breast examination, Core-needle biopsy and ultrasound
**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>
*[[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
**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
*[[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
**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
**Some surgeons recommend core-needle biopsy or [[FNA]] for all [[fibroadenomas]]
***Particularly in carriers of BRCA mutation  
***Particularly in carriers of [[BRCA]] [[mutation]]
*** Reduce the need for serial ultrasound
*** Reduce the need for serial [[ultrasound]]


==References==
==References==

Revision as of 16:19, 4 January 2019

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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 biopsy are core-needle biopsy, open surgical biopsy, and fine needle biopsy.

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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