Breast cancer biopsy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Ammu Susheela, M.D. [3]

Overview

Breast biopsy the only definite way to diagnose breast cancer. Hence, every patient with a doubtful lesion in her/his breast needs a biopsy to evaluate the nature of the mass precisely. Nevertheless, a large number of biopsy samples taken from breast lumps are found to be benign.

Biopsy

• Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.
• During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample.

• A breast biopsy is the only definite way to diagnose breast cancer. Most biopsy samples taken from breast lumps are found to be benign (non-cancerous).
• The type of biopsy will depend on whether the lump can be felt (palpable) or not (non-palpable). Ultrasound or computed tomography (CT) scan may be used to guide the biopsy. The types of biopsy that may be used are:

• Fine needle aspiration (FNA)
• Core needle biopsy
• Stereotactic core needle biopsy
• Wire localization biopsy
• Surgical biopsy to remove part of or all of a breast lump or abnormal area

• A biopsy is also done if inflammatory breast cancer is suspected, often including a skin biopsy. A biopsy of the nipple is taken if the doctor suspects Paget disease of the nipple.

As discussed below lymph node dissection would be either with or without sentinel node biopsy.

With sentinel node biopsy

For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting sentinel node biopsy. Sentinel node biopsy can establish cancer staging of the axilla if there are positive lymph nodes present. It also is less risky than performing lymphadenectomy, having fewer side effects and a much lower chance of causing lymphedema. If cancer is not present in sentinel lymph nodes then the axillary lymph node dissection should not be performed.

If one or two sentinel nodes have cancer which is not extensive, then no axillary dissection should be performed but the person with cancer should have breast-conserving surgery and chemotherapy appropriate for their stage of cancer.

With sentinel lymph node mapping

More recently, the concept of sentinel lymph node mapping has been popularized by Donald Morton and others.^{[citation needed]} Cancer with various primary sites (breast, melanoma, colorectal, etc.) often metastasize early to the first drainage lymphatic basin. This process is predictable anatomically according to the primary site in the organ and the lymphatic channels. The first nodes (sentinel nodes) can be identified by particulate markers such as lymphazurin, methylene blue, India ink and radio-labelled colloid protein particles injected near the tumor site. The draining sentinel node can then be found by the surgeon and excised for verification by the pathologist if tumor cells are present, and often these tumor cells are few and only easily recognized by careful examination or by using techniques such as special stains, i.e. immunohistochemical. When the sentinel node is free of tumor cells, this is highly predictive of freedom from metastasis in the entire lymphatic basin, thus allowing a full node dissection to be avoided.

The practice of sentinel lymph node mapping has changed the surgical approach in many cancer systems, sparing a formal lymph node dissection for patients with sentinel lymph node negative for tumor and directing a full node dissection for patients with sentinel lymph node positive for tumor metastases. For example in stage II breast carcinoma, using the sentinel lymph node technique, 65% of patients could be spared from a formal node dissection.

Complication

Lymphedema may result from lymphadenectomy. Extensive resection of lymphatic tissue can lead to the formation of a lymphocele.

Lymph node biopsy

A lymph node is a small, bean-shaped mass of lymphatic tissue along lymph vessels (tubes through which lymph fluid travels in the body). Lymph nodes store lymphocytes (a type of white blood cell that fights germs, foreign substances or cancer cells) and filters bacteria and foreign substances (including cancer cell biopsy removes lymph nodes during a surgical procedure so they can be examined under a microscope to find out if they contain cancer.

With breast cancer, lymph nodes from under the arm (axilla) are removed. Breast cancer cells can travel through the lymph system, and the first place they may spread is to these lymph nodes. The number of lymph nodes that have cancer helps to determine the stage stage A description of the extent of cancer in the body, including the size of the tumor, whether there are cancer cells in the lymph nodes and whether the disease has spread from its original site to other parts of the body. of breast cancer.

Axillary lymph node dissection

Axillary lymph node dissection (ALND) is a surgical procedure to remove the lymph nodes under the arm.

• Most breast cancers require staging with ALND.
• Axillary lymph node dissection is the standard method of checking lymph nodes.

Sentinel lymph node biopsy

• The sentinel node is the first lymph node in a chain or cluster of lymph nodes that receive lymph fluid from the area around a tumor. Cancer cells will most likely spread to these lymph nodes. Sentinel lymph node biopsy (SLNB) is the removal of the sentinel node so it can be examined to see if contains cancer cells.
• Sentinel lymph node biopsy may be offered to women with breast tumors smaller than 5 cm, and the axillary lymph nodes cannot be felt during an examination by the doctor.
• Sentinel lymph node biopsy may not be suitable for women:

• Who had breast surgery or radiation therapy in the past
• With axillary lymph nodes the doctor can feel
• With locally advanced or advanced breast cancer (tumors greater than 5 cm in size)
• With tumors in more than one area in the breast (multifocal tumors)
• With metastatic breast cancer
• Inflammatory breast cancer
• Who have had breast reduction surgery, or have breast implants