Breast lumps other diagnostic studies
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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]
Other Diagnostic Studies
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[1]
- Ultrasound guided-core needle biopsy[3]
- The needle is guided by use of ultrasound and patient lies on back or side
- Highly sensitivity and specificity
- Choice method for breast tissue sampling
- Stereotactic-guided core-needle biopsy
- 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[4]
- MRI-guided core-needle biopsy
- The needle is guided by Magnetic resonance imaging
- Freehand core-needle biopsy
- 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
Open surgical biopsy[1]
- Perform under general anesthesia
- 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
- 1-2 inch cut on breast tissue for breast lump removal
- Higher risk of complications (bruising, bleeding, pain and infection)
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
- 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
- Non-bloody fluid/resolved cyst
Triple test score is used by surgeons for assessment of palpable breast lumps [5] [6]
- 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 [7]
- If mammography is negative, biopsy is needed to rule out malignancy especially 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
- ↑ 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/
- ↑ 2.0 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/
- ↑ 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.
- ↑ 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.
- ↑ 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
- ↑ 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.
- ↑ 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/