Breast Core BiopsyBreast Core Biopsy

ByBy

Dr. Rania ZakariaDr. Rania ZakariaLecturer of PathologyLecturer of Pathology

Faculty of Medicine - Benha UniversityFaculty of Medicine - Benha University

Fine needle aspiration biopsyFine needle aspiration biopsy

Fine needle aspiration is a quick and less Fine needle aspiration is a quick and less invasive technique.invasive technique.

However, it is difficult to be interpreted as However, it is difficult to be interpreted as the cells collected by fine needle appears the cells collected by fine needle appears under microscope as a disorganized jumble.under microscope as a disorganized jumble.

It is not possible to distinguish insitu and It is not possible to distinguish insitu and invasive tumors on the basis of fine needle invasive tumors on the basis of fine needle aspiration biopsy alone.aspiration biopsy alone.

Core BiopsyCore Biopsy

DefinitionDefinition

A core biopsy is a procedure where a A core biopsy is a procedure where a needle is passed through the skin to take needle is passed through the skin to take a sample of tissue from a mass or lump.a sample of tissue from a mass or lump.

The tissue is then examined The tissue is then examined microscopically for any abnormalities.microscopically for any abnormalities.

Core BiopsyCore Biopsy

Core biopsy may be performed when Core biopsy may be performed when a suspicious lump is found, for a suspicious lump is found, for example a breast lump or enlarged example a breast lump or enlarged lymph node or if abnormality is lymph node or if abnormality is detected on an imaging test such as detected on an imaging test such as x-ray, ultrasound or mammography.x-ray, ultrasound or mammography.

Core BiopsyCore Biopsy

Core biopsy is a more invasive Core biopsy is a more invasive procedure than fine needle aspiration procedure than fine needle aspiration biopsy, as it involves a local biopsy, as it involves a local anaesthetic. However, it is quicker anaesthetic. However, it is quicker and less invasive than a surgical and less invasive than a surgical biopsy. In some cases, the result of a biopsy. In some cases, the result of a core biopsy will prevent the need for core biopsy will prevent the need for surgery to take place.surgery to take place.

How is a Core Biopsy Done?How is a Core Biopsy Done?

A core biopsy is a simple procedure to A core biopsy is a simple procedure to collect a sample of cells from a mass to collect a sample of cells from a mass to be examined microscopically.be examined microscopically.

No special preparation is required, No special preparation is required, though the patient is informed not to though the patient is informed not to use any powder (such as talcum use any powder (such as talcum powder), lotion, creams, perfumes or powder), lotion, creams, perfumes or deodorants near the area to be sampleddeodorants near the area to be sampled

How is a Core Biopsy Done?How is a Core Biopsy Done?

Core biopsy is performed with the use of local Core biopsy is performed with the use of local anaethetic to numb the area where the needle is anaethetic to numb the area where the needle is inserted. A small incision is made in the skin over the inserted. A small incision is made in the skin over the lump, and a specially-designed hollow needle is lump, and a specially-designed hollow needle is inserted through the incision. When the tip of the inserted through the incision. When the tip of the needle is in the area to be examined, it collect a needle is in the area to be examined, it collect a sample of the cells that are present.sample of the cells that are present.

The needle is then withdrawn, and the sample is The needle is then withdrawn, and the sample is extracted. This may be repeated, until an adequate extracted. This may be repeated, until an adequate sample has been collected.sample has been collected.

How is a Core Biopsy Done?How is a Core Biopsy Done?In some cases, the lump or the mass from In some cases, the lump or the mass from which the cells are to be taken is not easily felt which the cells are to be taken is not easily felt through the skin. through the skin.

In these cases, the radiologist, surgeon or In these cases, the radiologist, surgeon or pathologist collecting the sample may use pathologist collecting the sample may use ultrasound, where the needle can be seen on ultrasound, where the needle can be seen on the ultrasound monitor and guided to the area, the ultrasound monitor and guided to the area, or mammography which use 2 mammograms at or mammography which use 2 mammograms at different angles and a computer to locate the different angles and a computer to locate the correct area. This may make the procedure correct area. This may make the procedure take a little longer. take a little longer.

How is a Core Biopsy Done?How is a Core Biopsy Done?

Once the test is completed, a small Once the test is completed, a small dressing or some tape will be placed dressing or some tape will be placed over the biopsy site which may be over the biopsy site which may be removed the next dayremoved the next day..

CORE needle biopsyCORE needle biopsy

Ultrasound guidedUltrasound guided Core BiopsyCore Biopsy

Results of a Core BiopsyResults of a Core Biopsy

The samples taken are examined The samples taken are examined microscopically. A detailed report will then microscopically. A detailed report will then be provided about the type of cells that were be provided about the type of cells that were seen, including any suggestion that the cells seen, including any suggestion that the cells might be cancer.might be cancer.

It is important to remember that having a It is important to remember that having a lump or mass does not necessarily mean lump or mass does not necessarily mean that it is cancerous, many core biopsies that it is cancerous, many core biopsies reveal that suspicious lumps or masses are reveal that suspicious lumps or masses are benign.benign.

Results of a Core BiopsyResults of a Core BiopsyAspirate samples may be described as one of the Aspirate samples may be described as one of the following types:following types:

- - InadequateInadequate: The sample taken was not adequate to : The sample taken was not adequate to exclude or confirm a diagnosis of cancer.exclude or confirm a diagnosis of cancer.- - BenignBenign: There are no cancerous cells present.: There are no cancerous cells present.- - Atypical/ Intermediate, suspicious of malignancyAtypical/ Intermediate, suspicious of malignancy : : Some cells appear abnormal but are not definitely Some cells appear abnormal but are not definitely malignant so a surgical biopsy is required for proper malignant so a surgical biopsy is required for proper diagnosis.diagnosis.- - MalignantMalignant: show malignant criteria (loss of polarity, : show malignant criteria (loss of polarity, pleomorphism, increased nucleocytoplasmic ratio, pleomorphism, increased nucleocytoplasmic ratio, hyperchromasia, abnormal mitosis, etc.)hyperchromasia, abnormal mitosis, etc.)

How effective are core biopsies?How effective are core biopsies?

Core biopsy is an effective tool in Core biopsy is an effective tool in evaluating and diagnosing suspect evaluating and diagnosing suspect lumps or masses.lumps or masses.

Allow quick diagnosis.Allow quick diagnosis.

Core biopsy is also very good at Core biopsy is also very good at determining whether a lump is benign, determining whether a lump is benign, potentially avoiding the need for potentially avoiding the need for surgery.surgery.

How effective are core biopsies?How effective are core biopsies?

Core biopsy do require some expertise Core biopsy do require some expertise to perform and interpret.to perform and interpret.

To insure that an accurate result is To insure that an accurate result is achieved, it is important that the achieved, it is important that the radiologist, surgeon, pathologist and radiologist, surgeon, pathologist and oncologist who perform the procedure oncologist who perform the procedure has experience in core biopsy.has experience in core biopsy.

Benefits of a core biopsyBenefits of a core biopsy

Core biopsy is relatively quick and effective Core biopsy is relatively quick and effective for determining the status of suspect tissue.for determining the status of suspect tissue.

Core biopsy are particularly useful for Core biopsy are particularly useful for investigating abnormalities detected on investigating abnormalities detected on imaging tests (as x-ray). It is the imaging tests (as x-ray). It is the investigation of choice when breast investigation of choice when breast microcalcification is seen on mammography.microcalcification is seen on mammography.

Benefits of a core biopsyBenefits of a core biopsy

Also, because the needle used is large Also, because the needle used is large enough, it take a slice of tissue good for enough, it take a slice of tissue good for interpretation and distinguishing between interpretation and distinguishing between some types of precancerous diseases and some types of precancerous diseases and malignant diseases (such as DCIS and malignant diseases (such as DCIS and invasive ductal carcinoma).invasive ductal carcinoma).

Compared to surgical biopsy, core biopsy Compared to surgical biopsy, core biopsy involves little possibility of scaring, involves little possibility of scaring, infection or pain, and has a significantly infection or pain, and has a significantly shorter recovery period.shorter recovery period.

Risks of a core biopsyRisks of a core biopsy

There are generally no complications with this There are generally no complications with this procedure, though patient may experience some procedure, though patient may experience some tenderness or bruising over the needle insertion tenderness or bruising over the needle insertion site.site.

Risks of core biopsy include:Risks of core biopsy include:

- Bleeding, swelling, fever or pain (rare). - Bleeding, swelling, fever or pain (rare).

- Core biopsy may leave a very small, fine scar, - Core biopsy may leave a very small, fine scar, which usually fades with time.which usually fades with time.

Risks of a core biopsyRisks of a core biopsy

Risks of core biopsy include:Risks of core biopsy include:

- The possibility that malignant cells The possibility that malignant cells present could be trailed into unaffected present could be trailed into unaffected tissue as the needle is removed which tissue as the needle is removed which is rare when the test is performed by is rare when the test is performed by skilled practitioner.skilled practitioner.