Diagnosing Cancer

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Confirming the Diagnosis • FNA • Core Needle Biopsy • Surgical Biopsy

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Confirming the Diagnosis
The only sure way to confirm a diagnosis of breast cancer is to perform a biopsy—that is, to remove a small piece of the tumor, and have it examined under a microscope by a pathologist—a specialist in tumor identification. The sample can be obtained either with a needle, or surgically.

 

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FNA
If the tumor is small, or if there is a good possibility that it is not cancerous, your physician may choose either a fine needle aspiration or a core needle biopsy.

Fine Needle Aspiration, or FNA, is done with a very thin needle connected to a syringe. The needle is moved in and out several times to obtain the best sample possible. It feels like having your blood drawn, and does not require a local anesthetic.

The material drawn into the syringe will be sent to a pathologist for analysis. Even if no cancer cells are found, your doctor may want to have the lump removed surgically.

 

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Core Needle Biopsy
Core needle biopsy is done with a larger needle, which can yield a larger sample. The procedure can be done under a local anesthetic and takes only a few minutes. It is the least invasive form of biopsy, but it does require the expertise of a specialist. Most women who have had the procedure report only minor discomfort.

The core biopsy is performed with a device that works like an ear-piercing instrument: it propels a needle very rapidly through the lesion. A special notch in the needle traps a sliver of tissue for examination. Samples obtained with core biopsy are large enough to be cut into thin slices and examined under the microscope, providing a diagnosis that some doctors feel is more reliable than that from a FNA. Several newer devices use a small rotating cutter and vacuum to remove an even larger sample.

Whatever device is used, if the lesion is non-palpable (in other words, cannot be felt by hand) the needle is guided using special mammography equipment, called a stereotactic unit. This equipment enables the radiologist to place the needle precisely into the tumor, even if it is as small as a pea. The needle can also be guided with the help of a hand-held ultrasound unit. The biopsy also can be done using ultrasound equipment, or a special MRI scanner, to guide the needle. The choice generally depends on what your physician is most comfortable with.

 

 

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Surgical Biopsy
Another way your doctor may choose to obtain a biopsy is surgically. A surgical biopsy is performed under local anesthesia, sometimes with sedation. Most surgical biopsies are excisional, in other words the surgeon removes (excises) the entire tumor.

The surgical biopsy takes about an hour, and causes minimal post-operative pain that goes away in a few days. You can usually begin doing non-strenuous work the day after the biopsy, although you should not lift heavy objects for a few weeks. The incision usually heals within ten days. You should avoid activities that bounce your breast, such as jogging.

 

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