Wednesday, December 16, 2009

The “Core Needle Biopsy of the Breast”

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The “Core Needle Biopsy of the Breast”

Core Needle Biopsy of the Breast

Posted: 15 Dec 2009 07:52 AM PST

In the past decade, core needle biopsy has taken over fine needle aspiration (FNA) as the main tool for diagnosing image-detected or palpable breast lesions. While this biopsy technique is just a sample, cores of breast tissue are removed vs. individual cells as in FNA and thus the pathologist has more information to make an accurate diagnosis.

Once a core biopsy is performed and a diagnosis is rendered, there are several things that can happen:

1) The diagnosis is completely benign and correlates with the radiology so no further surgery is needed. Examples include:

  • Fibrocystic Changes Without Atypia
  • Sclerosing Adenosis
  • Columnar Cell Change Without Atypia
  • Fibroadenoma

2) An overt cancer is found, or the pathologist finds an atypical lesion where enough data from the breast literature shows that excision is necessary to rule out a more significant lesion, such as a cancer. Examples include:

  • Fibroepithelial Lesions with Cellular Stroma
  • Atypical Ductal Hyperplasia (please see my blog entry on focal ADH )
  • Ductal Carcinoma in Situ
  • Invasive Carcinoma

3) The findings from the pathologist don't correlate with the findings from radiology and so surgical excision is needed to clear up the discordance.

4) The biopsy contains a "gray" area of controversial findings where the breast literature has not come to universal agreement as to whether or not surgery needs to be performed. Many studies have shown these lesions should be excised, but other studies claim the opposite. Examples include:

  • Lobular neoplasia (ALH/LCIS)
  • Papilloma Without Atypia
  • Radial Scar/Complex Sclerosing Lesion
  • Flat Epithelial Atypia

It is unfortunate that we still have these "gray" areas where doctors can't universally agree on the need for surgery. This is mainly because most of the studies are small and within one institution so it is difficult to generalize the findings to the public. Larger prospective studies may help us define these "gray" areas better so that we can finally determine whether patients with these findings on core biopsy need to go to surgery.

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