Breast Cancer Biopsy

When there is a suspicious palpable tumor or a breast tumor with a serious chance of malignancy, without having performed an FNA, or when having performed a PNA , but there is no definitive diagnosis, then the patient must be taken to the OR and to have the tumor removed under general anaesthesia, and sent it for histology while the patient is still under anaesthesia.

This procedure is called quick biopsy, because the removed part is examined immediately by a pathologist under the microscope after freezing it to -200C for one minute in order to cut it into small slices.

While the surgeon is waiting in the OR for the results. In case of cancer, the surgeon proceeds with the necessary procedure, which has been previously agreed to by the patient. If the result is negative, the patient may return home on the same day.

The same goes if the reply of the quick biopsy raises a serious suspicion for cancer but does not confirm it with certainty.

In this case it is most preferable to postpone the final procedure for another day, awaiting the "normal biopsy" instead of proceeding with a partial or total mastectomy, which may prove unnecessary if there is no malignancy after all.

In the quick biopsy procedure, the pathologist, depending on his experience, picks from his material the most suspicious part and cuts it into very thin slices which are immediately examined under the microscope.

If cancer is hiding a few millimeters away, then there will be no cancer in these sections and consequently, the reply of the quick biopsy will be negative for malignancy, while this actually is not the case.

This is done for expediency reasons, because the patient is under anaesthesia and the surgical group is waiting, while the examination of the entire tumor under the microscope requires hundredths of sections and processing which takes several days.

This is exactly what happens at the normal biopsy, the entire tumor is cut into dozens of sections is examined in detail by one or more doctors. This method eliminates the possibility of "missing" a malignancy. A normal biopsy is always performed after the quick biopsy, on the rest of the material.

A normal biopsy or histological examination is always performed on every part removed from the human body. Nowadays, due to the progress of the science of cyttology, i.e. the science that can place a diagnosis of a disease upon examining cells, quick biopsies are more rare and are performed only in cases when repeated FNAs have not given a clear diagnosis,.

While the clinical and mammographic image are very suspicious. Nowadays, it is consider a mistake not to perform an FNA in all suspicious tumors, and to take the patient directly to the OR for a surgical procedure and a quick biopsy.

It is amazing how many women have underwent in the past unnecessary breast procedures for a biopsy of benign tumors, with an emotional impact and financial cost.

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By Michael Reader