Excisional Biopsy

Also known as a surgical or open biopsy, the purpose of the excisional biopsy is to remove the entire suspicious mass plus a rim of tissue surrounding the mass. The tissue that is removed is then sent to the pathologist, who determines if it is benign or malignant. For more information on this procedure, please see http://www.breastinfo.com/scare.htm.

Incisional Biopsy

An incisional biopsy (another kind of surgical or open biopsy) is different from the excisional biopsy because the surgeon does not remove the entire mass. The usual reason an incisional biopsy is performed is that the mass is very large. A wedge of tissue is removed and sent to the pathologist for examination. This procedure is infrequently performed.

Surgical biopsies are ambulatory or day surgery procedures, performed on an outpatient basis. You will be given a local anesthetic in the area of the breast and will not feel any pain during the procedure.

When a suspicious area is non-palpable, one of the following procedures may be recommended.

Ultrasound Guided Needle Biopsy,
Stereotactic Fine Needle Aspiration Biopsy, or
Stereotactic Core Needle Aspiration Biopsy

Since some non-palpable lesions can be visualized sonographically, using ultrasound, but not necessarily using mammography, some needle biopsies are performed under sonographic guidance. Other biopsies are performed using a special computerized mammography machine.

A radiologist using this special computerized mammography machine, called a stereotactic biopsy unit, inserts a fine needle or large core needle under the guidance of the mammogram into the area of suspicion. A sample of this area is taken through the needle. In the hands of an expert radiologist, the stereotactic technique is extremely accurate at pinpointing mammographically-detected suspicious areas. The pathologist examines the sample and makes the diagnosis so treatment planning can begin. A surgical biopsy is sometimes recommended after stereotactic biopsy in cases where the tissue obtained is not adequate to confirm either a cancer diagnosis or a benign lesion. A six-month mammogram is often recommended for follow-up of a benign stereotactic biopsy finding to assure that no changes have occurred.

Needle Localization

This procedure is used when the abnormality in the breast is not palpable, yet the mammogram results are suspicious and require a surgical biopsy. If the surgeon recommends an excisional biopsy to remove the non-palpable area of suspicion, then, using ultrasound or mammography, the radiologist inserts a thin needle into the breast before surgery that will guide the surgeon in locating the suspicious area for removal. Needle localization is also called pre-operative needle localization.

An X-ray is performed on the piece of breast tissue obtained during surgery to confirm that the suspicious area has been removed.

The Role of the Pathologist

The pathologist is a specialist trained to examine tissues and cells. The pathologist follows a series of steps for a complete tissue analysis:

Initially, he or she evaluates the characteristics of the tissue grossly or with the naked eye, sometimes magnified by a hand lens.

The tissue is then sliced with a sharp knife so that it can be further examined. At this point, the pathologist may make a preliminary or gross diagnosis. Usually, he or she will take one very thin slice or section of the suspicious area and freeze it. Then the section will be stained with a special solution.

The pathologist will further examine the frozen, stained tissue under the microscope while the patient is still in the operating room. This procedure is called a frozen section.

Since the frozen section only allows the pathologist to make a "fast" but highly accurate diagnosis of one small section of the tissue and the freezing process is not permanent, other steps are needed to examine all of the removed tissue.

The remaining tissue undergoes a series of steps that allow for a more detailed and definitive analysis. This process results in high quality slides called permanent sections. The pathologist uses them to make the final diagnosis.

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