Surgical Biopsies

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This will only be done if the other types of biopsy cannot be used, or do not give a definite result. Surgical biopsy means using a surgical knife (scalpel) to open the area and remove a tissue sample from the lump. Or, if the lump is small enough, the whole of it may be removed.

Depending on the scale of the biopsy operation, you may have this done under local or general anaesthetic. If the lump turns out to be benign, you may not have any more treatment. If it is cancer, your doctor will talk over the treatment options with you.

Surgical biopsy procedures include the following:

Excisional biopsy

This procedure can be performed whether or not the breast mass is palpable and is usually performed under local anesthesia (i.e., the patient remains awake during the procedure) on an outpatient basis. The area is numbed with a local anesthetic and a sedative is usually administered. A small incision of about 1 to 2 inches is made as close to the lump as possible. The surgeon removes a piece of tissue, or if it is small, the entire lump and the incision is sutured. The biopsy usually takes about an hour to perform. Postoperative pain is usually minimal and resolves within a few days.

If the lump cannot be felt, the procedure is slightly more involved and time consuming. Because it cannot be felt, it must be located by a process called needle localization. A mammogram or ultrasound is used to pinpoint the lump. A wire needle is inserted into the breast, marking the location of the lump. The wire is left inside the breast and taped to the skin, and the patient is taken to the operating room to have the biopsy.

Although the main purpose of an excisional biopsy is to diagnose cancer, the procedure can also be considered treatment if the surgeon finds the tumor and completely removes it. Excisional biopsy may be the only surgical treatment a woman needs to have a cancerous tumor removed from her breast. For other women, the removal of some lymph nodes may be necessary.

Advantages

  • The procedure is generally very accurate and produces very few false negative results. A false negative result is one that says cancer is not present when in fact it is.
  • An excisional biopsy provides complete information about the abnormality, such as the tumor’s size, type, grade and hormone receptor status. Such information is useful in planning a patient’s treatment.
  • Excisional biopsy also doubles as a treatment for breast cancer as it may be the only surgery a patient needs for removing the tumor.

Disadvantages

  • Excisional biopsy is expensive, has a more uncomfortable and longer recovery period and increases the risk of infection and bruising.
  • The amount of tissue removed can also affect the look and feel of the breast. If a very large lump was removed, the scar may be large and may leave an indentation in the breast.
  • Finally, if a woman chooses excisional biopsy as her first biopsy choice and the biopsy results are benign, she may have had more extensive surgery than necessary.

Incisional biopsy

In an incisional biopsy, only a portion of a lump or suspicious area is removed for diagnosis. The tissue is then examined under a microscope. This procedure is done most often on women with larger cancerous tumors too large to be removed with an excisional biopsy. The amount of tissue removed during incisional biopsy is enough to provide detailed information that can help a woman and her physician plan her treatment.

Most women undergoing biopsy will know beforehand which biopsy they will be getting. In some cases, though, when a surgeon finds that a tumor is too extensive to totally remove, an incisional biopsy will be performed to remove only part of the tumor.

In general, this procedure is similar to that for an excisional biopsy, but only less tissue is removed.

Advantages

  • Incisional biopsy is highly accurate, producing very few false negative results. A false negative result is one that says cancer is not present when in fact it is.
  • An incisional biopsy also provides a greater amount of information such as the tumor’s type, grade and hormone receptor status to help in a patient’s treatment plan.

Disadvantages

  • Incisional biopsy is expensive, has a more uncomfortable recovery period and increases the risk of infection and bruising.
  • The amount of tissue removed can also change the look and feel of the breast.
  • Incisional biopsy only removes part of the tumor rather than all of it, as in excisional biopsy. This means that additional surgery may still be necessary to treat the cancer.