Dedicated to the care of breast cancer and all breast conditions
+27 (0)11 484 0334
info@raynebreastcare.co.za
Parklane Hospital Women’s Wellness Centre
Waterfall Hospital (North): Rooms 210, South Block
 
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Needles and biopsies  
If you or your doctor notices a problem in your breast and you have a mammogram and ultrasound, a biopsy may be advised to you.

Biopsy means taking out a piece of the breast and examining the cells and surrounding tissue under a microscope to see what is causing the problem. Some biopsies will show cancer, but almost three-quarters of biopsies of the breast will not show cancer, and allow you to be reassured. An accurate biopsy depends on using the best methods of getting the piece of the breast. If cancer is present or suspected, a biopsy needs to show, not just the cancer cells, but the structure of the surrounding breast to see if it is invading.

International breast recommendations say that a full diagnosis should come from one invasive test. This is best done by an image-guided core needle biopsy.

Making sure that the biopsy is carried out under direct guidance (usually by ultrasound or mammogram) means that the doctor carrying it out can be sure they are removing the breast tissue from the right area and taking the right amount. It also means that the least damage is done resulting in less bruising or swelling. Blind biopsies done in a doctor’s rooms increase the risk of problems and make the need for a repeat biopsy more likely.
When should I have a biopsy done?
Core needle biopsy
Fine Needle Aspiration
Surgical biopsy
Hookwire biopsy
V-marker
When should I have a biopsy?
If your radiologist is concerned that you may need a biopsy, it is a good idea to talk over the reasons why and what they expect to find. Making the decision to have a biopsy is a stressful one, and does not need to happen at the same time as your mammogram. It is always possible to return later, in good time, for the biopsy. If you are concerned or anxious, take time to talk it over with your family, your doctor before going ahead. Also remember to speak to your medical aid, or get a full quote of all costs including the pathology costs for analysing the specimen. If you do not have a medical aid and are worried about the cost, remember that these investigations are available at government hospitals too.
 
Core needle biopsy
This hollow needle cores an area of breast tissue out under direct guidance. The size of sample take allows all diagnostic tests to happen without any further samples being required although the results may take several days to complete.

This type of biopsy is accurate and allows both you and your doctor to discuss and plan treatment no further painful tests. If there is no cancer in the area of the breast, normally there is no need for surgery.

Some people worry that putting a needle into a cancer can cause the cells to get angry or spread but this is not the case. There is no increased risk of cancer spread after a biopsy.
 
MRI (Magnetic Resonance Imaging)
MRI uses the effect of magnetic fields on your body’s water to generate a picture. It doesn’t just show the structure of the breast, but how it is behaving, including the behaviour of any lumps or abnormalities. It is not a comfortable test to go through, and it can be expensive, so normally it is used when additional information is needed after mammogram or ultrasound. It is also a great test for young women at very high risk of cancer.
 
Fine needle aspiration
An FNA sucks out a few of the cells from the abnormal area of the breast with a needle. Under a microscope the doctor can see if these are cancerous or not. This used to be the method that was commonly used to diagnose cancer. In the modern times however, we want to know more and more about the cancer cells before starting any treatments and this information cannot be obtained from an FNA, so it has become less useful in diagnosing breast problems. It can still be useful for sucking fluid out of painful breast cysts, or diagnosing problems in the lymph glands however.
 
Surgical biopsy
Very occasionally a core needle biopsy does not give enough information or is too difficult to carry out. When this happens you may need to have a small surgical procedure to remove the problem area. Less than 20% of breast problems should be diagnosed this way.

If the area is too small or cannot be felt it can be marked by ultrasound guidance, using a wire (a ‘hookwire’) or some dye, placed into the breast at the problem site.

In the operating theatre under a short general anaesthetic, a cut is made to the breast (normally the cut is hidden around the areola or under the breast) and the area removed for Xray, to make sure the right area has been taken, and then for diagnosis.
 
V Marker
After a cancer diagnosis on core biopsy, some patients go for chemotherapy first, if this is the case, the radiologist can use guidance to insert a small metal marker into the cancer. This helps with seeing the cancer on mammogram later, and marking the place that needs to be removed.
 
When should I have a biopsy?
If your radiologist is concerned that you may need a biopsy, it is a good idea to talk over the reasons why and what they expect to find. Making the decision to have a biopsy is a stressful one, and does not need to happen at the same time as your mammogram. It is always possible to return later, in good time, for the biopsy. If you are concerned or anxious, take time to talk it over with your family, your doctor before going ahead. Also remember to speak to your medical aid, or get a full quote of all costs including the pathology costs for analysing the specimen. If you do not have a medical aid and are worried about the cost, remember that these investigations are available at government hospitals too.
 
 
 
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