Breast Cancer Diagnosis

Fine Needle Aspiration

Fine needle aspiration (FNA) is the insertion of a small-gauge needle with an attached empty syringe into the lump. Aspiration is used to collect fluid and cells from the breast lump. The cells are then sent to pathology and identified under a microscope by a physician. If the lump is a cyst, which is totally benign (noncancerous), the physician will be able to aspirate fluid and the lesion may disappear. Fibroadenoma may be identified by pathology.
Fibroadenoma is a natural and frequent occurrence that happens to women in their 20's, 30's, and 40's. Fibroadenoma is also a benign condition.  The procedure can be done in the office with a physician and nurse. The physician numbs the breast with a needle injection. Once the area is numb, the doctor inserts a needle and aspirates to collect fluid and cells for analysis.
This is done three times. The procedure is relatively painless and takes approximately 15 minutes. Often, immediate interpretation and diagnosis is provided in the Breast Center. Should a diagnosis not be confirmed on site, patients will receive a telephone call from their doctor the next day with results.

Core Biopsy

The procedure takes about 15 minutes and the tissue samples are sent to the pathologist for evaluation Immediate results are not available on core biopsies, but are usually available in 24 to 48 hours. Your physician will call with a diagnosis.

Ultrasound Guided Biopsy

An ultrasound guided biopsy is necessary when the breast abnormality is not able to be felt. The ultrasound machine (sonogram) allows the physician to visualize the abnormality so that a biopsy can be taken. Either an FNA or a core biopsy can be obtained under ultrasound. Immediate results are available with ultrasound FNA, but the core samples require 24 to 48 hours to be read.

Sterotactic Biopsy

A stereotactic biopsy is used for non-palpable lesions best seen on mammography. Often times microcalcifications appear as little white specks on the mammogram, the abnormalities for which a stereotactic biopsy is required. Microcalcifications can be classified as benign, indeterminate or highly suspicious. Indeterminate or suspicious microcalcifications would require biopsy.
The patient lies on her belly on a special table which allows her breast to hang freely through a hole in the table.
An imaging/biopsy machine is under the table and computer guidance directs the physician to the exact place the biopsy needs to be taken. The procedure lasts about 40 minutes and, as with a freehand or ultrasound guided biopsy, the patient goes home with only a band-aid. Pathology results (because with a stereotactic, cores are always taken) are completed in 24 to 48 hours.

Excisional Biopsy

Occasionally a lump or imaging abnormality requires removal of the area of concern.
If the area of concern is able to be felt by the physician, the patient will be asked to report to the operating room. After a brief history and physical exam, as well as some lab work, the patient will be taken into the operating room. An IV will be placed and the patient will receive some medication that will allow them to fall asleep.
A small incision is made in the breast and the area of concern is removed with a rim of normal breast tissue all around it. The procedure lasts about 30 minutes and the patient will go home with absorbable sutures and a few steri-strips. Pathology on the excised abnormality will be available in 24 to 48 hours.
The patient may be a little sleepy the rest of the day, but should be able to return to normal activities the next day.
Should the abnormality not be felt, needle localization may be required. When needle localization is required, the patient is asked to report to radiology one hour prior to the scheduled surgery. In radiology, a thin wire is placed in the breast (either with ultrasound or stereotactic guidance) to mark the area of concern for the surgeon. This is done to assure the abnormality is removed. The wire is removed in the operating room along with the area of concern.