Breast biopsy is performed to find out whether a mass in the breast that can be felt by the patient or doctor by palpation or detected by examinations such as mammography, ultrasound and MRI is cancer. Many biopsy techniques can be used in the breast, but the most common is the cutting needle biopsy. In this biopsy, also known as Trukat or core biopsy, the suspicious mass is entered with a special needle under the guidance of ultrasound, mammography or MRI. When the button of the needle is pressed, a 1-2 mm thick strip-shaped piece is cut from the mass and taken out. Generally, 3-4 pieces are taken from each mass and these pieces are taken into a liquid called formaldehyde and sent to pathology.
The cutting needle is the standard biopsy method applied in the breast today and has a very high accurate diagnosis rate. Needle biopsy, which was done manually by simple injectors, mostly by surgeons in the past, should be completely abandoned today. Simple needle biopsy has the following important drawbacks:
Since the cutting needle biopsy is performed visually with imaging devices such as ultrasound, mammography and MRI, it can be ensured that the needle has entered the mass and that the biopsy is taken from the right place. However, since a simple needle biopsy is done by hand without seeing it, it is not possible to be sure that a piece is taken from the right place.
A large number of tissue pieces are cut from the suspicious mass with a cutting needle. With a simple needle, only cell fragments can be taken, and the diagnostic value is low. Therefore, cancer can be missed in many patients with a simple needle biopsy.
While cutting needle biopsy provides many important additional information that guides cancer treatment, such as the type of cancer if the patient has cancer, its growth rate, whether it has spread to vessels and nerves, and the amount of hormone receptors, simple needle biopsy can only show with low accuracy whether the tissue is cancer or not.
For these reasons, if a breast biopsy is to be performed, imaging-guided cutting needle biopsy should be used and simple needle biopsy should be abandoned.
In some cases, it may be preferable to remove all or most of the suspicious mass in the breast. Sometimes, the suspicious area may not be as sharply demarcated as a mass, but may be a wide area with uncertain borders and this entire area may need to be removed. The classical method applied in these cases is the surgical removal of the suspicious area or mass. For this, the suspicious mass or area is usually marked with a wire first, and then the suspicious area is taken out with a large incision, following the wire by the surgeon. However, the surgical method has some disadvantages:
Two procedures (first wire marking and then surgery) are often required to remove the mass.
If the suspicious mass turns out to be benign, the patient will have been operated in vain. The scar tissue formed by the incision both distorts the image and causes appearances that are confused with cancer in ultrasound and mammography controls.
If the mass is cancerous, the results of axillary sentinel lymph node biopsy may be distorted due to the surgical operation.
For these reasons, methods have been developed that can be an alternative to surgical biopsy in cases that require large tissue removal from the breast.
These methods are BLES and vacuum biopsy. In the BLES procedure, which is derived from the initials of the English words Breast Lesion Excision System, the mass in the breast is entered through a tiny incision with a 4-5mm thick needle under local anesthesia and ultrasound guidance. When the mass is reached and the device is started, some wires come out from the tip of the needle. These wires cut the tissue by burning with radiofrequency energy and grasp the mass like a scoop. Then, the mass is pulled out as a whole by stretching it through the incision.
In vacuum biopsy, the breast is entered through a 3-4 mm incision under local anesthesia and under ultrasound guidance, and a vacuum biopsy needle is placed in the lower part of the mass. When the device is operated, the vacuum biopsy needle both sucks the tissue towards itself, cuts the tissue into strips with the cutter blades inside, and takes the cut pieces out and collects them in a chamber.
Both BLES and vacuum biopsy have their own advantages and disadvantages. BLES cuts the tissue by burning very little bleeding and the mass is removed as a single piece. However, a mass with a maximum diameter of 2.5 cm can be taken. In vacuum biopsy, there is no diameter limit, but the mass is removed by fragmentation and bleeding is slightly more. Both methods are successfully used in the non-surgical treatment of benign tumors such as fibroadenoma in the breast, apart from biopsy.
