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Biopsies

Percutaneous Biopsy

Percutaneous biopsies (through the skin) are most frequently carried out by a radiologist using local anaesthetic. The Biopsy is done using a needle, and may be guided using either ultrasound or mammography depending on the type of abnormality being investigated

The sample tissue is sent to the laboratory for anatomopathological examination.

biopsie percutanée

The limitations of this test

The Biopsy only applies to an area of around 1 mm in diameter. However, if no abnormality is found, and the clinical examination, mammogram or ultrasound are suspicious, then investigations must be pursued and a surgical biopsy must be carried out.

In the event of a solid and well-defined mass, the doctor will collect very detailed information to enable him to determine whether the tumour is malignant or benign. However, if the 'target' for the biopsy sample is imprecise, the sample will probably be inconclusive. Again, only a surgical Biopsy will be able to tell whether or not it is cancer.


Surgical biopsy

biopsie chirurgicale

Methods

  • Anaesthesia may be general or local, depending on the depth and size of the tumour.
  • The procedure is done on an outpatient basis (the patient leaves the same day).
  • It takes 15-30 minutes.
  • The incision in the breast depends on the location of the suspicious nodule. It can be located next to the tumour or in an area where the scar will be inconspicuous, such as the areola or the under-breast crease (inframammary fold).
  • Normal activities can be resumed after one day of rest.

Note

When the lesion is visible using imaging but cannot be felt, the radiologist helps the surgeon to identify it by placing a very fine metal wire (hook) inside the breast, in contact with the lesion.

During the procedure, a radiograph of the biopsy is carried out in order to verify that the entire suspicious area seen on the mammogram has been removed.


Diagnostic biopsy, excisional biopsy

There are two types of surgical biopsies.

  • If the sole purpose is to remove a piece of the tumour to verify its nature, then this is called a diagnostic biopsy
  • If the nodule is completely removed, this is called an excisional biopsy (or diagnostic and therapeutic excision).

In some cases, after discussing all of the eventualities with the patient, the surgeon asks for a frozen section analysis: microscopic examination of the biopsy is carried out in the operating room by a pathologist in order to guide the following surgery. If the exam confirms the cancer diagnosis, it enables both the diagnosis and surgical treatment of the cancer to be carried out in one procedure.

This test is not performed for tumours that are extremely small, so as not to 'spoil' the tissue and to keep everything intact for the final histological examination. Even if no cancer cells are detected during this examination, the result must still be confirmed via a final examination conducted in the laboratory, as this is more accurate.