Treatment decisions for a patient are made based upon the pathology diagnosis provided on a tissue sample. Frequently, the first tissue sample taken from a patient is called a “biopsy.” A biopsy sample is obtained from the patient by the procedural physician, and this tissue is submitted to the pathologist for evaluation. The biopsy type can vary, depending on the clinical presentation. Examples of biopsies include fine needle aspiration, core biopsy, incisional biopsy, and excisional biopsy.
The breast is biopsied if there is a lump the patient or physician feels on physical examination, or if the radiology studies appear abnormal. If the radiology study is abnormal, then the biopsy typically is performed by the radiologist through imaging assistance. These different imaging modalities include ultrasound, stereotactic and MRI. The purpose of the biopsy is to sample the abnormality within the breast. How well the lesion is sampled depends of course on the size of the biopsy. Almost all radiographically guided biopsies represent cylindrical cores of tissue. Analogy: Imagine you are trying to sample a seed (the lesion) within an orange with a straw (core biopsy). You can’t feel the seed with the straw; so you would need some assistance to see the seed and successfully aim the straw. A larger biopsy may be indicated, and these are typically performed by physicians who specialize in this surgical technique.
The surgeons will occasionally use radiographic assistance to localize the breast abnormality, such as needle localization. To continue the analogy, the seed would be sampled by slicing into the orange with a sharp knife, and removing a slice of pulp with the seed. These larger excisional biopsies, or “lumpectomies,” typically occur after an initial core biopsy. Rarely, if a patient presents with advanced breast cancer, based on a physical exam, a physician may decide to do an incisional biopsy to confirm the diagnosis and to obtain additional information for treatment options.
Once the biopsy is removed from the patient, the tissue immediately begins to undergo cell death. This cell death is stopped when a fixative is added; the preferred fixative for breast biopsies is 10% neutral buffered formalin. This biopsy has to be fixed for a proper length of time. Then the sample undergoes processing within the histology department. The final product is a glass slide containing a 2-dimensional representative slice of the tissue. This slide is then examined under a microscope by a pathologist. The pathologist is the physician who provides a diagnosis for the treating physician. This pathology information is then correlated with the clinical presentation and radiology findings – also known as the “triple” test. What happens next after the biopsy depends, of course, on the diagnosis.
Breast disease is very complex, with numerous variables involved in any decision-making. Having a good relationship with your physician, with open communication and understanding, is essential.