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Breast biopsy Intervention Surgeon doing a surgical breast biopsy ICD-9-CM 85.11-85.12 Several methods for a breast biopsy now exist. The most appropriate method of biopsy for a patient depends upon a variety of factors, including the size, location, appearance and characteristics of the abnormality. Contents 1 Fine needle aspiration 2 Core needle biopsy 3 Vacuum assisted biopsy 4 Direct & frontal biopsy 5 Open surgical biopsy 6 References Fine needle aspiration Fine needle aspiration (FNA) is a percutaneous ("through the skin") procedure that uses a fine needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass. With FNA, the cellular material taken from the breast is usually sent to the pathology laboratory for analysis. A technique similar to FNA can also be used by the radiologist or surgeon to drain fluid from a benign cyst. This procedure is called cyst aspiration. A fine needle aspiration procedure is generally almost painless and takes only a few minutes to perform. Technically, this FNA procedure is not a biopsy as the material retrieved is made of fluid coming either from a cyst or from the intercellular space and a few cells, when a biopsy is bringing back a piece of tissue where the architecture of the tissue is preserved. Core needle biopsy A core needle biopsy is a procedure that removes small but solid samples of tissue using a hollow "core" needle. For palpable (“able to be felt”) lesions, the physician fixes the lesion with one hand and performs a freehand needle biopsy with the other. In case of non-palpable lesions stereotactic mammography, or ultrasound, or PEM guidance is used. With stereotactic mammography it is possible to pinpoint the exact location of a mass based on images taken from two different angles of the x-ray machine. With ultrasound, the radiologist or surgeon can watch the needle on the ultrasound monitor to help guide it to the area of concern. With PEM (positron emission mammagraphy), the lesion is targeted in 3D based on a positron emission tomography (PET) image of the breast. The needle used during core needle biopsy is larger than the needle used with FNA. The core biopsy needle also has a special cutting edge allowing removal of a bigger sample of tissue. With core needle biopsy a relatively large sample can be removed through a small single incision in the skin. Typically, the breast area is first locally anesthetized with a small amount of anesthetic fluid. Then, the needle is placed into the breast. As with FNA, the radiologist or surgeon will guide the needle into the area of concern by palpating the lump. If the lesion can’t be felt the core needle biopsy is performed under image-guidance using either stereotactic mammography, ultrasound or even magnetic resonance imaging (MRI). A core needle biopsy procedure takes a few minutes to perform and is almost painless. Vacuum assisted biopsy Vacuum assisted biopsy is a version of core needle biopsy using a vacuum technique to assist the collection of the tissue sample. The needle normally has a lateral ("from the side") opening and can be rotated allowing multiple samples to be collected through a single skin incision. The Vacuum assisted biopsy procedure is similar to normal core needle biopsy. The vacuum assisted biopsy category also includes automated rotational core devices.[1] Direct & frontal biopsy Recent innovations in tissue acquisition for the human breast have led to the development of unique direct frontal systems. Efficacy is considered optimal if the diagnosis by transcutaneous biopsy is identical to the surgical specimen in case of malignancy or in line with clinical follow-up when benign. The direct and frontal biopsy systems are safe for the patient, and the procedure can even be considered relatively painless. The quality of the sample is sufficient for research on molecular biology. The direct frontal tissue-acquisition systems can be added to the list of safe and efficient macrobiopsy methods to be used in the early detection of breast cancer.[2][3][4][5] Open surgical biopsy Open surgical biopsy means that a large mass or lump is removed during a surgical procedure. Surgical biopsy requires an approximately 3 to 5 centimeters incision and is normally performed in an operating room in sterile conditions. Open surgical biopsy in some cases can be performed with local anesthesia but in most cases general anesthesia may be necessary. Ten years ago, most breast biopsies were open surgical procedures. Today most patients are candidates for less invasive biopsy procedures such as core needle biopsy. Depending on the location of the lesion to be biopsied, a radiologist will often perform needle localization beforehand to guide the surgeon to the site being biopsied. References ^ Coding Breast Diseases and Surgery ^ Efficacy and safety of direct and frontal macrobiopsies in breast cancer Ann Cornelisa, Marcel Verjansa, Thierry Van den Boscha, Katrien Wouters, Johan Van Robaeysc, Jaak Ph. Janssensd and Working Group on Hormone Dependent Cancers, The European Cancer Prevention Organization ^ High-Precision Direct and Frontal Breast Biopsy to Assure Adequate Surgical Margin Interpretation; Jaak Janssens, MD, PhD; Ruediger Schulz-Wendtland, MD, PhD; Luc Rotenberg, MD; John-Paul Bogers, MD, PhD 1. University Hasselt, Hasselt, Belgium; 2. University of Erlangen, Erlangen, Germany; 3. Hôpital Hartman, Paris, France; 4. University of Antwerp, Antwerp, Belgium ^ ^ European Journal of Cancer Prevention This medical article is a stub. You can help Wikipedia by expanding it.v · d · e v · d · eOperations/surgeries and other procedures of the breast (ICD-9-CM V3 85, ICD-10-PCS 0H) Breast surgery Breast-conserving surgery (Lumpectomy) · Mastectomy (Radical mastectomy) Mammoplasty (Breast implant, Breast reduction) · Mastopexy · Breast reconstruction Breast biopsy (Needle aspiration biopsy) Medical imaging X-ray (Mammography/Xeromammography) · Thermography (Breast thermography) · MRI (Breast MRI) · Ultrasound (Breast ultrasound) · Scintimammography Other Breast self-examination M: BRE anat/phys/devp noco/cong/tumr proc