There are three stages or phases of mammography and each have a different role in the detection of abnormalities in the breast tissue. A biopsy would be last if it's necessary.
A Biopsy is the next step after investigations of screening and/or diagnotic mammograms find abnormal mass tissues suspected of being cancerous. A biopsy will remove a certain amount of tissue sample so a specialist can view it under a microscopic and determine what exactly it may be.
There are several types of biopsies and choosing which one to do depends on the characteristics of the suspected cancerous mass and the patient.
Fine needle aspiration biopsy (FNAB): This procedure involves using a thin needle with a syringe to remove a cell sample from the breast lump or mass. This procedure is easily performed when the lump is located at the surface of the breast tissue. When the tumor is deep within the breast, this procedure will be performed under ultrasound.
A stereotactic needle biopsy is performed with the help of a computer device that analyses two mammograms taken from 2 different angles to indicate the precise location of the tumor. It is a more precise version of fine needle aspiration biopsies.
Stereotactic core needle biopsy: This procedure is performed with the patient put under local anesthesia and involves removing a small cylinder of tumor tissue.
There are two new sterotactic methods that remove more tissue than a core biopsy: mammotome or vacuum-assisted biopsy and advanced breast biopsy instrument (ABBI). The mammotome procedure involves taking a consistent sample of tumor tissue (twice as much tissue that is removed through a core biopsy) using a cylinder inserted into the breast tissue. This cylinder contains a special rotating knife that removes the tissue sample when inserted into the breast tissue.
Surgical biopsy: This is a procedure where the whole tumor or a part of the tumor is removed for a detailed lab examination. There are two types of this procedure. Incisional biopsies remove a small piece of a big tumors for examination and excisional biopsies remove the whole tumor with the surrounding margin of normal-appearing breast tissue completely for a lab examination. Both these biopsies are performed under local anesthesia. Sometimes, if the lump is hard to locate by touch or the surrounding area looks suspicious, these biopsies are is used in conjunction with another procedure called wire localization. Wire localization is performed under imaging techniques used to help the doctor guide the needle in the target area. A thin wire is inserted into the tissue through the center of the needle and is used to locate the area that needs to be removed.
ABOVE: Wire guided mammogram biopsy of breast taken during procedure.
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