Arlene Sussman, MD, Director, Breast Health Program in Winthrop�s Institute for Family Care
obody enters a doctor�s office for a screening mammogram expecting that an abnormality will exist,� noted Arlene Sussman, MD, Director, Breast Health Program in Winthrop�s Institute for Family Care. �When it does, the ability to quickly and accurately provide a diagnosis is a powerful and compassionate approach to relieving women of fears and anxieties.�
If a breast abnormality is discovered by self-examination, the first step should be a mammogram and physical examination by a physician. If it is a cyst, which is benign, but is causing pain, it can be immediately drained in the office. �The relief that women experience is dramatic,� said Dr. Sussman.
�If an abnormality is detected on a mammogram but cannot be felt, then in most cases a biopsy can be obtained with X-ray or ultrasound guidance,� explained Dr. Sussman. Ultrasound can detect a solid mass, whereas X-ray guidance is required to image microcalcifications. These are tiny deposits which may be clustered or dispersed throughout the breast, and which may be associated with cancer up to 20-30 percent
of the time.
Most abnormalities that cannot be felt by the surgeon or viewed with ultrasound can still be biopsied non-surgically, using stereotactic biopsy equipment.
Mammotome� Core Biopsy
In Winthrop�s Breast Health Center, part of its Institute for Family Care, women may undergo
stereotactic biopsy using the Mammotome� system, a
technology that allows the radiologist to remove a
large core of tissue.
�Women can be confident in their biopsy results because the Mammotome� system is designed to accurately diagnose breast cancer at its earliest stages, when it is most treatable,� said Dr. Sussman.
With stereotactic biopsy, the radiologist uses mammographic images to guide her to the abnormality in order to obtain a precise sample of tissue. X-ray images of the area are first obtained from two angles, enabling the physician to accurately calculate the location of the lesion. A small amount of local anesthetic is applied to the skin, a tiny nick is made, and a needle placed into the area. Digital images are again obtained to confirm that the needle is in the right location. Tissue samples are then taken and sent to the laboratory for analysis.
�Sometimes, the abnormality is completely removed at the time of biopsy,� Dr. Sussman noted. �In this case, a tiny, two-to-three millimeter clip is placed in the breast to mark the location in case a malignancy is found and surgical treatment is necessary.�
After the needle is withdrawn, a band-aid and an ice pack are applied. No stitches are required, no general anesthesia is administered, and women are able to go home 15 minutes after the procedure is completed. Results are available within 48 to 72 hours.
If the biopsy shows a malignancy, surgery would likely be required in order to ensure that a sufficient margin of tissue around the lesion is removed.
Sentinel Node Biopsy Permitted
William P. Reed, MD, Chairman of the Department of Surgery at Winthrop, favors stereotactic biopsy as often as possible. �The incision is smaller � 1/8 of an inch versus two inches.� Another advantage is that it permits the surgeon to perform sentinel node biopsy should a malignancy be detected. Sentinel node biopsy is a newly emerging technique that can spare women with breast cancer from unnecessary lymph node removal.
The technique alerts the surgeon to whether the cancer has spread by identifying and testing the first, or sentinel, lymph node to receive cells that have drained from the tumor. A small amount of dye and a radioactive tracer help pinpoint the sentinel lymph node. At the time of surgery, the sentinel node is removed and sent to Winthrop�s diagnostic laboratory for immediate analysis. If it is cancer-free, then no further removal of lymph nodes is required.
Unlike stereotactic biopsy, surgical biopsy can impede the surgeon�s ability to perform sentinel node biopsy. During a surgical biopsy, a cavity may be created and the lymphatic drainage system could be interrupted.
Stereotactic Biopsy Not Always an Option
Despite its advantages, however, Dr. Reed noted that there are circumstances in which stereotactic biopsy cannot be performed. Because the Mammotome�
needle obtains a 1/2 inch slice of tissue, it cannot be used on lesions that are very close to the chest wall. Elderly women or those with disabilities may have
difficulty lying in a prone position, which is required during stereotactic biopsy. Women with bleeding
disorders may not be candidates for the procedure.
Fortunately, 70 - 80 percent of breast biopsies are benign. However, if a malignancy is diagnosed, Winthrop offers the full range of treatment options. Foremost is surgery, which may involve either lumpectomy, often combined with radiation, or mastectomy, with or without reconstruction.
�Most surgeons feel that lumpectomy is a better option for the majority of patients,� Dr. Reed stated. �Survival rates are equivalent to mastectomy, and cosmetic and functional results are better.�
Many women also receive some form of chemotherapy, especially if there is lymph node involvement.
Physicians in Winthrop�s Institute for Family Care work collaboratively with their colleagues in the Institute for Cancer Care to ensure a seamless continuum of care throughout diagnosis and treatment. Supportive programs to help patients cope with the psychological and emotional demands of illness and treatment are also in place.
For additional information about the Breast Health Program in Winthrop�s Institute for Family Care, or a physician referral, call Women�s Health Services at 1-888-53-WOMEN.