What is the difference between needle aspiration and stereotactic biopsy

However, because of the smaller volume of tissue obtained at stereotactic core biopsy, only the benign part of the lesion may be excised. When these high-risk histopathologies are removed, surgical biopsy should be routinely performed to assess for the possibility of coexistent carcinoma. The most common of these entities is atypical ductal hyperplasia or ductal atypia.

Radial scars should also routinely be considered for surgical excision. In other cases, a pathologist may require a larger volume of tissue than that obtained at stereotactic core biopsy to make a definitive diagnosis. Most commonly, this occurs in patients with fibroepithelial lesions, in whom it may be difficult to differentiate a fibroadenoma from a phyllodes tumor. Atypical Ductal Hyperplasia or Ductal Carcinoma? In one study of consecutive cases of pure DCIS, it was found that atypical ductal hyperplasia was also present in 17 cases.

In one series, 25 consecutive women diagnosed with atypical ductal hyperplasia at stereotactic biopsy were recommended for surgical excision of the biopsy site. Because of these data, lesions found to be atypical ductal hyperplasia at stereotactic core biopsy should be surgically excised.

Because larger volumes of tissue are removed with vacuum-suction biopsy needles, carcinoma may be missed less frequently when it coexists with atypical ductal hyperplasia. This reduction in the underestimation of lesions with vacuum-suction biopsy was due to the acquisition of a larger number of cores, 10 per lesion, and a greater volume of tissue in each core, resulting in better sampling of the area.

However, in those women in whom this diagnosis is made at stereotactic core biopsy, surgical biopsy of the site remains necessary. Because some lesions are largely DCIS but also have sites within the tumor that harbor invasive carcinoma, not sampling the entire lesion can result in failure to diagnose the invasive component.

Because of this experience, a stereotactic core biopsy diagnosis of DCIS needs to be confirmed by surgical histopathology. If axillary dissection is required for adequate treatment, planning of the complete surgical treatment may not be possible based on stereotactic core biopsy results. Special note should be made of the stereotactic core biopsy diagnosis of lobular carcinoma in situ LCIS. Because LCIS has no specific mammographic findings and is an incidental diagnosis made at the time of excision of another lesion, it should not be accepted as consistent with the imaging findings that mandated breast biopsy.

Specimens obtained at stereotactic core biopsy should be sent for paraffin sectioning, not frozen-tissue analysis. The diminished quality of cytologic detail in frozen-section analysis increases the possibility of overdiagnosing invasive carcinoma due to the mingling of proliferative epithelium and stroma in such lesions as sclerosing adenosis and radial scar. Stereotactic core biopsy also results in the displacement of epithelial fragments beyond the main tumor mass in a considerable percentage of patients.

Epithelial displacement is also seen following needling procedures, including anesthesia injection, suturing, needle localization, and fine-needle aspiration biopsy. Pathologists should be careful not to interpret these foci of displaced epithelium as sites of invasive carcinoma. The issue of whether displacement of tumor at the time of needling has any clinical significance is difficult to assess.

However, in a study by Berg and Robbins[44] that assessed the long-term outcome of women with palpable, stage-matched breast cancers, year survival did not differ between women diagnosed with or without aspiration biopsy. The full potential of stereotactic core biopsy to improve the quality of care available to women and to decrease the cost of breast cancer diagnosis will only be realized if facilities with appropriately trained staff make this procedure available to the community.

An accreditation program for stereotactic breast biopsy has been established by the American College of Radiology and joined by the American College of Surgeons. Other components of the program include standards for radiation exposure, quality-control procedures, and evaluation of practice outcomes data.

Stereotactic core biopsy makes it possible to diagnose many mammographically evident breast lesions with greater speed, less cosmetic deformity, and less expense than traditional surgical biopsy. Performance of stereotactic core biopsy in any individual case may be limited by equipment availability, breast size, and coexisting medical conditions. Small lesions can be accurately targeted, but caution should be exercised before fully removing these lesions unless a localizing clip can be placed or an adjacent landmark identifies the site.

Minor complications of ecchymosis, pain, and anxiety are common. The accuracy of stereotactic core biopsy diagnosis is high, but biopsy results must be interpreted in light of the probable imaging diagnosis. A benign histopathology for a very suspicious imaging pattern suggests that the lesion targeted for biopsy may have been missed and that a repeat biopsy may be needed. Because of the histologic heterogeneity of some lesions, sampling with stereotactic core biopsy may only remove areas from the less aggressive components of the lesion.

A stereotactic core biopsy diagnosis of atypical ductal hyperplasia raises the possibility of coexistent carcinoma, usually DCIS, and should prompt surgical excision of the lesion. A radial scar should be managed in the same fashion. Other, less common histologies may also require surgical excision in order to establish a definitive diagnosis. Diagnosis of DCIS by stereotactic core biopsy may also represent understaging of the lesion, as areas of invasion will be found at surgical excision in some of these cases.

Therefore, it may not be possible to plan for axillary lymph node dissection preoperatively in some of these women. Radiology , Am J Roentgenol , Reston, Virginia, American College of Radiology, Dershaw DD: Stereotaxic breast biopsy.

Breast J , New York, Churchill Livingstone, Nath ME, Robinson TM, Tobon H, et al: Automated large-core needle biopsy of surgically removed breast lesions: Comparison of samples obtained with , , and gauge needles. Radiol Clin North Am , Jackman RJ, Burbank F, Parker SH, et al: Atypical ductal hyperplasia diagnosed at stereotactic breast biopsy: Improved reliability with gauge, directional, vacuum-assisted biopsy.

Burbank F: Stereotactic breast biopsy of atypical ductal hyperplaisa and ductal carcinoma in situ lesions: Improved accuracy with directional, vacuum-assisted biopsy. Radiology suppl , Jackman RJ, Nowels KW, Shepard MJ, et al: Stereotaxic large-core needle biopsy of non-palpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia. Walker TM: Impalpable breast lesions: Stereotactic core biopsy with an "add-on" unit.

Cancer , Ann Surg , Lagios MD: Ductal carcinoma in situ: Controversies in diagnosis, biology and treatment. CA Cancer J Clin , Am J Surg Pathol , Dershaw DD: The importance of stereotactic breast biopsy accreditation editorial.

Physician qualifications for stereotactic breast biopsy. Am Coll Radiol Bull , Stereotactic Breast Biopsy: Indications and Results. June 1, Advantages of Imaging-Guided Biopsy As compared with traditional surgical biopsy, stereotactic core biopsy of the breast offers several advantages. Patient Selection Lesions Apropriate for Stereotactic Biopsy Stereotactic core biopsy is an appropriate technique for the biopsy of nonpalpable, mammographically evident lesions that require tissue sampling.

Lesions Inappropriate for Stereotactic Biopsy Lesions that are inappropriate for stereotactic core biopsy include those that are clearly benign on imaging work-up and those that are probably benign BI-RADS category 3 and are best assessed using short-term mammographic follow-up.

Stereotactic Guidance Unit The stereotactic biopsy unit operates on the principle of triangulation. Needle Design A variety of needle designs are available to perform core biopsy. Complications In reported large series of stereotactic core biopsy, major complications have been rare. Diagnostic Limitations of Stereotactic Biopsy The accuracy of stereotactic core biopsy in patient care depends on appropriate tissue sampling, histologic analysis, and correlation of histopathology with imaging findings.

The doctor doing the CNB may put the needle in place by feeling the lump. But usually the needle is put into the abnormal area using some type of imaging test to guide the needle into the right place. Some of the imaging tests a doctor may use include:. The procedure itself is usually quick, though it may take more time if imaging tests are needed or if one of the special types of CNB described below is used.

You may be sitting up, lying flat or on your side, or lying face down on a special table with openings for your breasts to fit into. You will have to be still while the biopsy is done. For any type of CNB, a thin needle will be used to put in medicine to numb your skin. The biopsy needle is put into the breast tissue through this cut to remove the tissue sample. You might feel pressure as the needle goes in. Again, imaging tests may be used to guide the needle to the right spot.

There are many ways to biopsy the skin. Your doctor will choose the one best suited to the type of skin tumor suspected. Punch biopsies or excisional biopsies as discussed previously remove deeper layers of the skin, and can be used to find out how deeply a melanoma has gone into the skin — an important factor in choosing treatment for that type of cancer. Lymph node mapping helps the surgeon know which lymph nodes to remove for biopsy. Sentinel node mapping and biopsy has become a common way to find out whether a cancer especially melanoma or breast cancer has spread to the lymph nodes.

This procedure can find the lymph nodes that drain lymph fluid from where the cancer started. If the cancer has spread, these lymph nodes are usually the first place it will go. This is why these lymph nodes are called sentinel nodes meaning that they stand watch over the tumor area, so to speak. To find the sentinel lymph node or nodes , the doctor injects a small amount of slightly radioactive material into the area of the cancer. By checking various lymph node areas with a machine that detects radioactivity like a Geiger counter , the doctor can find the group of lymph nodes the cancer is most likely to travel to.

Then the doctor injects a small amount of a harmless blue dye into the site of the cancer. After about an hour, a surgeon makes a small cut in skin to see the lymph node area that was found with the radioactive test. Those lymph nodes are then checked to find which one s turned blue or became radioactive. Sometimes the dye and the radioactive material may be mixed together, or either part may be used alone.

If cancer cells are found in the sentinel node, the rest of the lymph nodes in this area are removed and looked at, too. This is called a lymph node dissection.

The American Cancer Society medical and editorial content team. Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing. American Cancer Society medical information is copyrighted material.

For reprint requests, please see our Content Usage Policy. Download this topic [PDF]. Types of biopsies used to look for cancer Types of cytology tests used to look for cancer What happens to biopsy and cytology specimens?

What do doctors look for in biopsy and cytology specimens? Tests used on biopsy and cytology specimens to diagnose cancer Reasons for delays in getting your biopsy and cytology test results How to learn more about your pathology results What information is included in a pathology report?