BREAST DIAGNOSTIC PROCEDURES
The diagnosis of breast problems can usually be done by taking a history from
the patient and having a physical examination by one of our experienced breast
surgeons. Mammograms and ultrasounds are valuable aids to the diagnosis of
breast problems. Mammograms are also recommended annually to screen all woman
over the age of 40 for abnormalities in the breast that cannot be felt. When
further diagnostic methods are needed, our surgeons have many techniques
available including an office breast ultrasound unit.
Occasionally various breast biopsy procedures are needed to help determine
the diagnosis. We offer a number of Non-Surgical
Biopsy Techniques:
1. Fine needle aspiration biopsy (FNAB):
FNAB is a biopsy technique done with a very small needle, only slightly larger
than the caliber of a human hair. This needle is passed in and out of
the breast lump using local anesthesia. Suction is applied while the needle is
being moved and this pulls out microscopic amounts of breast tissue from the
lump. This breast tissue is microscopically analyzed for suspicious cells
using a technique similar to Pap smears. We feel that this is best applicable
to lumps that are easily felt. It is the least expensive biopsy technique
available and takes only 5-10 minutes. It is no more painful than having a
blood test drawn. The results are available within 24-48 hours. FNAB does not
always give precise information and thus is not used in all circumstances.
2. Ultrasound guided biopsy:
This biopsy technique is used in our office frequently. Using our office
ultrasound machine and local anesthetics, the breast lump is located. A
special biopsy needle, larger in caliber than the FNAB needle, is guided
through a small nick in the skin that has been anesthetized. This needle is
guided down to the lump using the ultrasound images generated by the
ultrasound machine. When the needle is in the area of the lump, the needles
biopsy mechanism is activated by the surgeon and quickly harvests a small core
sample of breast tissue about the size of a half inch long piece of pencil
lead. This is usually done 2 or 3 times to make sure the lump has been
adequately sampled. This procedure takes about 15 minutes and is made painless
by using generous amounts of local anesthetics and requires no special
preparation on the part of the patient. The results are usually quite precise
and are available in less than 24 hours.
3. Stereotactic biopsy:
This technique uses the same type of special biopsy needle as with the ultrasound guidance. However, the guidance mechanism here is a
special mammographic technique that is computer aided. This biopsy technique
is done in coordination with the radiologist at the hospital and occurs in the
mammogram suite. This technique is usually used in cases where the abnormality
can only be seen on a mammogram and may simply be invisible to ultrasound.
Again several biopsies are taken to ensure accuracy and the results are also
available in less than 24 hours. It is also done using local anesthetic
techniques and requires no preparation.
These three techniques are all outpatient procedures. All can be done
quickly with the patient able to resume normal activities immediately
afterwards.
SURGICAL
BIOPSIES are occasionally required where incisions are
actually made on the breast. These biopsy techniques include the wire
localized biopsies that are particularly useful when microscopic
calcium deposits noted on the mammogram are of concern. These surgical biopsies
are done in the various operating rooms in our community and are usually done
with local anesthetic or sedation. Occasionally, full general anesthesia is
required or desired by the patient or the surgeon, but are always outpatient
procedures.
If breast cancer is diagnosed by one of the biopsy techniques, various breast
therapeutic procedures and treatment plans are available. Some of these
treatment plans start with surgery and others start with chemotherapy and finish
with surgery. Our breast surgeons are part of a breast cancer
treatment team that meets regularly to plan the breast treatments
for each person. This team concept ensures that the
latest and most effective therapies are available including investigational
therapies.
BREAST THERAPEUTIC PROCEDURES
A number of surgical options are available to the patient when breast cancer
surgery is necessary.
1. Breast lumpectomy: This
surgery involves removing the cancerous area of the breast plus a surrounding
area of noncancerous breast tissue. Every attempt is made to preserve breast
shape and size. This approach is appropriate for most small breast cancers and
some larger breast cancers. It is accompanied by removal of a portion of the
lymph glands under the arm, where breast cancer tends to spread first. After
healing is complete, radiation treatment is given to the remaining breast
tissue to minimize the chance of recurrence. Radiation treatments are
performed using the linear accelerators at the hospital. The linear
accelerator delivers radiation in a much more precise and controlled fashion
than the older cobalt units that were previously used. Lumpectomy is one of
the most popular current surgical treatment plans for breast cancer. The
lumpectomy procedure is usually done with an overnight stay, but can be
done as an outpatient. Average recovery time is one week.
2. Mastectomy: This
operation has been available in a number of forms for at least 100 years. It
has been modified so that currently the operation removes only the nipple and
a small amount of surrounding skin along with all the underlying breast
tissue. Additionally, some lymph glands under the arm are removed. No muscles
are affected and rarely are there any side effects that were often seen with
some of the older forms of mastectomy. Seldom is radiation required.
This operation is used often for very large or extensive tumors, or for people
unwilling or unable to accept the requirements of a proper lumpectomy
treatment plan such as radiation therapy. This surgery is also usually done
with an overnight hospital stay, but can be done as an outpatient. Average
recovery time is 7 to 10 days. Older forms of mastectomy, such as radical
mastectomy, which involves the removal of a large amount of tissue and chest
muscle are only rarely performed. Radical mastectomies are rarely
indicated and rarely utilized.
3. Post-mastectomy
reconstructionPost-mastectomy
reconstruction: For patients who wish or require mastectomy, our group
has developed an association with the Plastic Surgery Department at Indiana
University. This allows all forms of breast reconstruction to be available
locally. The Plastic Surgeons come to our office regularly and coordinate
these surgeries with us so that the Plastic Surgeon can perform the breast
reconstruction at the same time as a mastectomy or at a later time, if needed.
All the most sophisticated forms of breast reconstruction are available. These
procedures are done on an inpatient setting, with hospitalization averaging
two to five days depending on the type of procedure performed. Recovery
averages from two to six weeks for full recovery, again depending on the exact
procedure performed.
4. Sentinel lymph node biopsy:
Within the last two years, surgeons have developed a surgical technique to
reliably identify the specific lymph nodes draining the area of the breast
where a cancer arose. These lymph nodes can be precisely identified and
removed by an injection of a radioactive tracer and a blue dye in the area of
the cancer just before surgery. These lymph nodes bear a great deal of
prognostic significance, but until now were difficult to locate with
precision. The lymph nodes located with this cutting edge technique then
undergo extra special microscopic testing to determine, with the highest
possible accuracy, the stage of the breast cancer.
This staging process helps determine the likelihood that an individual
patients cancer cells have begun to spread. This allows the breast cancer team
to develop the most accurate recommendations for treatment that fits the
patient's situation. In some situations, sentinel lymph node removal will
suffice for the more the standard partial axillary lymph node removal. This
very new and exciting procedure is available through our breast surgeons. It
is integrated into our team approach with our radiologists, pathologists,
radiation oncologists and medical oncologists.
Click
here for our Breast Cancer Web Links
.
