Biopsy, fine needle puncture, punch biopsy, vacuum biopsy, MIBB = minimally invasive breast biopsy, excision biopsy
Biopsy (tissue sample)
Despite the exhaustion of all diagnostic possibilities, often only a biopsy provides final clarity on the question of whether the tumour is benign or malignant. If a biopsy is performed, this does not necessarily mean that cancer is present. Today it is possible to biopsy almost all abnormal or suspicious findings in the breast, i.e. to take a sample and make a diagnosis.
A biopsy is easy to perform, places hardly any stress on the breast tissue and can usually be performed without a hospital stay, although the examination can be quite painful. The sample taken is then examined by a pathologist – a specialist in tissue and cell examinations. The pathologist can make his diagnosis based on the cells of the tissue, as cancer cells look different from healthy cells.
This is known as a histological or histological examination. In the past, an incision had to be made to remove a piece of tissue. Today, so-called minimally invasive procedures are used, in which samples are taken with needles in order to protect the breast tissue as well as possible.
There are numerous procedures for this, from wafer-thin needles to relatively thick hollow needles. The idea of being stuck in the breast with a needle is frightening for most women. The most unpleasant part of the examination is the moment when the skin is pierced.
Depending on the diameter of the needle used, you will feel a weaker or stronger pain comparable to a blood sample. The skin is locally anaesthetised beforehand. The actual movement of the needle in the breast tissue, on the other hand, can hardly be felt.
The possibility of a biopsy can prevent many unnecessary operations. The different methods can basically be divided into two categories. For palpable findings, fine needle puncture and ultrasound-guided punch biopsy are possible methods.
For findings that can only be detected by mammography, stereotactic biopsy procedures are possible (see below). If the findings are recognized as benign after the tissue sample has been taken, no further intervention is necessary. The further procedure depends on the patient’s symptoms. The lump can be removed if it causes pain, continues to grow or is simply felt to be disturbing and/or worrying. However, depending on the size of the lump, this may result in retractions, changes in shape and scars on the breast, which in turn may again cause pain.
What can the pathologist identify from a tissue sample?
On the basis of the tissue sample, the pathologist can first determine whether the change is benign or malignant. In this context, a positive finding means that the finding is positive for cancer, i.e. malignant. Conversely, a negative finding means that there is no evidence of cancer.
In the language of pathologists, “positive” in other examinations always means that something has been proven or is present, not that the result is “good” for the patient. In addition, the pathologist can also infer the origin of the cells. This means that he can generally tell whether a lump in the liver is liver cancer or whether, for example, the daughter tumour of a breast carcinoma is present.
Based on the tissue sample, the pathologist creates a kind of “tumor profile”, i.e. a list of characteristics of the tumor. The treating physicians can use this information as a basis for their therapeutic approach and make statements about the prognosis of breast cancer. The pathologist creates a “grading” if there are any changes in the cells.
The grading of the cells indicates how much the cells still resemble their original tissue or, vice versa, how much they have changed. This is also called the degree of differentiation of the cells. In addition, attention is paid to characteristic changes in the cell nuclei and to the occurrence of necroses (dead tissue parts).
The “grading” of the cells has an influence on the prognosis and possible treatment strategies and indicates the aggressiveness of the tumour. Using various test procedures, the pathologist can also make statements about other characteristics of the cells that make them particularly sensitive to certain forms of therapy and at the same time have a bearing on the prognosis. These include certain receptors that some tumour cells have and others do not.
