Breast Biopsy: Know About Micro & Macro Biopsy

The Micro Biopsy: what is it?

The micro biopsy consists of taking, using a needle, one or more breast tissue samples (usually two to six samples are required). These samples are then sent to the laboratory, where they are analyzed. Depending on the shape and architecture of the cells, it is there that a possible diagnosis of cancer can be established with precision.

How’s it going?

The micro biopsy is usually done under the supervision of ultrasound. For this, the woman is lying down, as for an ordinary ultrasound. The skin is disinfected. The radiologist performs local anaesthesia before intervening. Using a sort of automatic pistol, he takes tissue fragments from the nodule (the suspect “ball”). The exam lasts a few minutes. A compression bandage is then placed; it must be kept for three to four hours. Subsequently, the pain is rare, but a hematoma or bruise may appear.

When the suspicious mass is only visible on the mammogram, the sample can be taken under radiological guidance.

The interest of the Micro Biopsy

The interest is to know the exact nature of the mammary abnormality. It makes it possible to distinguish benign and malignant lesions in more than 98% of cases, provided that one is certain of the biopsy site.

It thus makes it possible, in benign cases, to avoid performing a biopsy by a surgical operation requiring general anaesthesia.

In the case of the discovery of cancer, thanks to the biopsy, the exact knowledge of the type of cancer will make it possible to propose a suitable surgical operation immediately, thus avoiding successive operations.

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The risks associated with the Micro Biopsy

A caregiver will always be by the patient’s side during the biopsy in the event of temporary discomfort (the operation is not painful, but it can be impressive, given its location). After the examination, a compression must be exerted at the biopsy site to avoid the risk of hematoma. Infectious complications are exceptional. There is a risk of bleeding in people taking blood thinners or aspirin.

Precautions to be taken

We must inform the doctor about the treatments we are taking, mainly if they are anticoagulants or allergic ground.

• Do not take aspirin one week before the procedure.
• On the day of the exam, no preparation is necessary. We can eat normally.
• Don’t forget to bring your mammograms. There is no hospitalization.

The limits of the Micro Biopsy

These limits are linked to the small volume of gland collected. This volume is usually sufficient to diagnose tissue nodules reliably. But this sample is insufficient for the analysis of microcalcifications (between 50 and 90% of negative results, which do not make it possible to exclude a diagnosis of cancer). In these cases, it is preferred to perform a macrobiopsy.

Concept Of Macro Biopsy

The macro biopsy is known under the brand name of the device: the Mammotome®. This technique has been around for ten years now. It has revolutionized the management of breast microcalcifications, allowing a diagnosis as precise as the biopsy performed by a surgical operation. It is known that 75% of these biopsies reveal benign lesions, which allows these women to avoid unnecessary surgery, general anaesthesia and hospitalization.

Usually done under radiological guidance for microcalcifications, macro biopsy under ultrasound guidance is a more recent technique. It allows a larger volume of tissue to be taken (10 to 30 times more than with a micro biopsy).

She can sometimes even remove the lesion in its entirety, which avoids diagnostic surgery on specific complex lesions where a complete analysis would be necessary. Collecting the central part of the lesion gives a much smaller margin of error and thus a reliable diagnosis in cases where the micro biopsy results are doubtful.

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Macrobiopsy: what is it?

The practitioner operates with a hollow needle 3 to 4 mm in diameter, equipped with a small rotating cylindrical knife and a vacuum suction system. The tissue to be collected is sucked and then cut inside the needle.

Unlike the micro biopsy, this system only requires a single puncture, the probe remaining in place to collect several samples.

The operation is performed under local anaesthesia and does not leave a scar (there is any suture). The intervention lasts 40 minutes on average; then, the patient can return to her home. A dressing should be kept for 24 to 48 hours. The results are obtained after about a week.

How’s it going?

In the case of radiological guidance, the technique is called “stereotaxis”. This makes it possible to calculate the exact position of the part to be biopsied using X-ray images.

The woman can be in a seated position, the breast compressed in a mammography machine, or lying on her stomach, on a specific stereotaxic table, the breast passing through an opening.

In ultrasound guidance, the woman is placed on her back for a standard ultrasound.

After local anaesthesia, the radiologist makes a small three to four-millimetre incision. The probe is then introduced.

The advantages and limitations

In France, more than 50,000 women have already benefited from this technique. However, it is not yet offered in all specialized care and radiology centres and is rarely used under ultrasound guidance.

The investment in time and equipment is expensive, which explains why this technique is found primarily in large hospitals.

This is unfortunate because it is an effective technique to avoid unnecessary surgery after the micro biopsy. The reliability is close to 100%, and the precision of the order of a millimetre. As for the complications, they are almost nil.

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