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Patient Education (5) Biopsy
BREAST BIOPSY: WHAT YOU SHOULD KNOW
A surgical biopsy is indicated when doubts exist regarding the nature of a persistent lump, nipple discharge, rash, or puckering of the skin or nipple. A biopsy may also be indicated for abnormalities seen on mammograms, even if a lump can not be felt. Biopsy with microscopic examination of the tissue by a pathologist remains the only accurate method of diagnosis at this time.
INFORMED CONSENT FOR SURGICAL BIOPSY
When a surgical biopsy is recommended, most health care facilities require patients to sign a form stating their willingness to permit diagnosis and medical treatment. This is to certify that you understand what procedures will be done and that you have consented to have them performed.
The breast biopsy is performed in a hospital setting under general anesthetic. It is considered to be an "outpatient procedure". You do not spend the night in the hospital; you go home the same day. Prior to surgery you will sign a consent form for the scheduled surgery. Do not be frightened by the terminology, PARTIAL MASTECTOMY. This is the technical term for a breast biopsy. It means a "part" of the breast tissue is being removed. If the entire breast were going to be removed, the consent would read "MODIFIED RADICAL MASTECTOMY". Biopsy, lumpectomy and partial mastectomy all refer to the same procedure: removal of a portion of breast tissue not the entire breast.
During the biopsy procedure, the surgeon removes the entire suspicious tissue to have it examined by a pathologist. The pathologist will determine if it is benign or malignant. If malignant, the pathologist will identify the type of cancer cell, how fast they reproduce (flow cytometry), if the cancers growth is affected by hormones (estrogen-receptor tests) and other prognostic indexes. All of this information will enable the surgeon and you to determine the best treatment for you.
There are two ways a pathologist prepares the tissue for examination. The first method is the "frozen section" in which the tissue is frozen into a block of ice so it can be sliced and carefully examined under the microscope by the pathologist while you are still under anesthesia. If the tissue is benign, as it is in four out of five cases, no further surgery is needed.
The second way that a pathologist prepares the tissue for examination is the "permanent section". The permanent section is performed to confirm the findings of the frozen section. It is a more thorough analysis. It takes approximately forty-eight hours to obtain the results of the permanent section. In this process, the tissue is treated by a series of chemical solutions that provide a high-quality slide.
ONE-STEP AND TWO-STEP PROCEDURES
When a surgical biopsy is necessary, you have a choice of two procedures that should be discussed and agreed upon by you and your surgeon: the One-Step and the Two-Step procedures.
In the ONE-STEP PROCEDURE, the biopsy, diagnosis of cancer, and therapeutic treatment are completed in a single operation performed in the hospital under general anesthesia. Before the One-Step procedure, you and your surgeon must agree before surgery that you will undergo the therapeutic treatment during this surgery if the lump is malignant. You will be asked to sign a surgical consent for the biopsy and any additional surgery if the biopsy is positive (malignant). Your surgeon will explain the full details of a mastectomy (surgical removal of the breast) before the biopsy, even though the lump may not be malignant. Currently, the One-Step procedure is seldom recommended. Patients who have had a previous history of breast cancer, may opt to undergo the One-Step procedure.
In most cases the surgeon recommends the TWO-STEP PROCEDURE for his patient. The first step of this method involves an excisional biopsy (lumpectomy, partial mastectomy) to obtain a diagnosis. Once this first step is completed the patient goes home. This is followed by a period of time to discuss treatment at a later date if a malignancy has been found. The biopsy and the treatment of the cancer are performed in two separate stages in this procedure. In the Two-Step procedure, if the lump is malignant, the patient has a more active part in the decision making process and has more time to think. This is emotionally beneficial for the patient. They feel as if they have more control over what is happening to them during this difficult time. In most cases, a patient feels the more they know the better it is.
If it is necessary for you to have a biopsy, discuss these two procedures with your surgeon. The two of you can decide which option is best for you.
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