Ultrasound breast core needle biopsy University Hospital Split Department for diagnostic and intervetional radiology Localisation Križine dr. Davor Luetić dr. Ana Krnić Ultrasound breast core needle biopsy single centre experience 2

Breast biopsy: A procedure in which a sample of a suspicious breast growth is removed and examined, usually for the presence of cancer. 3

Different types of biopsy may be done: In fine needle aspiration biopsy a very thin needle attached to a syringe are used to aspirate a small amount of tissue from the suspicious area. This tissue is then looked at under a microscope. If the area to be biopsied can be felt, the doctor locates the lump or suspicious area and guides the needle there. If the lump can’t be felt, ultrasound might be used to watch the needle on a screen as it moves toward and into the mass. (This is called an ultrasound-guided biopsy.) A fine needle aspiration biopsy are giving small amount of cells and can sometimes miss cancer if the needle does not get a tissue sample from the area of cancer cells. If it doesn’t give a clear diagnosis, a second biopsy or a different type of biopsy should be done. 4

Core needle biopsy (CNB) is much like an fine needle biopsy. A slightly larger, hollow needle is used to withdraw small cylinders (or cores) of tissue from the abnormal area in the breast. This takes longer than an fine needle biopsy, but it’s more likely to give a clear result because more tissue is taken to be checked. CNB usually does not leave scars inside or outside the breast. Surgical (open) biopsy is done by cutting the breast to take out all or part of the lump so it can be looked at under a microscope. A surgical biopsy is more involved than a fine needle aspiration or a core needle biopsy. Stitches are often needed, and it will leave a scar. 5

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What are the risks of a Breast Core Biopsy ? bleeding – hematomas ( 2 - 10 %) infection (4 – 6 % ) 38

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Documentation First and last name of the patient Localisation of CNB Clinical findings Indications for biopsy (calcifications, not only BI-RADSTM category) Size of mammography or ultrasound-detected lesions Number of samples 40

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What are the benefits of a Breast Core Biopsy? the pathologist's viewpoint 42

the core biopsy is used to take samples of palpable and non-palpable breast lesions so that a pathologist can examine it and make a diagnosis. It is a way of getting accurate information without needing an operation to surgically remove the tissue for testing. CNB of the breast is used to reduce the incidence of open surgical biopsies. CNB allows ancillary testing such as immunohistochemical studies to be performed. Most pathologists prefer CNB to fine needle aspiration. 43

For benign lesions, establishing a definitive diagnosis obviates unnecessary surgical excision or protracted follow-up, both of which are costly in psychosocial and resource terms. In this way, it does not destroy tissue needed for further analysis (hormone receptors, Ki67 proliferative index, HER2 status) - particularly important for small breast tumors. A definitive diagnosis of cancer allows the patient to make an informed choice and to obtain counseling before surgery. 44

The samples obtained by CNB, according to CAP / ASCO guidelines from 2014. are appropriate for the assessment of HER2 status, hormones receptors status and proliferative activity, and except in certain indications, need not to be repeated in the operative material. 45

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In metastatic or inoperable breast tumors, breast needle biopsy provides enough material for diagnosis, determination of nuclear grade, assessment of hormone and HER2 status, as well as proliferation activities, based on which it can make a decision for the type of treatment. 47

What are the benefits of a Breast Core Biopsy? a surgeon's viewpoint 48

More precise diagnosis than ex tempore CNB can also be used to detect in situ as well as invasive malignancy. The main advantage of core-needle biopsy is that it enables histological diagnosis, which is vital to the planning of subsequent surgery and treatment of the patient. 49

What are the benefits of a Breast Core Biopsy? the oncologic viewpoint 50

CNB is gold standard in the diagnosis of breast cancer according to applicable international and Croatian standards. CNB enables histological diagnosis, and is appropriate for the assessment of HER2 status, hormones receptors status and proliferative activity which is vital to the planning of subsequent surgery and treatment of the patient. 51

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THANK YOU FOR YOUR ATTENTION 53