Surgical (open) breast biopsy entails surgically removing an abnormal or suspicious area of the breast.
This biopsy type is recommended when Micro Biopsy or Macro Biopsy histological samples are either not possible or unhelpful.
In the situation where a lesion has already been diagnosed, this method is then called surgical treatment (see breast cancer treatments).
The goal of a surgical (open) biopsy is twofold: recognize the nature of the lesion and design the most appropriate treatment plan.
What happens during a surgical (open) biopsy?
These biopsies are generally carried out under general anesthetic. The surgeon makes an incision into the breast and if the lesion is easily felt it is removed at this stage. If the lesion is not easy to feel (which is very frequently the case) then it will have already been identified by the radiologist who uses a wire localization technique. This entails positioning the tip of a thin steel wire within the area to be removed (for example an area of microcalcifications, an area that is distorted or one that is excessively dense…) The surgeon follows the wire and removes the tissue the wire is in contact with.
Once the sample is removed it is x-rayed to verify that abnormal zone has been totally removed and then it is sent for analysis to an anatomopathologist. This analysis is either:
- a first analysis (called extemporaneous as it is conducted almost immediately after the biopsy whilst the patient is still asleep) that confirms the presence of any cancer and can indicate if all surgical treatment work can be done at this time by means of a lymph node excision
- an analysis where the sample is sent to the anatomopathologist for a laboratory examination that keeps the tissue intact and in principle renders the best possible diagnosis. A separate further round of surgery may then be required according to the laboratory results.
Once the tissue is removed, the surgeon then proceeds to correct any breast shape defects using oncoplasty. The surgeon repairs the ‘defect’, closes the wound and sometimes leaves a drain in (a small tube to collect any blood) for 24 or 48 hours.
In general the patient does not suffer post-operative pain, although some temporary discomfort may be experienced with perhaps even a feeling of induration that may last some weeks.
Whatever the biopsy method: the tissue analysis should be able to deliver a diagnosis sufficient to consider which treatment plan is appropriate (for example, does the tumour suggest ductal or lobular cancer, what is a tumour’s histological prognostic grade, are there any hormone receptors, does the tumour have HER2 Neu (human epidermal growth factor receptor 2). See the section Histological analysis below.