Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What are the advantages and disadvantages of non-surgical procedures versus surgical breast biopsies?
Generally, non-surgical biopsies are less stressful, do not disfigure the skin, leave no internal scar to interfere with the accuracy of future mammograms, and minimize the risk of complications.
However, non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis. For this reason, some patients who undergo a non-surgical biopsy must also undergo a follow-up surgical biopsy.
What are the different types of breast biopsy procedures and what do they involve?
How is a fine needle aspiration biopsy (FNAB) done?
A fine needle aspiration biopsy (FNAB) can be done in several different ways:
Fine needle aspiration biopsy (FNAB) for palpable growths: A palpable growth is one that can be felt. The patient usually sits up while the doctor inserts a small hollow needle with a syringe to withdraw (aspirate) fluid and cells from the growth for testing. To guide the needle to the site, the doctor simply feels (palpates) the suspicious area. When the needle reaches the mass, the doctor suctions out a sample with the syringe. The doctor repeats this procedure several times. If the mass is a cyst, the withdrawn samples will consist mainly of fluid and the cyst may collapse, relieving any pain the patient feels. If the mass is solid, the samples will consist primarily of tissue cells.
By analyzing the samples immediately after their withdrawal, a doctor may be able to determine that they came from a cyst and simply discard them, diagnosing the growth as benign. In all other cases, fluid and tissue samples are placed on slides and then analyzed in a laboratory by a pathologist.
Guided FNAB for Non-Palpable Growths: When a growth is too small or deep to palpate (feel), the doctor must locate it with one of several imaging techniques. First, the patient lies face down on a table with the breasts suspended through an opening. With stereotactic mammography, mammograms of the suspicious breast site are taken from different angles to form a virtual three-dimensional (stereotactic) image that precisely pinpoints the location of the suspicious area. The computer then uses a motor to guide a small hollow needle to the site to remove the samples. The withdrawn samples are then analyzed for the presence of cancer. Ultrasound and MRI are other imaging techniques that may be used to guide breast biopsies.
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
Fibrocystic breast condition (sometimes called fibrocystic breast disease) is characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign (not malignant). Fibrocystic breast condition is the most common cause of "lumpy breasts" in women. A common symptom of fibrocystic breast condition is breast pain or discomfort. There are two types of fibrocystic breast condition, cysts and fibrosis, and Hyperplasia and atypical hyperplasia of breast cells.
Breast lumps in women can have a variety of causes such as breast inflammation, infection, injuries, cancer, and non-cancerous growths. Breast lumps in women are diagnosed with physical exam, mammogram, ultrasound, MRI, and biopsy. Treatment of breast lumps in women depend on the cause.
The breast generally refers to the chest, however, more specifically, to the mammary gland. The mammary gland is a milk producing gland comprised largely of fat. Within the mammary gland is a complex network of branching ducts. The ducts exit from sac-like structures called lobules, which can produce milk in females. The darkened area around the nipple is called the areola. Common medical concerns in regard to the breast include breast lumps, breast cysts, breast cancer, and breast infections.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Inflammatory breast cancer is an accelerated form of breast cancer that is not usually detected by mammogram or ultrasound. Symptoms of inflammatory breast cancer include pain in the breast, skin change in the breast area, bruise on the breast,sudden swelling of the breast, nipple retraction or discharge, and swelling of the lymph nodes.
Lifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
As breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
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