Lymph Node Status and Your Treatment Decisions

by palm stephan
When I woke up from my breast biopsy, my husband told me it was indeed cancer. I began to weep, thinking I would have to undergo surgery, chemotherapy, and updating my will (just in case). But more news was to come, and so much to learn.

At first we thought it was well-contained (in-situ), not invasive breast cancer. But we also needed to know the tumor size, grade, hormone status, HER2 status, and whether it had spread beyond my breast. So I started down the road for more tests, including testing of my lymph nodes. I had no idea why those tiny things were so important.

But now I know, and to help you understand how your lymph node status affects your treatment decisions, I looked up the experts in UpToDate -- a trusted electronic reference used by many of the oncologists who treat breast cancer patients.

Here's what the experts say, and below that, you'll see my notes about lymph node status and how that may affect your treatment decisions.

The importance of the axillary lymph nodes: A discussion on diagnosis and staging workup from UpToDate

"One of the first sites of breast cancer spread is to the lymph nodes located in the armpit (axilla). These nodes (referred to as axillary lymph nodes) can become enlarged and can sometimes be felt during a breast examination. However, even if the lymph nodes are enlarged, the only way to determine if they truly contain cancer is to examine a sample of the tissue under the microscope.

The presence or absence of lymph node involvement is one of the most important factors in determining the long-term outcome of the cancer (prognosis), and it often guides decisions about treatment."

Why Are Lymph Nodes Important?
Breast cancer starts out with just a few cells, which group together in your breast tissue. They may be camping out in the system where breast milk is produced: your ducts and lobes. As these cells grow and divide, they may also invade nearby tissue. A growing tumor may shed a cell, or a clump of cells. This independent cancer cell can use your blood or lymph system like a network of highways so it can travel throughout your body. Your lymph system works with your circulating blood to provide nutrients to all your cells, as well as remove cellular waste products. The lymph nodes are the "pit stops" on this highway system, where lymphatic fluid is filtered, mixed with immune cells (lymphocytes), and passed back into your circulating lymph fluid. So, if a loose cancer cell makes it to your lymph nodes, it's also possible that the cancer could get sent along to other parts of your body. If you get an infection, your lymph nodes near the affected area may swell because they have collected germs. And if you develop breast cancer, the lymph nodes in your armpit (axillary lymph nodes) is the most common place that cancer cells would lodge, causing those nodes to swell.

Why Do I Need a Lymph Node Biopsy?
Breast tissue itself contains some lymph nodes, which process lymphatic fluid and pass it along. Breast tumors tend to drain towards your axilla, or underarm area. Checking the underarm lymph node location should be part of a clinical breast exam, as well as your breast self-exam. Swollen lymph nodes might be evidence that cancer has spread beyond your breast, but the only way to know for sure is to have them removed and tested. There are two procedures for lymph node biopsy: sentinel node biopsy and axillary lymph node dissection (removal of all the nodes). The pathology report about these lymph nodes gives you your lymph node status.

How Does My Lymph Node Status Affect My Treatment Options?
Your lymph nodes may be clear of cancer, and if so, your lymph node status is negative, and rated N0. If you have a small tumor and clear nodes, it is less likely that you will need to have chemotherapy. That is not a guarantee, however, because your doctor will also consider your tumor grade, tumor size, hormone receptor status and how effective surgery can be for you. If your lymph nodes do contain cancer, they are considered positive, or involved, and are rated N1, N2, or N3 depending on the number affected and the location. Having involved lymph nodes suggests that the cancer has demonstrated an ability to spread beyond your breast, and you will be advised to have adjuvant systemic therapy, such as chemotherapy, after surgery to kill any additional cancer cells that persist in your body.

What Does All This Mean For My Prognosis?
Prognosis, also called outlook, is one way a doctor talks about how the odds for survival stack up for you, after you've completed treatment. Remember, having just one cancer cell in your body is one too many. Treatment is designed to kill off as many, if not all, of your cancer cells as possible. If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is pretty good. On the other end of the spectrum, if you had 10 or more involved lymph nodes and a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine, until after you've finished all treatments. No matter where your diagnosis fits on that scale, please know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer can be managed like a chronic disease.

Want to learn more? See UpToDate’s topic, "Patient information: Breast cancer guide to diagnosis and treatment: The importance of the axillary lymph nodes," for additional in-depth, current and unbiased medical information on breast cancer, including expert physician recommendations.

Axillary Lymph Node Dissection - Types of Surgery and Effect on Treatment Plans

by palm stephan
A breast tumor can shed cancer cells into your lymph system. Those cells may get trapped in nearby lymph nodes, usually your axillary nodes. Your surgeon may remove some lymph nodes so they can be examined under a microscope. If cancer cells are present in your lymph nodes, your risk for metastatic breast cancer rises. The procedure for underarm lymph node removal is called axillary lymph node dissection.

Axillary Lymph Node Dissection (ALND)
Axillary lymph node dissection may be done as part of a lumpectomy or mastectomy. Your surgeon may remove a small group of nodes or all of the nodes in your axilla. These will be sent to the pathology lab where they will be carefully examined for cancer cells. You will need to know if your lymph nodes are negative (clear of cancer) or positive (contain cancer). This important information affects the staging of your cancer and influences your treatment options.
Importance of Lymph Nodes
Although lymph nodes are present in groups throughout your body, your axillary nodes are the most likely location to which breast cancer cells may travel. Lymph nodes work as filters where bacteria, viruses or cancer cells are caught. When cancer cells are present in your nodes it means that the disease has gained the ability to leave your breast and travel to other parts of your body.

If cancer cells do lodge in a lymph node, it may swell. You should always check your underarm area during your monthly breast self-exam to keep tabs on your axillary lymph nodes.
Types of Lymph Node Dissection
Lymph nodes may be removed as part of breast surgery, or as a separate procedure. Here are different types of lymph node dissection surgeries:

* Sentinel Lymph Node Biopsy (SLNB): This is a diagnostic procedure done to remove a small sample of lymph nodes to which the cancer may be draining. These sentinel nodes are thought to be the first nodes to which cancer cells must travel before going any further. A blue dye and a weak radioactive agent will be used to help your surgeon locate the specific nodes. This procedure removes the least number of lymph nodes.

* Axillary Lymph Node Dissection (ALND): This procedure is usually done as part of a radical or modified radical mastectomy or a lumpectomy. As few as 10 or as many as 40 lymph nodes may be removed for testing.

* Full Axillary Lymph Node Dissection:
If cancer is found during your sentinel node or axillary node biopsy, your surgeon may go ahead and remove all of your axillary lymph nodes, so that all of the nodes can be examined for possible metastasis.

Risks and Side Effects of Axillary Lymph Node Dissection
The most common side effect of a lymph node dissection is lymphedema (swelling of the arm). Since, after surgery, you have fewer lymph nodes under your arm to process lymphatic fluid, the fluid may build up and cause swelling along your arm and sometimes your hand. If just a few nodes are removed, lymphedema may be a temporary condition, but if most of your lymph nodes were removed, it may be a long lasting problem.

Therapeutic massage and pressure garments can help with lymphedema. Your axillary skin may be numb or less sensitive to touch after surgery, because nerves may have been damaged during the procedure. Arm and shoulder range of motion may be affected, so be sure to ask for physical therapy to help regain your motion and strength.

Lymph Node Status Affects Treatment
Axillary lymph node dissection is an important part of your complete diagnosis and staging. Clear nodes and a small tumor will require less treatment because the chances of metastasis are low. However, it's important to know how many nodes are involved with cancer, so more tests can be done to determine if and where the cancer may have spread. This information impacts your treatment options and helps you and your doctor choose the most effective treatment plan for you.

Sentinel Node Biopsy What To Expect During Sentinel Node Biopsy

by palm stephan
Sentinel Node Biopsy - An Important Diagnostic Test:
Sentinel node biopsy is a surgical diagnostic procedure done to remove a small sample of lymph nodes so they can be tested for metastasis. Those sentinel nodes will be examined to determine if cancer cells have metastasized (spread) beyond the original tumor. If done no other surgery is being done at the same time, this is an outpatient procedure, and is important in staging of your breast cancer. If you are having a lumpectomy or mastectomy, sentinel node biopsy may be done along with that procedure. Here's what to expect during a sentinel node biopsy.

Getting Started With Medical Imaging:
Before this surgical procedure, your surgeon will need to know the locations of your tumor and the sentinel lymph node. A combination of imaging techniques will be used to find and mark these locations before surgery.
Finding The Tumor:
You will go to the Nuclear Medicine Department of the hospital or clinic where your sentinel node biopsy will be done. As you would for a mammogram or breast ultrasound, you will undress from the waist up, and put on a hospital gown. Next, you will lie down on an exam table. A radiology technician will use an ultrasound machine to find your tumor. The tumor site will be marked on your skin, so your surgeon can easily find it.
One Shot or Two – Blue Dye and Painkiller:
A radiologist or nuclear medicine specialist will inject a weak radioactive dye (technetium-labeled sulfur colloid), or a blue dye (isosulfan blue), or a combination of both, into the tumor site. This can be painful, so you may be given a choice of whether or not to have an injection of numbing medication first. Since injecting the dyes can take longer than a flu shot usually does, you might like to seriously consider asking for the numbing medication, if it is not offered.
Lymph Node Mapping:
Once injected, the dyes need some time to travel from your tumor site to your lymph nodes. You will spend some time in a nearby waiting room, so bring along some reading material or music. When the dyes have reached their destination, you be asked to return to the Nuclear Medicine Department, and lie down on the exam table again. Imaging studies (lymphoscintigraphy) will be done to show which clump of lymph nodes is receiving the dyes, and that indicates where your sentinel lymph node will be found. The technician will mark this location on your skin, so your surgeon will know where to start looking.
Removing the Sentinel Lymph Node:
You will be brought into the operating room, where your surgeon will be ready to begin. You will be given general anesthesia. The surgeon will use a hand-held probe to find the lymph nodes that contain the most radioactive dye. In that location, your surgeon will make a small curved incision, and look for the lymph nodes that have been stained with blue dye. Only one to three nodes will be removed, unless many more are stained. These nodes are sent to the pathology department, where they are examined for metastasis and micrometatasis.
Your incision will be closed and dressed, and you will be taken to Recovery.
Testing the Sentinel Node in Pathology:
Once in the pathology lab, your nodes will be tested for cancer. Sometimes your surgeon will order a frozen section test for the nodes, in order to get results right then. If your nodes do contain cancer cells, you may have a full lymph node dissection immediately, to find the full extent of lymph node involvement. If a frozen section is not ordered, and your nodes contain cancer, a full lymph node dissection will be done later.
Recovering From Your Sentinel Node Biopsy:
If blue dyes were used to find your sentinel lymph node, expect to see blue dye in your urine for about 24 hours. Sometimes there will be some bruising and blue dye on the skin around the incision. You will have a dressing and sutures to keep dry, and may need pain medications until healing begins. Use the surgery-side arm gently (no lifting!) for at least a week after the procedure. The stains from the blue dye will diminish and the bruises will heal, the incision itself will fade to a fine line over time.
Getting Your Biopsy Results:
Your surgeon or oncologist will call you about results of the biopsy as soon as the pathologist has completed their analysis. The report will include information on how many, if any, lymph nodes contain cancer cells. Ask for a copy of your pathology report and keep it with your health records. If a node contains cancer, it is diagnosed as positive, and if no cancer is found in a node, it is diagnosed as negative. A diagnosis of positive lymph nodes means that your cancer has spread (metastasized) beyond the original tumor. These results will affect the staging and treatment needed to treat your breast cancer.
Risks of Sentinel Node Biopsy:
Lymphedema
A common result of a full lymph node dissection is a condition called lymphedema. Because lymph nodes in your armpit area are missing, the lymph fluid that is usually processed there can build up and cause swelling. If this persists or increases, it can become painful. However, if you require only a sentinel node biopsy, you will still have enough nodes to handle the lymph fluid that travels through your armpit region, so the rate of lymphedema in that case is only about five percent.
False Positives or Negatives
Lymph nodes can vary in size, some small as a pinhead, others large as a bean. Your surgeon will be hunting through skin and fat, looking for blue-dyed nodes, and must use some skill and judgment. It's possible that the sentinel node will test negative (clear of cancer), but cancer may be in some other lymph nodes. This is called a false negative. To protect you from false results, your surgical and pathology teams will follow strict guidelines, and if the results are in any doubt, more nodes will be removed and tested, to make sure of accurate results.

Ductal Lavage Screening for Pre-Cancerous and Cancerous Breast Cells

by palm stephan
What is Ductal Lavage?:
Ductal Lavage has been referred to as the "Pap smear for the breast." With a very tiny tube, fluid can be sampled from the breast ducts, and examined under a microscope or screened at the molecular level for cancer cells.
Who needs this test?:
Women who are at high risk for breast cancer should ask their doctor if this test would help determine whether they may have a pre-cancerous condition, or if they have breast cancer cells present in the breast ducts.
How ductal lavage is done:
The nipple has many milk ducts that open onto its surface. A very tiny tube is inserted into one (or more) of these ducts, and intense suction is applied to the nipple. Some saline solution (mild salt water) is sent through the tube and into the duct, then washed out again, carrying with it a sample of cells from the duct tissue.
Does this test hurt?:
You will feel suction on your nipple - without it, the test won't work properly. You may feel a slight bit of poking sensation when the tube is being positioned and placed into your nipple. The tiny tube which is inserted in through the nipple should not be painful. If it is, let your doctor or nurse know about it.
How are the duct cell samples screened for breast cancer?:
There are now two ways the cells can be screened:

* microscopic pathology - the cells will be viewed under a microscope by a pathologist, and visually compared for irregular shape. Cancer cells have a particular shape which sets them apart from healthy cells.
* cytopathology - the cells will be separated from the saline wash, and sorted for chemical tags in their DNA that indicate whether or not they are cancerous.

What are the advantages?:
This is a non-surgical technique, and therefore less invasive than a biopsy. It may be done during an office visit, so it should cost less than a biopsy, and will not leave any scars. Recovery time, if needed, should be very quick.
What are the disadvantages?:
While ductal lavage can help determine if breast cancer is present in the ducts, it cannot show us precisely where the cancer is living. So, if the results of your test come back positive for ductal carcinoma, you will also need a dagnostic mammogram and perhaps an ultrasound as well, in order to locate the actual site of the cancer.

Open Surgical Breast Biopsy

by palm stephan
Surgical Biopsy for Breast Lumps:
Most breast lumps are benign. In fact, 4 out of every 5 breast lumps are not cancerous. If you have a breast lump and want it checked out, a surgical biopsy is a good way to get a clear diagnosis. This type of breast biopsy removes the largest size of tissue sample, as compared to any type of needle biopsy. Surgical biopsy is done in a hospital, with general anesthetic, and is usually an outpatient procedure.
Other Terms Used for a Surgical Biopsy:

* Open surgical biopsy
* Breast biopsy
* Partial mastectomy
* Excisional breast biopsy

Reasons for a Surgical Biopsy:
An open surgical breast biopsy is needed if the results of a needle biopsy are unclear or if a lump is so hard that a needle cannot obtain a good tissue sample. Also called a "partial mastectomy," a surgical biopsy is done to remove a tissue sample that is larger than a sample from a core needle or vacuum-assisted biopsy. In some cases, the entire mass and a margin of healthy tissue may be removed. The tissue will be examined in a lab right away to ensure that it is an accurate sample and get a diagnosis.
Finding the Breast Lump for a Biopsy:
For a breast mass that is easy to locate by touch, your surgeon may use mammograms or ultrasound and palpation to locate the tissue for a biopsy. If your mass is quite small or hard to find by touch, you may have a wire localization done prior to your biopsy. This is done while you are awake, and local anesthesia is used to numb your breast. Using mammography, a hollow needle is guided in to your breast mass, and a thin wire is fed through the needle to that location. The wire is left in place to help guide your surgeon to the right spot for your biopsy.
What to Expect During Your Breast Biopsy:
You will be prepared for surgery and given a general anesthetic, which puts you to sleep. Your surgeon will make an incision over the mass to be biopsied and locate the mass using touch or wire localization. Small masses may be removed entirely, but in most cases, a slice of the mass will be taken and sent to the lab. When there is enough tissue to make a clear diagnosis, your incision will be closed with stitches and dressed. You will be taken to Recovery to sleep until the anesthetic wears off. You will be able to go home the same day, but someone else must drive for you.
Recovery and Self-Care:
A surgical biopsy will result in a small scar on your breast skin. Be sure to keep your surgical dressing dry until you have gone for your follow-up visit. Take a full day to recover from your biopsy, as you may have some residual anesthetic in your system. If you have pain at the biopsy site, it's OK to take ibuprofen and use a cold pack.
Getting Fast, Accurate Results from Pathology:
A pathology lab can use two methods to study your tissue sample. The quickest method is called "frozen section" or cryosection. The tissue is rapidly frozen and sliced with a special blade into a section thin enough to see through. This gives a diagnosis of benign or malignant, but no other details. A permanent section is a more thorough process, using special chemicals to get more information from the tissue slide. This process takes about 48 to 72 hours and gives a bigger picture of your diagnosis: if it is malignant, you can find out if it is hormone sensitive and whether it is high or low grade.
Dealing with Your Biopsy Results:
When you awaken from surgery, you may be told your preliminary biopsy results. If your mass was benign, then you won't need any further surgery. If your diagnosis was malignant (cancerous), though, you will need to wait two or three days to get your full pathology results. Your doctor will meet with you to explain the details of your diagnosis, but you won't need to rush in to treatments. Take your time to study all of your options before deciding on a treatment plan. Remember, you are still the same person you were before your biopsy — having breast cancer does not define you!
Pros and Cons of a Surgical Biopsy:
Surgical breast biopsy takes the largest tissue sample and has the highest accuracy rate of all biopsy methods. On the other hand, some disadvantages may be the need for stitches to close your incision and the resulting scar and internal scar tissue that will appear on future mammograms. In a few cases, patients develop bleeding and infection at the biopsy site or have a bad reaction to the anesthesia. Be sure to ask your doctor if a surgical biopsy will really work best for you or if other methods, such as core needle biopsy or vacuum-assisted breast biopsy, would be good alternatives.

Stereotactic Breast Biopsy for Breast Abnormalities

Definition of Stereotactic Breast Biopsy:
A stereotactic biopsy is used take samples from a lump that cannot be felt during a breast exam, but can be seen on a mammogram or an ultrasound. A lump deep inside the breast, or an abnormality too small to feel, can be biopsied using this technique.
Stereotactic Imaging Improves Accuracy:
During stereo imaging, two-dimensional digital images of your breast are taken from two different angles. Both images are sent to a computer for image analysis. The computer compares the data from each image and calculates the three-dimensional location coordinates for your breast abnormality. With such precise information to guide the biopsy needle, your doctor or radiologist can accurately sample fluid or tissue.
Other Terms for Stereotactic Biopsy:

* Stereotactic (mammographically guided) breast biopsy
* Stereotactic core needle biopsy
* Stereotactic-guided biopsy
* Breast stereotaxy
* Mammotome vacuum-assisted biopsy

Reasons to Have a Stereotactic Biopsy:
When your mammogram shows an abnormality that raises concern, and your doctor needs a tissue sample, a stereotactic biopsy is one way to get tissue from a specific location. Examples of abnormalities could be: a dense, irregularly-shaped mass, microcalcifications, a distortion of breast tissue or internal structure, or a new mass at a previous surgery site. Stereotactic biopsy is a good alternative to surgical biopsy if you or your doctor prefers to try a needle biopsy before opting for surgery.
Stereotactic Guidance Assists Needle Biopsies and Wire Placement:
The accuracy of stereotactic images can assist in several types of biopsy:

* fine needle aspiration - removing fluid from a cyst
* core needle biopsy - taking tissue from a mass
* vacuum-assisted biopsy - using suction to collect several tissue samples
* wire localization - locating the mass in preparation for surgical biopsy

Patient Comfort and Biopsy Technology:
Stereotactic biopsy can be done in a clinic or hospital that has special breast biopsy equipment. The equipment consists of a digital mammogram machine, linked to a computer, and a needle guidance system. Since you will be awake during the procedure, but must remain very still, your comfort is very important. Some biopsy equipment is configured so that you can sit in a chair during the imaging and biopsy, while other clinics use a special exam table that you can lie down on. Your breast will be given a local anesthetic, so you should not feel anything other than some pressure.
What to Expect During a Stereotactic Biopsy:
Your breast is numbed, and you are positioned for stereotactic mammography. Some compression is used to keep your breast still. Several pairs of images are taken. A small cut is made in your breast skin, so the needle can enter your breast. Your doctor or radiologist uses the image-guided needle to target the breast abnormality. More images are taken to confirm that the needle is in the right place. Using suction or special blades, fluid or tissue is collected for examination. If you're having a surgical biopsy, a wire will be placed at the location and depth of the tumor to guide your surgeon.
Getting Tagged, Recovery and Self-Care:
A fine needle or core needle biopsy won't leave any internal scars, but a vacuum-assisted biopsy (which may take eight or ten tissue samples) will leave its mark. Because those scars can show up on mammograms and ultrasound, a tiny metal tag, clip, or marker may be left at the biopsy site. This tag should not cause discomfort or harm; it will help radiology technicians locate the biopsy site.

It is normal to have some bruising and swelling after a biopsy. Use cold packs and ibuprofen while you are recovering, which should take about 24 hours. If you have bleeding, drainage or inflammation, alert your doctor.
Getting Results from Your Biopsy:
Your fluid or tissue samples will be given to a pathologist, who will carefully examine and test them. A pathology report will be written and sent to your doctor, who will contact you about the results. Remember that having a biopsy doesn't mean that you have a malignancy, since four out of five biopsies come back negative for cancer.
Accuracy of a Stereotactic Biopsy:
Compared to a freehand needle aspiration or an ultrasound-guided needle biopsy, a stereotactic breast biopsy will give you the most accurate results. The precision of a computer-guided needle, combined with larger tissue samples, yields the most information of any type of needle biopsy. An open surgical biopsy, which removes the largest sample of tissue, may be more accurate than a stereotactic biopsy.

Benefits and Risks of Stereotactic Biopsy
A stereotactic biopsy is less invasive and less expensive than an open surgical biopsy. This is a fairly simple and quick biopsy method, with a short recovery time. You do have a small risk of infection, bleeding, and pain following the procedure. If you are pregnant, or think you may be, let your doctor know so that you can be protected from x-rays used in breast imaging.

Mammotome and ABBI, and MRI Technologies
Two other techniques are used with stereotactic imaging to perform breast biopsy to remove twice as much tissue than is taken with a core needle. Mammotome uses a hollow probe with a rotating blade to suction and cut a cylinder of tissue from the target area. ABBI (Advanced Breast Biopsy Instrument) uses a probe, a circular blade, and a thin, electrically heated wire to capture and remove a cylinder of tissue that is larger than the Mammotome sample. MRI (magnetic resonance imaging) is sometimes used in place of stereotactic mammography.

Core Needle Biopsy - Breast Biopsy

by palm stephan
Core Needle Biopsy for Breast Masses:
A core needle biopsy is used when your doctor needs more information about a breast lump than a mammogram, ultrasound, or fine needle aspiration can give.

A core needle, or hollow core needle, can be used to get small tissue samples from a breast lump. The tissue samples will be sent to the pathology lab for examination. This procedure can be done in an office, clinic or hospital by a doctor who is trained in the technique.

Having a core needle biopsy might help you avoid an open surgical biopsy.
Other Names for a Core Needle Biopsy:

* CNB
* hollow core needle biopsy
* incisional needle biopsy

Reasons to Have a Core Needle Biopsy:
Having a breast biopsy of any kind can be stressful, but it's a good way to find out the true nature of a breast mass that is causing concern. You may have already had a fine needle aspiration (to remove fluid or tissue), but didn't get clear results. A hollow core needle (16-, 14-, or 11-gauge needle) can take larger tissue samples of a breast mass as well as nearby healthy breast tissue. Your pathologist can do more accurate tests and microscopic examinations on larger tissue samples, giving you and your doctor a better idea of how to proceed.
Techniques for Core Needle Biopsy:
Core needle biopsies are done several different ways, depending on the size or location of the breast mass being sampled. Freehand needle biopsy can be used for lumps or masses that can easily be felt. But if a lump is too small to be felt, or too deep to aim a needle at, there are other methods that use imaging and mechanical assistance: ultrasound-guided needle biopsy, stereotactic needle biopsy, and vacuum-assisted biopsy.
What to Expect During a Core Needle Biopsy:
You will be awake during the procedure, but your breast will be numbed with a local anesthetic. Your doctor will locate the lump by touch or with guidance from imaging technology. Your doctor will insert the core needle through your skin into the lump to take tissue samples. To ensure accuracy of results, three to six samples will be taken. You should expect to feel some pressure during the procedure, but be sure to let your doctor know if you feel significant pain. After the procedure, you may have some bruising at the needle sites, but no scars. You will be able to return to work or home right away.
Getting Results From Your Biopsy:
Your tissue samples will be tested in the pathology lab, and a written report will be sent to your doctor. A negative result means that no cancer was found. A positive result means that the mass is malignant, and more tests will be needed to get an accurate diagnosis.
Accuracy of a Core Needle Biopsy:
Because a core needle can remove a larger tissue sample, and more samples are taken for comparison, a core needle biopsy is more accurate than a fine needle aspiration. A core needle biopsy may be between 97 and 100% accurate in giving a diagnosis. If you have very small breasts or very hard lumps, a core needle may not be able to take a good tissue sample, and other biopsy methods may be required.
Benefits and Risks of This Procedure:
A core needle biopsy is more accurate than an aspiration and less invasive than an open surgical or excisional biopsy. The needle biopsy will leave no external or internal scars, and so it will not affect future breast imaging studies. There is always the chance that the needle may miss a malignant area, but your doctor will try to minimize this possibility. A core needle biopsy is not a treatment, and it will not remove all of a malignancy. If your results come back positive for cancer, you will need to consider more tests and treatment.