Use of Biopsy in Breast Cancer Diagnosis

Introduction

Breast cancer is among the leading causes of female mortality in the world today. WHO has estimated that yearly, breast cancer accounts for 2.3 million incidences, out of which 0.6 million are deaths. It has been established that early detection and accurate diagnosis of breast cancer lead to improvement in the patient’s survival rate. There has been an ongoing use of different diagnostic methods in identifying breast cancer; however, this has remained the key method that establishes the presence of cancer.

In the diagnosis of breast cancer, biopsy plays a crucial role, and its significance and use should be comprehended by healthcare workers and the populace intending to seek treatment.

What is Biopsy?

A biopsy is therefore a surgical operation whereby tissues or cells are removed from a given part of the body to be viewed under the microscope. It is used to determine whether there is a malignant tumor, its type, the likelihood of the tumor spreading, and whether it is hormone-positive or not. Biopsy, in most cases, constitutes the reference technique in the diagnosis of cancer and accounts for the most accurate and specific information about the cancer. Various types of biopsy can be performed on the breast depending on the situation and/or needs of the patient in the diagnosis of breast cancer.

Need of Biopsy

Mammography and ultrasound detect abnormal growth and lumps in the breast, and a biopsy confirms whether the growth is cancerous or not. If the patient has the following symptoms, then the doctor recommends a biopsy for deciding suitable breast screening method.

• Depressed skin
• Visible lump
• Discharge of blood
• Texture change
• Color change

Role of Biopsy in Breast Cancer Management

Confirming cancer diagnosis: A biopsy is the only technique that can tell for sure whether one has cancer or not. Often a screening test like mammography, ultrasound, or MRI may show an abnormality that may be cancerous. However, the only way to be certain about the condition is by performing a biopsy.

Identifying cancer type: A biopsy enables the determination of the type of breast cancer—ductal carcinoma in situ, invasive ductal carcinoma, or invasive lobular carcinoma. This information is useful in establishing the right treatment plan to take since different forms of breast cancer may require diverse treatment.

Determining aggressiveness: The biopsy assists in evaluating its aggressiveness, also practiced as the grade of the OM cancer. The high-grade tumors are more virile and have higher chances of metastasizing to other parts of the body. Such information is crucial for the prognosis and an estimate of the treatment.

Hormone receptor status: Breast cancers are generally classified with the hormone receptors through which the tumors can be fueled by estrogen (ER) and/or progesterone (PR). Hormone treatment has to be chosen carefully, and this information is valuable to do so because it may halt or even reverse cancer.

Identifying HER2 status: HER2 is a protein that is found on the surface of certain cancer cells. Another aspect of biopsy essential for cancer treatment is to find out whether the cancer cells have high levels of HER2 or not since anti-HER2 medications like trastuzumab (Herceptin) are usable to hinder the impacts of HER2 on cancer cell growth.

Types of Biopsy Procedures

Fine needle aspiration (FNA) biopsy

In this procedure, a small needle is used to penetrate the tumor or area that looks suspicious to obtain some cells. Relative to an open FNA biopsy, CT-guided FNA is smaller in size and can be accomplished with local anesthesia. They are often utilized for diagnosing the disease and identifying hormone receptors and Her2 status. However, this characteristic may not help define the grade and the type of cancer.

Core needle biopsy (CNB)

A wider needle is used to take out a small biopsy from the tumor or an area that is considered to be highly suspect. CNB is a more invasive procedure than FNA but yields a greater amount of tissue, thereby permitting a more accurate determination of the cancer type, grade, and hormone receptor status. This technique can also be used to determine HER2 status. HER2 is gaining importance as a biomarker and molecular target in breast cancer since it is involved in the achievement of the aggressive phenotype of cancer cells.

Vacuum-assisted biopsy (VAB)

VAB is a development of CNB in which typical tissue samples of different sizes are obtained using a special apparatus from the tumor mass or the area of interest. VAB obtains a significantly greater amount of tissue, which leads to higher accuracy in cancer assessment and is beneficial in cases when the lesion cannot be reached or its malignant features are barely noticeable.

Open biopsy or surgical biopsy

If imaging methods, FNAC, or needle biopsy do not give a conclusive diagnosis or the size and location of the tumor are unclear, an open biopsy might be carried out. This includes coming up with an incision that will enable a physician to obtain a big tissue sample for biopsy. The open biopsy takes a larger portion, usually in situations where the diagnostic core needle biopsy has not yielded favorable results or when there is a need for a Sentinel lymph node biopsy.

Sentinel lymph node biopsy

This method entails mapping and removing those nodes that are the first to receive and drain the tumor, the sentinel nodes. This assists in establishing the extent of the spread of cancer to the lymph nodes, which is important in staging and management. In an open biopsy, a sentinel lymph node biopsy is normally conducted.

Advantages of biopsy

The advantages of biopsy in breast cancer diagnosis include:

1. Offering a clear prognosis of cancer.
2. Items: the type of cancer, the aggressiveness of the cancer, the hormone receptor status, and HER2 status.
3. To decide whether cancer extends to the level IV lymph nodes or not.
4. Which makes it possible to provide targeted, individualized intervention and care.

limitations of biopsy

However, biopsies also have limitations:

1. These may involve biopsies and can be carried out under local or general anesthesia but may be uncomfortable or lead to complications.
2. Complications that may arise at the site of the biopsy include bleeding and infection as well as scarring.
3. Sometimes, biopsy procedures may be negative or falsely negative, hence other invasive tests to uncover the disease begin.

Newer Approaches to Biopsy

Over the years, several improvements have been made in terms of biopsy methods to increase specificity and perform minimally invasive procedures. These include:

1. Image-guided biopsy: taking pictures through ultrasound, mammogram, or MRI to map the tumor, and using that picture to help guide the biopsy needle. This makes the biopsy much more precise and requires fewer tries at grabbing a sample.
2. Advanced biopsy devices: Since the introduction of vacuum-assisted biopsy devices, it has become possible to obtain a larger amount of tissue in fewer passes, further enhancing the diagnostic yield.
3. Molecular testing: Molecular analysis through next-generation sequencing and fluorescence in situ hybridization has begun to develop an understanding of this biopsy specimen at a molecular level to interpret the behavior of the tumor to various therapies.

Conclusion

The actual best tool for determining breast cancer is biopsy, as it provides information on cancer type, its aggressiveness, hormone receptor status, HER2 status, and lymph node involvement. The techniques for performing a biopsy are numerous, and each of them also has its strengths and weaknesses; therefore, the choice depends on the patient’s case. In recent years, there have been enhancements in the methods of biopsy, including image-guided biopsy and molecular testing, which enhance the identification and treatment of breast cancer. Knowledge about the place of biopsy in the diagnosis of breast malignancy is crucial in healthcare practice and practice for consumers.