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Times have changed when it comes to diagnosing breast cancer.Until a few years ago, the only option for women who had an abnormal area on their mammogram was to have a surgical biopsy. Surgical biopsies enable doctors to take a closer look at abnormal tissue, and in most cases, rule out cancer. Because abnormalities seen on the mammogram cannot always be distinguished between benign or malignant, about an seventy-five percent of all biopsies are benign, or non-cancerous. But as a result of this meticulous evaluation of abnormal mammograms, many more very early cancers are being diagnosed, and women who have cancer have a much better chance of survival. In an effort to diagnose breast problems without surgery, radiologists began doing fine needle aspirations of abnormal areas seen on the mammogram. This is when cells, not tissue, are removed from the area through a needle. These cells can then be viewed under a microscope to make a diagnosis. Fine needle aspirations are very helpful in aspirating cysts and in diagnosing lumps that can be felt. But it turned out that they were only about 50% accurate in diagnosing non-palpable lumps, or lumps that cannot be felt. So, many times, the woman ended up having to undergo surgery anyway. In 1994, UVa began participating in a nationwide study to decide whether a new non-surgical biopsy procedure would give an accurate diagnosis of abnormal areas seen on the mammogram. This new procedure is called core biopsy. Like fine needle aspirations, it uses a needle. But the needle takes tissue samples instead of cell samples. This makes a difference in the ability to accurately diagnose breast problems seen on the mammogram. Studies have found that core biopsies are 96% - 98% accurate, states Dr. Jennifer Harvey, Assistant Professor of Radiology at the University of Virginia. Because of the core biopsy, our surgeries on non-palpable lesions have dropped 80%, and we are now serving as a training center for this procedure. It offers the patient an accurate alternative to surgery. Very early cancers can still be diagnosed using this technique. Core biopsy is an option for most women.The decision to recommend a core biopsy is made after careful evaluation of the mammogram. If we do not feel comfortable with what the core biopsy tells us, surgery may be necessary in order to get more tissue so that we can be sure we have an accurate diagnosis, says Dr. Harvey. Fortunately, this happens in only a small percentage of cases. Core biopsies have other advantages. Dr. Harvey states that it is a quick (about 1 hour), convenient procedure that has a low complication rate and produces no scar. During a core biopsy procedure, the patient is placed face down on a table. Her breast is accessible via an opening in the table. The equipment used to perform the biopsy is located beneath the table. The breast is compressed, and a mammogram is taken. A computerized stereotactic machine then locates the abnormality allowing the radiologist to direct the needle to the right area. The breast area is numbed, and approximately 5-10 samples are taken to ensure an accurate diagnosis. Results usually take about 3 working days. It is important to understand that the availability of this procedure does not eliminate the role of the surgeon in the evaluation of breast problems. The combined information obtained from the breast exam and the mammogram is important when determining the best option for a patient. This procedure just adds a new dimension to the available choices when an abnormality is found on the mammogram. Innovative medical technology is being developed and tested. Look for new advances in digital imaging this fall which will enhance the evaluation of mammograms. It will also provide a way to transport images to television screens in the hospital so that other specialists involved in one's care can see the mammogram as it is being discussed.
By Diane Cole, MPH
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