The magic of 3- the power of triple assessment in a breast clinic
The advent of spring loaded biopsy instrument has revolutionised the assessment process in both screening and symptomatic breast clinics. This has more or less replaced the use of fine needle cytology. The name one stop clinic was based on the use of the cytology results (in addition to radiology) on tests done with needle and syringe which could be reported by pathologists within an hour but soon it was realised that this wasn’t the best practice because results could be inadequate, inaccurate and often led to further biopsies. Therefore over time it has been superceded by core biopsy which although takes longer (about a week) gives us not only more accurate and dependable results.
In the age of personalised medicine the core biopsy gives us far more information and allows us to make much more precise decisions on all range of conditions from harmless to the cancerous ones to the ones in intermediate zone. The harmless benign ones like fibroadenoma can be safely left alone, the intermediate ones like ADH & papilloma can be monitored and the cancerous ones treatments can be designed by not only confirming the diagnosis but also important information of what other treatment like tamoxifen, herceptin and chemotherapy. This has led to reduction in excision biopsies which left scars, needed general anaesthetic and hospital admission. Instead core biopsy can be done as an outpatient procedure under local anesthesia using a tiny scar which fades over time and reducing disruption to family and working life. The biopsy takes actual tissue for analysis under microscope using the ultrasound, mammogram or in small number of cases MRI to accurately target the area of concern and takes 15–20 minutes. The common issues are bruising and pain, the rare complication of puncture of lung is getting even rarer thanks to the improved skills of operators (radiologists and trained radiographers).
The patients with cancer we can now advise better because we have information of the grade, receptors and growth rate. Some patients are now being sent for chemotherapy before surgery and genetic testing before surgery. Patients who are unfit for surgery may have choice of being treated with tablets like Letrozole if they are hormone receptor positive and can be monitored by checking response on repeat biopsy. Patients who develop secondary cancer in other areas like can have biopsies not only to confirm but to plan treatments.
Advancements in technology led to adoption vaccum assisted biopsy now in routine practice. This is being used get more tissue for diagnosis, monitoring and removal of fibroadenoma. We are awaiting results of a trial of removal of cancers in patients unfit for surgery and it’s within the realms of possibility that one day in the near future it may be used to treat small cancers by avoiding conventional lumpectomy.
There is no truth in heresays that biopsies change a harmless lump to cancer or promotes spread of the cancer.
This is a perfect example how technology has come to help establish a safe and efficient delivery of diagnosis and treatment in breast clinics around the world.
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