Early detection is key to defeating breast cancer. The cancer specialists at Penn Women's Specialty Center employ a variety of techniques to detect breast cancer at its earliest stages.
Breast Biopsy
Every breast biopsy is precisely targeted to disrupt only the suspicious breast tissue, leaving the rest of the breast intact. In fact, 90 percent of breast biopsies can be obtained in a minimally-invasive manner without an incision or general anesthesia.
Your physician will recommend the most minimally-invasive procedure possible depending on the size and location of your mass. Having an expert opinion about the type and grade of cancer will affect your treatment from the very beginning. We offer the following biopsies:
Breast Biopsies That Need Only Local Anesthesia:
- Fine Needle Breast Biopsy - When the mass is easily felt by the physician or easily seen on ultrasound, a fine needle biopsy may be recommended. Local anesthesia is used to numb the area and a fine needle is used to withdraw enough tissue for examination under a microscope. This procedure is performed by a radiologist or surgeon. Sometimes, lymph nodes in the armpit can also be assessed this way.
- Stereotactic Breast Biopsy - This kind of biopsy is performed when the breast lump is so small that it cannot be felt during an exam or if suspicious microcalcifications were seen on a mammogram. You will lie on a table on your stomach, with your breast dropping through an opening to allow for the breast to be biopsied. While the breast is compressed by mammography paddles, the image is projected on a computer screen. A special needle designed to obtain tissue samples is guided to the suspicious mass. Several samples will be taken and images will confirm that an adequate amount was removed for examination under the microscope. This procedure is performed by a radiologist.
- Ultrasound-Guided Core Biopsy - This kind of breast biopsy is performed when the lump is palpable during an exam or if it is easily seen on an ultrasound. Using ultrasound to locate the mass, a large needle withdraws tissue samples for examination under the microscope.
Breast Biopsies Using Local or General Anesthesia:
- (Open) Excisional Biopsy - This biopsy is done by making an incision in the breast and removing tissue from the suspicious area. It is sent to a pathologist for a diagnosis. Excisional biopsy and lumpectomy should not be confused with one another. Lumpectomy is performed when there is a known diagnosis of breast cancer and the mission is to remove all of the cancer with a healthy margin of tissue around the tumor. An excisional biopsy is not a surgical treatment, it is diagnostic.
- Sentinel Lymph Node Biopsy - The sentinel lymph node is the lymph node in the armpit that is the first place cancerous breast tumors can spread. Also called the guard node, it is identified using a special blue dye or radioactive isotope that is injected before the surgery. Following the path of the dye or isotope, your surgeon will identify the sentinel node, remove it, and send it to pathology for review. Knowing if the cancer has spread to the nearby lymph nodes is a critical part of staging and treatment of breast cancer. This procedure is performed when there are known invasive breast cancer cells in the breast, or when mastectomy is being done for the treatment of DCIS. If the sentinel lymph node is positive for cancer, additional lymph nodes are removed to determine the extent of disease.
- MRI-Guided Biopsy - During this kind of biopsy, your physician uses an MRI machine to get a precise reading on the location of the tumor. By doing so, your physician can make sure that he or she is pinpointing the tumor and removing enough tissue to get an accurate reading of the biopsy under the microscope.
Breast MRI
For most women, mammograms are the only screening technology they will ever need for monitoring their breast health. Women with suspicious masses or fibrous breast tissue can expect to have an ultrasound, and possibly a MRI (Magnetic Resonance Imaging).
Breast MRI is very sensitive and is useful for assessing invasive carcinomas. It is also used to assess high-risk patients who have more than a 20 percent chance of developing breast cancer in their lifetimes based on genetics (BRCA1 and BRCA2) and strong family history of breast cancer. Since it is such a sensitive technology, benign findings may be detected on MRI. This can cause the patient unnecessary anxiety.
If a MRI detects a suspicious lesion that isn't recognizable and doesn't correspond to anything visible on the mammogram, then a second-look ultrasound is recommended. If visible, the lesion may be biopsied under ultrasound guidance; if not, it may need to be biopsied under MRI guidance.
Breast Pathology
Ensuring the accuracy of your pathology results is of utmost importance. Knowing the exact type of breast cancer and the specifics of its prognostic factors is critical to creating a treatment plan that will provide you with the best opportunity for defeating this disease.
Our pathologists include physicians who who specialize in breast cancer and have extensive experience evaluating and accurately classifying breast tissue specimens. Our pathologists are so trusted that they are frequently asked by other physicians throughout the nation for assistance.
Common Breast Cancer Pathology Terms
The following terms were developed by pathologists to describe the types and kinds of breast cancers. These descriptions help the breast surgical oncologist, medical oncologist and radiation oncologist design an individualized treatment plan for each patient.
- HR-Positive/Negative (Hormone Receptor Status) - If breast cancer cells are stimulated by hormones, then they are considered hormone receptor (HR) positive. This is a favorable prognosis; your cancer will probably respond to hormonal therapies, which will also be used as a part of your treatment. There are two types of female hormones the tumor is tested with: estrogen and progesterone. When a tumor is positive for estrogen, or positive for estrogen and progesterone, hormonal therapy (the opposite of hormone replacement therapy) may be recommended as part of the treatment. It can greatly aid in preventing recurrence of the disease and can help control breast cancer that has spread to other organs.
- HER-2/Neu Receptor - The human epidermal growth factor receptor 2 (HER-2/neu) is a prognostic factor used to measure how quickly a breast tumor is growing and how erratic it is. Using an oncogene measurement, which measures cell growth, pathologists can determine if the cells contain extra protein that makes them grow out of control. If the HER-2 test is positive it means the cancer cells have too much HER-2 receptor protein on the surface of the cell, or there are extra copies of the HER-2 gene that can lead to HER-2 overexpression.
If your tumor is found to have the HER-2/neu receptor, special recommendations for targeted biological therapy might be recommended as part of your treatment. HER-2 negative is a favorable prognostic factor; being positive is not favorable. Positivity is usually recorded as being "3+" or "+++." Negativity is recorded as "0," "negative" or "+or++."
There is also something commonly referred to as triple negative breast cancer, which refers to the prognostic factors of breast cancers whose cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors (ER) and progesterone receptors (PR).
- Grade - This is a measurement of cell growth. Pathologists use a classification of 1, 2 or 3. If the cells are 1 they are slow growing; 2, average growing; and 3, rapidly growing.
- Benign Breast Diseases - Around 80 percent of suspicious masses found on mammograms or breast exams are benign, meaning they are not cancerous and pose no health risk. If our pathologists examine your slides and find no evidence of cancer, the surgeon will determine if the benign tumor, usually a fibroadenoma, needs to be removed. If they are large, increasing in size or causing pain, the surgeon will remove them.
- Malignant Tumors - Malignant tumors are cancerous tumors and need to be treated as such. Our pathologists will carefully evaluate all biopsies and slides to give the treating surgical, medical and radiation oncologists information about the size, type and prognostic factors of the tumor.