https://my.clevelandclinic.org/health/diagnostics/24204-breast-biopsy-overview

Breast biopsy is not a single procedure; rather, it is a combination of procedures tailored to specific clinical needs. Understanding the differences among these procedures can help clinicians develop the most appropriate diagnostic pathway for their patients.

Procedure 1: Fine Needle Aspiration Biopsy Procedure

This is the most minimally invasive procedure. It uses 22G to 25G fine needles to penetrate the lesion and extract cells by injection-like injection. The operation takes only a few minutes and causes almost no pain. No anesthesia is required. The core of the procedure lies in the suction action: after the needle tip enters the mass, it repeatedly pulls the needle plug to create negative pressure, obtaining a small amount of cell smear for examination. It is suitable for evaluating cystic lesions or determining lymph node metastasis. However, due to the inability to obtain tissue structure information, the false negative rate for benign lesions is relatively high. Currently, it is more often used as a screening method.

Procedure 2: Hollow Needle Biopsy Procedure

This is the current gold standard procedure. Using a 14G to 18G hollow cutting needle, it is driven by a spring gun to rapidly eject and cut the tissue. The procedure consists of two steps: the first step is to confirm that the needle slot is aligned with the lesion before firing; the second step is to pull the trigger, with the inner core penetrating first, and the outer sleeve immediately cutting, leaving a cylindrical piece of tissue in the slot. This procedure can obtain complete tissue strips, preserving the cellular structure and basal membrane integrity. It can not only distinguish between benign and malignant, but also perform immunohistochemical detection (such as ER, PR, HER2). The entire procedure is usually completed within 15 minutes under ultrasound guidance.

Procedure 3: Vacuum-assisted Rotary Biopsy Procedure

When a larger sample size is required or when complete removal of small lesions is necessary, this procedure should be enabled. Use a special rotary cutting needle ranging from 7G to 11G and connect it to a vacuum pump. The procedure is complex but efficient: after the needle is inserted, negative pressure is applied through the side hole to suck in the tissue, and then the internal rotary cutter rotates to cut it. Approximately 100mg of tissue can be obtained each time, and continuous sampling can be achieved with a single puncture. It is particularly suitable for dealing with multiple small calcified lesions or suspicious lesions of BI-RADS category 4 or above that require complete removal. The disadvantage is that the cost is higher and the risk of postoperative hematoma is slightly increased.

Procedure 4: Open Surgical Biopsy Procedure

Although minimally invasive techniques are prevalent, when the results of the puncture do not match the imaging findings significantly, or when the location of the lesion is extremely critical, surgical resection and biopsy will still be performed. This is a small surgical procedure that requires cutting through the skin and completely removing the lesion and its margins. It provides the most adequate specimen, but it causes the most trauma and leaves a noticeable scar. It is no longer the preferred method at present.

Each procedure has its own indications. An excellent breast specialist is like a skilled dispatcher, flexibly choosing the most appropriate procedure based on the size, location, imaging features of the lesion, and the patient's condition, finding a balance between minimal trauma and the highest diagnostic accuracy.