When patients with suspected breast cancer come to the clinic, they usually ask: “Doctor, do you think it is cancer or not? When will the diagnosis be confirmed?
How do doctors usually answer?
The answer is basically the same – we can’t confirm it yet, let’s wait for the pathology report.
Frankly speaking, this answer is not an evasion of responsibility: the pathological examination of breast cancer has its own logic, and the doctor’s conclusion must be based on evidence. Zhao Xiaobo, Department of Breast and Thyroid Surgery, Affiliated Hospital of Sichuan North Medical College
So, how to confirm the diagnosis of breast cancer, ultrasound? Or tumor markers? Or PET/CT?
Neither! In a nutshell: although there are many examination methods, only the pathological results obtained from biopsy (biopsy) can be the only basis for definite diagnosis.
Excisional biopsy]
Excisional biopsy is the most common method to obtain a histological diagnosis of breast disease.
When a malignant lump is suspected, the lump and a certain range of surrounding tissues are removed directly surgically, generally requiring at least 1 cm from the edge of the tumor to be removed as completely as possible.
In layman’s terms, this means that the tissue of the lesion is directly excavated for biopsy.
The excised biopsy specimen can be examined by conventional pathological examination (paraffin section) and intraoperative rapid pathological examination (rapid frozen section).
Frozen sections usually take 30 minutes to 1 hour to produce results, and paraffin sections take 3-7 days to produce results.
In the past, there used to be a misconception that pathological diagnosis and surgery should ideally be done on the same day to avoid tumor progression affecting survival rates. In fact, there is no evidence to prove that the few days waiting for pathology results can bring any adverse prognosis.
Therefore, we oppose the practice of performing intraoperative rapid pathological examination in order to pursue the same day diagnosis and the same day surgery.
It is clear that excisional biopsy, while unquestionably accurate, has significant shortcomings –
If the pathological examination results in benign breast disease that does not require surgery, then the knife is obviously in vain, a huge loss (the significance of the breast for women, no need to say); even if it is a malignant tumor, the knife opened, but also have to make up another knife.
[Puncture biopsy].
Modern medicine demands more and more clear diagnosis before surgery; precisely because excisional biopsy has a series of limitations or deficiencies, from the 1970s onwards, foreign countries began to shift to using puncture biopsy instead of surgical biopsy.
The concept of puncture is easy to make up on your own, so I won’t expand on it. In a word, a needle is inserted and pulled out, and the small handful of cells or tissues within the lesion with a hollow syringe can be used as a biopsy specimen.
Because puncture needles are thick and thin, punctures can be divided into fine needle biopsies and coarse needle biopsies. In general, needles with a numerical designation greater than 20 can only be called fine needles. Fine needle aspiration cytology has less material to take, has certain false positive and false negative rates, and cannot be pathologically typed, so it cannot replace histological biopsy, and is rarely used in the clinical diagnosis of breast cancer; however, there are some patients with deep lesions, and bleeding is easy with coarse needles; or the location of lesions is special, such as supraclavicular fossa, and coarse needle aspiration can easily injure the aorta, in this case, we will use fine needle Puncture sampling.
The thick needle usually refers to the needle with the number code less than 20, and the oncology hospital usually uses 14-gauge needle to do it.
How thick is a 14-gauge needle? Let’s say it is similar to the woolen needle used for knitting sweaters.
If you think about it, a thick needle is really thick.
Because of the thickness, the thick needle can take a piece of tissue and can be used for histological biopsy in the strict sense, while the fine needle can only obtain cell samples, which is not allowed as a means to confirm the diagnosis and can only be used to clarify the stage of the tumor. Of course, coarse needle puncture also has limitations – only one strip can be pierced at a time, and the amount of tissue is also limited, which can cause bias or even underestimate some malignant lesions for some lesions with more complex pathology, so now there is a vacuum-assisted spin biopsy gun, which is not only as minimally invasive and less painful as coarse needle, but also requires only one puncture to obtain more More adequate tissue samples are available for pathological diagnosis.
A special point to note is that some patients believe in internet rumors and mistakenly believe that coarse needle puncture will bring out the cancer cells in the lesion, which will lead to spread. This is a pure assumption.