BREAST DISEASE INVESTIGATIONS
Excisional biopsy. This essentially means cutting out the lump and having a look at it. This is the most reliable way of investigating a lump. Surgeons can often perform this procedure under local anaesthesia, or it can be done under a general anaesthetic.
Some women may be offered a ‘frozen section’ option. This involves having the suspicious lump removed in an operating theatre, and examined by a pathologist while the woman is still on the operating table. (This process gives an answer more rapidly than routine pathology procedures because the removed tissue is snap frozen, to enable the pathologists to look at sections under the microscope immediately. Routine processing can take a few days.) An answer about whether the lump is malignant or not can be relayed directly to the surgeon, and further surgery can proceed if the lump is found to be cancerous. The woman will have had these options and possible surgery explained in detail before proceeding to frozen section.
Frozen section seems to be used less often in some centres, as surgeons are using aspiration cytology more, in order to have a positive diagnosis of cancer before operating. However, if cytology is inconclusive, or the diagnosis is uncertain, excisional biopsy will usually be performed. The lump will be removed, and either frozen section will be performed, or the initial operation will stop there, and a formal report from the pathologist will be used in determining the necessity of further surgery.
If the lump does turn out to be malignant, the delay (sometimes a week or two) between an excisional biopsy and definitive treatment does not worsen the situation or the prognosis. In fact for many women it is of benefit, as it gives them some time to come to terms with the diagnosis and to explore their treatment options. For some women this may be all the surgery they require, as the lump will have been adequately removed.
Apart from allowing accurate diagnosis, the other benefit of excisional biopsy is that it removes the lump. In many cases it also removes the anxiety associated with having any lump, no matter how benign it looks, in your breast.
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