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      Healthwach: Improved breast biopsies

      COLUMBIA (WACH) - Imaging techniques, like a MRI or a mammogram, along with physical exams of the breast can lead doctors to suspect that a person has breast cancer. However, the only way to know for sure is to take a sample of tissue from the suspicious area, called a biopsy. Usually, if the doctor notices anything suspicious he or she will order a biopsy. The tissue sample is examined by a pathologist to see if cancer cells are present or not.

      There are several ways to do a breast biopsy, including:

    • Fine-needle aspiration biopsy: the doctor inserts a thin needle into a lump and removes a sample of cells or fluid.
    • Core needle biopsy: the doctor inserts a needle with a special tip and removes a sample of breast tissue about the size of a grain of rice.
    • Open (surgical) biopsy: the doctor will make a small cut in the skin and breast tissue to remove part or all of a lump. This may be done as a first step to check a lump or if a needle biopsy does not provide enough information.
    • Vacuum-assisted core biopsy: this is performed with a probe that uses a gentle vacuum to remove the breast tissue sample. The small cut does not require stitches and leaves a very small scar.
    • â??Thereâ??s about 1.2 million what we call core biopsies, needle biopsies of the breast annually in the United States. I do about 400 a year where a woman presents either with a mass sometimes that they feel but most commonly, most often, a mass thatâ??s seen by ultrasound and/or by a mammogram. They come into your office and you see it and, under image guidance, you place a needle within the mass or the calcifications. The specimen is then placed in a formalin jar and sent to your pathologist. Sometimes radiologist perform these biopsies, so they have to send out these specimens and there are about eighteen steps from the time that the surgeon performs the core biopsy until a report is generated that tells the patient if they do or you do not have cancer. There are approximately 300,000 breast cancers diagnosed annually in the United States. One in 100 times you tell a patient you have cancer and you donâ??t. Thatâ??s the mistake rate. Now for every false positive, unfortunately thereâ??s a sister lesion, a sister error, that the woman you told who doesnâ??t have cancer actually does. There are 6000 cases annually where either you do have cancer and you donâ??t or you donâ??t have cancer and you do. Obviously the former, where you tell a patient you do have cancer and she doesnâ??t, is more egregious and potentially leads to unnecessary chemotherapy, hormonal therapy, surgery, even mastectomies as weâ??re probably going to talk about. Two thirds of the time you catch them, but a third of the time you donâ??t. So annually about 1000, maybe 1500, women are told that they have breast cancer but do not. They then go on to receive unnecessary surgery, radiation, or possibly chemo.â??