Non-Surgical Biopsy Spots Cancer in Lymph Nodes

< December 1, 2004 > -- An ultrasound-guided needle biopsy is just as effective as traditional surgery in identifying malignant lymph nodes in women with breast cancer, according to a study presented at the Radiological Society of North America annual meeting.

Experts say this means that some women diagnosed with breast cancer could avoid one of the two surgical procedures that are sometimes necessary in breast cancer treatment.

"We are trying to spare women an extra surgery, and it has been a positive experience for patients who can be diagnosed without surgery," says Dr. Alexis Nees, a radiologist at the University of Michigan Medical School and author of the study.

Lymph Node Status Crucial Information

Following a diagnosis of breast cancer, physicians must first assess the size and type of the tumor and then learn if the cancer has spread to the lymph nodes under the arm, she explains.

The traditional method to learn whether or not nodes are cancerous is the use of a surgical procedure to remove several or all of the lymph nodes in the underarm area. 

A sentinel node biopsy is used to determine if cancer cells have spread to other parts of the body. This surgical procedure may be performed during the initial diagnostic period to aid in staging of the breast cancer.

This procedure involves injecting a dye or radioactive substance near the tumor. This injection helps to locate the lymph node closest to the tumor (sentinel node) - the one that is most likely to have cancer cells present if the cancer has spread.

The surgeon removes the lymph node that absorbs the dye and radioactive substance and sends it to the pathologist to examine it closely for the presence of cancer cells.

Often, a woman has surgery for her breast tumor before the results of the lymph node biopsy can be obtained, Dr. Nees says.

When a woman choses to have only several of her lymph nodes removed, which is called a sentinel lymph node sampling, and those nodes are found to be malignant, she must then undergo a second surgery to have the rest of the lymph nodes removed.

When a woman has all of her lymph nodes removed, which is called axillary lymph node dissection, she does not need further surgery.

However, Dr. Nees says, many women choose to have the partial lymph node sampling because the procedure is linked with an increased risk for other health problems.

Using ultrasound to view the lymph nodes, physicians use a fine needle to draw cells from a node that looks abnormal, and then the cells are examined.

The surgeon can obtain the information he or she needs before surgery about whether or not to remove the lymph nodes.

Test Used To Confirm Cancer in Nodes

However, Dr. Nees says, the technique is reliable only to confirm malignancy in the lymph nodes. If the biopsy results find no cancer or are inconclusive, the patient must then undergo a surgical procedure to make sure there is no further cancer in the lymph nodes.

"This is a helpful tool to alert doctors to a positive - or malignant - finding, so you can tell the surgeon and do everything in one surgery," says Dr. Jolinda Mester, a radiologist at Mount Sinai Medical Center.

For the study, researchers used ultrasound to examine 57 women newly diagnosed with breast cancer. If the lymph nodes appeared abnormal on the ultrasound, the researchers conducted a needle biopsy of the nodes.

The patients then had breast surgery, and either some or all of their lymph nodes were removed at the same time.

Pathology reports from the surgery were compared to the findings from the ultrasound-guided fine needle aspiration.

All the women with an abnormal ultrasound and a positive biopsy were found to have cancer in their lymph nodes at surgery.

Always consult your physician for more information.

Online Resources

American Cancer Society

American Society for Clinical Oncology

Centers for Disease Control and Prevention (CDC)

National Cancer Institute

National Institutes of Health (NIH)

National Women's Health Information Center

Susan G. Komen Breast Cancer Foundation

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Breast Imaging Tests

Imaging tests may include one or more of the following:

diagnostic mammography - a diagnostic mammogram is an x-ray of the breast used to diagnose unusual breast changes, such as a lump, pain, nipple thickening or discharge, or a change in breast size or shape.

A diagnostic mammogram is also used to evaluate abnormalities detected on a screening mammogram. It is a basic medical tool and is appropriate in the workup of breast changes, regardless of a woman's age.

ultrasonography - uses high-frequency sound waves, not heard by humans. The sound waves enter the breast and bounce back. The pattern of their echoes produces a picture called a sonogram, which is displayed on a screen. This exam is often used along with mammography.

scintigraphy - a breast scan is a specialized radiology procedure used to assess the breasts when other examinations have been inconclusive. A breast scan is a type of nuclear radiology procedure. This means that a tiny amount of a radioactive substance is used during the procedure to assist in the examination of the breasts. The radioactive substance, called a radionuclide (radiopharmaceutical or radioactive tracer), is absorbed by certain types of body tissues.

Based on these exams, your physician may decide that no further tests are needed and no treatment is necessary. In such cases, your physician may want to check you regularly to watch for any changes.

Breast Biopsy

Often, however, the physician must remove fluid or tissue from the breast to be sent to the lab to look for cancer cells. The procedure, called biopsy, may be performed using a needle to acquire a tissue sample or a surgical method.

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A breast biopsy is a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery to determine if cancer or other abnormal cells are present.

Biopsies may be performed under local or general anesthesia. There are several types of breast biopsy procedures. The type of biopsy performed will depend upon the location and size of the breast lump or abnormality.

Types of breast biopsy procedures include, but are not limited to, the following:

fine needle aspiration biopsy - a very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help to differentiate a cyst from a lump.

core needle biopsy - a large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.

surgical biopsy (also called an open biopsy) - a surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are two types of surgical biopsies. During an incisional biopsy, a small part of the lump is removed; whereas during an excisional biopsy, the entire lump is removed.

In some cases, if the breast lump is very small and deep and is difficult to locate, the wire localization technique may be used during surgery. With this technique, a special wire is placed into the lump under X-ray guidance. The surgeon follows this wire to help locate the breast lump.

There are special instruments and techniques that may be used to guide the needles and to assist with biopsy procedures. These include, but are not limited to, the following:

stereotactic biopsy - stereotactic biopsy finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a three-dimensional (3D) picture of the breast. A sample of tissue is removed with a needle.

Mammotome® breast biopsy system (also called vacuum-assisted biopsy) - a type of tube is inserted into the breast lump or mass. The breast tissue is gently suctioned into the tube, and a rotating knife removes the tissue. In 1999, the US Food and Drug Administration (FDA) approved the use of the hand-held Mammotome device.

ultrasound-guided biopsy - a technique that uses a computer and a transducer that sends out ultrasonic sounds waves to create images of the breast lump or mass. This technique helps to guide the needle biopsy.

Always consult your physician for more information.