Wednesday, September 10, 2003
THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A # 14 NEEDLE AND A GOOD STRONG ARM.....
New York Times had an article yesterday about the advances in biopsy technology. The author touts the advances in minimally-invasive biopsies of the breast, colon, and prostate. The potential pitfalls of these techniques are examined. The big two are sampling error and insufficient tissue for diagnosis. In my practice I perform a good deal of core biopsies of the breast, either freehand, ultrasound guided, or stereotactic (mammography based). I give my patients the option of this approach or a more conventional open biopsy. I explain to them the worries over sample error and tissue quantity. I tell them if the path report doesn't jibe with everything else, an open biopsy may be needed. I explain the benefits of cosmesis and minimal discomfort. I am also able to facilitate their workup by doing the freehand or US cores in the office, same day, or can usually get time on the stereotactic table within a day or so. A free spot on the OR schedule may not be available for an open biopsy for a week or so.
One of the shortfalls of stereotactic breast biopsy is what to do with atypical ductal hyperplasia (ADH). Roughly eleven percent of biopsies with ADH have co-existing ductal carcinoma in situ. A conventional biopsy is indicated to properly diagnose these patients.
Another issue with core biopsy of the breast is that the mass is not removed. Some women have undergone core biopsy with a benign diagnosis and then return months later because the mass can still be felt and it bothers them. They want it out. So far all of my core biopsy diagnoses have been confirmed by excisional biopsy. (knock knock)
Of course doing these procedures in the office may be deadly, but more on that later. |
New York Times had an article yesterday about the advances in biopsy technology. The author touts the advances in minimally-invasive biopsies of the breast, colon, and prostate. The potential pitfalls of these techniques are examined. The big two are sampling error and insufficient tissue for diagnosis. In my practice I perform a good deal of core biopsies of the breast, either freehand, ultrasound guided, or stereotactic (mammography based). I give my patients the option of this approach or a more conventional open biopsy. I explain to them the worries over sample error and tissue quantity. I tell them if the path report doesn't jibe with everything else, an open biopsy may be needed. I explain the benefits of cosmesis and minimal discomfort. I am also able to facilitate their workup by doing the freehand or US cores in the office, same day, or can usually get time on the stereotactic table within a day or so. A free spot on the OR schedule may not be available for an open biopsy for a week or so.
One of the shortfalls of stereotactic breast biopsy is what to do with atypical ductal hyperplasia (ADH). Roughly eleven percent of biopsies with ADH have co-existing ductal carcinoma in situ. A conventional biopsy is indicated to properly diagnose these patients.
Another issue with core biopsy of the breast is that the mass is not removed. Some women have undergone core biopsy with a benign diagnosis and then return months later because the mass can still be felt and it bothers them. They want it out. So far all of my core biopsy diagnoses have been confirmed by excisional biopsy. (knock knock)
Of course doing these procedures in the office may be deadly, but more on that later. |
