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Breast mass biopsy - Medium 1-3 cm

Biopsy
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Report in 288Hrs

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At Home

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No Fasting Required

Details

Biopsy of smaller breast lump.

₹370₹529

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Breast Mass Biopsy - Medium 1-3 cm

  • Why is it done?
    • Tissue Diagnosis: Obtains a sample of breast tissue from a palpable or imaging-detected mass to determine if the lesion is benign or malignant
    • Suspicious Findings: Performed when mammography, ultrasound, or clinical examination reveals a mass measuring 1-3 cm with concerning features such as irregular borders, heterogeneous density, or vascular changes
    • Diagnostic Classification: Provides pathological classification according to the Breast Imaging-Reporting and Data System (BI-RADS) categories to guide clinical management
    • Cancer Detection: Identifies malignancy when imaging shows BI-RADS 4 (suspicious abnormality) or BI-RADS 5 (highly suggestive of malignancy) findings
    • Patient Anxiety Management: Provides definitive diagnosis to clarify whether a palpable mass requires treatment or can be safely monitored
    • Timing: Typically performed when imaging-guided biopsy is recommended, usually within 2-4 weeks of suspicious imaging findings to provide timely diagnosis
  • Normal Range
    • Benign Pathology (Negative for Malignancy): Normal or benign histological findings such as fibroadenoma, fibrocystic changes, adenosis, papilloma, fat necrosis, or inflammatory lesions indicating no cancer is present
    • Concordant with Imaging: Benign pathology findings that are consistent with the radiological impression, supporting safe follow-up rather than surgical intervention
    • Adequate Sampling: Tissue sample contains sufficient material for diagnostic interpretation and special studies if needed
    • Specimen Quality: The biopsy material is well-preserved with minimal crush artifact and appropriate fixation for histological examination
    • Result Interpretation Categories:
    • BI-RADS 1 (Negative): No findings of concern; recommended follow-up with routine screening
    • BI-RADS 2 (Benign): Definitely benign findings; recommended routine follow-up screening
    • BI-RADS 3 (Probably Benign): Less than 2% likelihood of malignancy; typically recommended short-term imaging follow-up
  • Interpretation
    • Benign Findings (Negative Result):
    • Fibroadenoma: A benign tumor composed of glandular and fibrous tissue; common in younger women; requires no treatment but may be surgically removed if enlarging or concerning
    • Fibrocystic Changes: Benign alterations including fibrosis, cyst formation, and adenosis; extremely common and not associated with increased cancer risk unless atypical features present
    • Papilloma: A benign intraductal growth; may require surgical excision if associated with discharge or imaging concern
    • Fat Necrosis: Benign lesion resulting from trauma or prior surgery; self-limited and requires only reassurance and follow-up
    • Atypical Findings (High-Risk Lesions):
    • Atypical Ductal Hyperplasia (ADH): Increased cellularity with some but not all features of ductal carcinoma in situ; carries approximately 4-5 times increased risk of breast cancer development; typically requires surgical excision for complete evaluation
    • Atypical Lobular Hyperplasia (ALH): Increased cellularity of lobular units with cytologic atypia; similar risk stratification as ADH; requires surgical excision and close follow-up
    • Lobular Carcinoma in Situ (LCIS): A high-risk marker for ipsilateral and contralateral breast cancer development; often multifocal and multifocal; requires careful clinical correlation and often leads to surgical consultation
    • Malignant Findings (Positive Result):
    • Invasive Ductal Carcinoma (IDC): Most common type of breast cancer (70-80% of cases); indicates invasion beyond the basement membrane into surrounding tissue; grading (1-3) provides prognostic information
    • Invasive Lobular Carcinoma (ILC): Represents 10-15% of breast cancers; often more diffuse and may be multifocal; similar or slightly worse prognosis compared to IDC
    • Ductal Carcinoma in Situ (DCIS): Non-invasive cancer confined to ductal epithelium; considered pre-malignant with risk of progression to invasive cancer; requires surgical excision with clear margins
    • Special Tumor Types: Tubular, mucinous, papillary, and tubular carcinomas generally have more favorable prognoses than invasive ductal carcinoma
    • Factors Affecting Interpretation:
    • Concordance with Imaging: Discordance between pathology and imaging findings may necessitate rebiopsy or surgical evaluation
    • Adequate Sampling: Insufficient tissue may result in 'B1' classification (non-diagnostic) requiring rebiopsy
    • Grade (if malignant): Nottingham grade (1-3) predicts prognosis and treatment response in invasive carcinomas
    • Hormone Receptor Status: Estrogen receptor (ER) and progesterone receptor (PR) expression guides hormonal therapy decisions
    • HER2 Status: Human epidermal growth factor receptor 2 overexpression affects treatment options and prognosis in invasive carcinoma
  • Associated Organs
    • Primary Organ System:
    • Mammary Gland: Bilateral breast tissue comprised of lobules and ducts; site of all sampled pathology in this procedure
    • Axillary Lymph Nodes: Regional lymph drainage from breast tissue; involved in staging and determining prognosis if malignancy identified
    • Chest Wall: Underlying musculature and ribs; may be involved in advanced breast cancer
    • Associated Benign Conditions:
    • Breast Fibroadenoma: Most common solid breast mass in women under 35 years; benign with no malignant potential
    • Fibrocystic Breast Disease: Extremely common benign condition affecting up to 60% of women; includes cysts, fibrosis, adenosis, and epithelial proliferation
    • Breast Cysts: Fluid-filled sacs that are benign; common in perimenopausal women and can fluctuate with hormonal changes
    • Intraductal Papilloma: Benign tumor within a mammary duct; may present with nipple discharge
    • Mastitis and Breast Abscess: Inflammatory conditions usually secondary to infection; may present as palpable mass
    • Associated Malignant Conditions:
    • Invasive Ductal Carcinoma: Most common type (70-80%); originates in ductal epithelium with potential for metastasis
    • Invasive Lobular Carcinoma: Accounts for 10-15% of cases; often multifocal and has higher risk of contralateral involvement
    • Ductal Carcinoma In Situ: Pre-malignant lesion with risk of progression to invasive cancer; varies from 5-50% depending on grade and completeness of excision
    • Lymphoma: Rare primary breast lymphoma; may present as mass with systemic symptoms
    • Secondary Metastases: Metastatic disease to breast from distant primary tumors; rare but may occur
    • Associated Systemic Complications of Malignancy:
    • Regional Lymph Node Involvement: Axillary, supraclavicular, and internal mammary node metastases affect staging and treatment decisions
    • Distant Metastases: Spread to bone (70-80% of metastases), lung, liver, brain, and other organs; significantly impacts prognosis and treatment strategy
    • Pleural Effusion: May develop with advanced disease or lung metastases; causes respiratory symptoms
    • Skin Involvement: Peau d'orange appearance or satellite lesions indicate advanced local disease with poor prognosis
  • Follow-up Tests
    • If Benign Pathology (BI-RADS 2-3):
    • Follow-up Mammography: Routine screening mammography at 6-12 months if BI-RADS 3 findings; standard annual screening if BI-RADS 1-2
    • Follow-up Ultrasound: May be performed 6 months after biopsy to document stability of benign lesions, particularly in dense breast tissue
    • Clinical Breast Examination: Periodic clinical assessment to document stability and rule out new lesions
    • If High-Risk Atypical Pathology (ADH, ALH, LCIS):
    • Surgical Excision: Excisional biopsy or lumpectomy recommended to rule out associated invasive disease and ensure complete removal
    • Enhanced Surveillance: Close clinical follow-up with imaging every 6-12 months for several years given increased cancer risk
    • Risk Reduction Counseling: Discussion regarding chemoprevention with tamoxifen or aromatase inhibitors based on menopausal status and risk factors
    • If DCIS (Non-Invasive Cancer):
    • Surgical Excision: Excisional biopsy with adequate margins (6-10 mm) required to ensure complete removal; re-excision if margins inadequate
    • Radiation Therapy: May be recommended after breast-conserving surgery to reduce recurrence risk
    • Endocrine Therapy: Tamoxifen or aromatase inhibitors considered for high-grade DCIS given increased invasive disease risk
    • Lifelong Surveillance: Mammographic and clinical surveillance with regular imaging to detect new lesions or recurrence
    • If Invasive Carcinoma (IDC or ILC):
    • Tumor Board Review: Multidisciplinary evaluation for staging and treatment planning
    • Breast MRI: May be performed for staging, assessing contralateral breast, evaluating extent of disease, and surgical planning
    • Imaging and Staging: CT scan of chest/abdomen/pelvis or PET-CT for evaluation of metastatic disease, particularly if high-grade tumor or other risk factors present
    • Bone Scan or Skeletal Survey: May be considered to evaluate for skeletal metastases in high-risk patients
    • Axillary Staging: Sentinel lymph node biopsy or axillary dissection to determine nodal status and staging
    • Hormone Receptor Testing: ER/PR immunohistochemistry (IHC) performed on biopsy tissue to guide endocrine therapy decisions
    • HER2 Testing: IHC and/or FISH/CISH testing for HER2 status to determine eligibility for trastuzumab (Herceptin) therapy if overexpressed
    • Genomic Testing: Multigene assays (e.g., Oncotype Dx, MammaPrint) may be recommended to further stratify risk and guide chemotherapy decisions
    • Surgical Treatment: Lumpectomy with sentinel node biopsy or mastectomy with axillary evaluation depending on tumor size, grade, and patient preference
    • Adjuvant Therapy: Chemotherapy, radiation therapy, and/or endocrine therapy based on tumor characteristics, grade, nodal status, and receptor status
    • Serial Tumor Markers: CEA and CA 15-3 may be monitored during treatment follow-up, though clinical utility is limited
    • Genetic Counseling: Referral for BRCA1/BRCA2 and other hereditary cancer gene testing if personal or family history suggests hereditary breast cancer
    • Long-term Surveillance: Regular clinical examinations and imaging (annual mammography) for early detection of recurrence or contralateral cancer; varies by stage and treatment received
  • Fasting Required?
    • No - Fasting is NOT required for breast mass biopsy
    • Pre-Procedure Preparation:
    • Routine Diet: Patient may eat and drink normally; no dietary restrictions are necessary
    • Medications: Continue all regular medications unless otherwise specifically instructed by the radiologist or referring physician; aspirin and NSAIDs should typically be discontinued 5-7 days prior to procedure to reduce bleeding risk
    • Anticoagulants: If patient takes warfarin or other anticoagulants, inform the radiologist in advance; timing of discontinuation depends on INR and type of anticoagulant
    • Prophylactic Antibiotics: Not routinely required; antibiotics are given only if significant risk factors for infection are present
    • Day of Procedure:
    • Clothing: Wear comfortable, loose-fitting clothing that allows easy access to the breast being biopsied
    • Identification: Bring photo identification and insurance cards
    • Prior Studies: Bring all relevant mammography films, ultrasound images, or reports from prior imaging if not already available at the imaging facility
    • Informed Consent: Review and sign consent form; discuss procedure risks, benefits, and alternatives with the radiologist beforehand
    • Post-Procedure Instructions:
    • Supportive Bra: Wear a well-fitting supportive bra for 24-48 hours after biopsy to minimize motion and discomfort
    • Activity Restrictions: Avoid strenuous activities, heavy lifting, and vigorous breast manipulation for 24-48 hours to prevent hematoma formation
    • Ice Application: Apply ice packs for 20 minutes several times per day for the first 24 hours to reduce swelling and bruising
    • Pain Management: Acetaminophen or ibuprofen may be used for post-procedure discomfort; aspirin should generally be avoided for 48 hours after biopsy
    • Bleeding or Hematoma: Minor bleeding and bruising are common and expected; report significant bleeding, expanding hematoma, or severe pain to physician
    • Infection Signs: Monitor for signs of infection including increasing pain, warmth, redness, purulent drainage, or fever; report immediately if suspected
    • Dressing Care: Keep biopsy site clean and dry; change dressing as instructed and keep biopsy site uncovered after first 24 hours if approved by radiologist
    • Result Timeline: Pathology results typically available in 3-7 business days; physician will contact patient with results and discuss next steps

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