A new tool takes the surgery out of breast biopsies
For most women, there's no such thing as a routine mammogram. A woman may have an annual mammogram that's characterized as routine, but the fact that the purpose is to screen for breast cancer leads to some level of anxiety prior to, during, and until a woman receives the results.
That concern is not unfounded. In about 10 percent of cases, a routine mammogram shows some abnormality. If an abnormality is confirmed through additional views or an ultrasound, a biopsy is ordered. Although 70 to 80 percent of abnormalities found through mammograms are benign, a biopsy is the only way to reach an accurate diagnosis. Until recently, a surgical biopsy was the only option.
Stereotactic biopsy offers new option
For several years,Mary Ann Gilbert's annual mammograms showed small calcium deposits in one breast, with little variation year to year. But last fall, after the radiologist detected a "small change," a stereotactic
(image-guided) biopsy was recommended to determine if the change was an indication of early-stage breast cancer. Gilbert was referred to Maureen Kling, MD,
a breast surgeon at Virtua Memorial Hospital, for this effective, less-invasive, non-surgical alternative to the traditional biopsy.
"The radiologist and Dr. Kling were very reassuring and made me feel comfortable about the procedure," said Gilbert. "Dr. Kling explained what the biopsy would entail and made me feel that it wasn't going to be a big deal … and it wasn't."
Gilbert emphasized that although the procedure caused some concern, it was the thought of having breast cancer that troubled her most. "I knew about the miniscule calcification. But when the radiologist saw the change, I thought, 'Oh my goodness…what's this?' Dr. Kling put my mind at ease as much as she could."
"Sometimes breast cancer shows up as a lump that a woman and her doctor can feel with their fingers," said Dr. Kling. "But sometimes the cancer is in the form of a lesion, microcalcifications (small calcium deposits) or spicules (small needle-like structures). In those cases, a stereotactic biopsy helps surgeons determine the exact location of the abnormality and obtain a tissue sample that a pathologist can examine to make an accurate diagnosis. Fortunately, in most cases, we're able to rule out breast cancer."
Michele Fantazzio, MD,
a Virtua breast surgeon, adds, "The Virtua pathologists are incredible in their ability to pick up everything from even the smallest samples."
A patient-centered approach
Drs. Fantazzio and Kling view Virtua Health's personalized approach to health care as particularly important for patients who require a stereotactic breast biopsy, which literally puts a woman in an "awkward" position.
She must lie on her stomach, her breast suspended through a hole in an elevated biopsy table. The breast is compressed similar to a mammogram, and the physician performs the biopsy from below.
Dr. Fantazzio says, "There are many advantages to a stereotactic biopsy. We're making a small incision - a nick in the skin - and not taking a large amount of tissue. There may be a small amount of soreness and bruising, but the next day patients can resume normal activity."
While patients are encouraged to have a family member or friend accompany them, many women drive themselves to and from the procedure.
Early detection saves lives
A stereotactic biopsy is another tool in the arsenal available to physicians in the early detection of cancer. "Years ago, breast cancer often wasn't detected until a woman had a golf-ball sized tumor in her breast," said Dr. Kling. "It was obvious by then there was a problem, and it often meant that the cancer was at an advanced stage."
"This procedure helps with early detection," agrees Dr. Fantazzio. "We biopsy more women because we're detecting changes earlier and the procedure is less traumatic. Only when the results of a stereotactic biopsy show a malignancy, does a woman need to go through the stress of a surgical biopsy and/or lumpectomy to remove the tissue and test the lymph nodes."
Gilbert visited Dr. Kling in mid-December to discuss the results of her stereotactic biopsy. She recalls that it was a Monday … a very happy Monday.
"Everything was okay," said Gilbert. "It was amazing to me that the whole process was so easy. There really and truly was no actual discomfort. I'm so happy with Dr. Kling, my experience with Virtua and, of course, the good news I received."
Michele Fantazzio, MD,
is a board-certified breast surgeon at Virtua Voorhees. She earned her medical degree from Jefferson Medical College. Dr. Fantazzio completed an internship and residency in general surgery at Lankenau Hospital.
Maureen Kling, MD,
is a board-certified breast surgeon at Virtua Memorial. She earned her medical degree from the Medical College of Pennsylvania. Dr. Kling completed her internship and residency in general surgery at the University of Massachusetts Medical Center.