Biopsy
What is a biopsy?
A biopsy is a procedure to remove a piece of tissue to send off for testing. Lab pathologists receive the tissue and determine whether the cells within it are normal or abnormal.
What is a biopsy used for?
Biopsies are performed for tissue diagnosis. Tissue diagnosis helps to determine if the cells within an abnormal area are malignant or benign.
What are the different types of biopsies?
The different types of biopsies noted for Mammologix's audits are stereotactic core biopsy, ultrasound biopsy, MR-guided biopsy, and excisional biopsy.
What data relating to biopsies is shown in a medical audit?
In Mammologix's medical audits, data relating to biopsy procedures includes:
- Biopsy yield
- Positive Predictive Value 2 (PPV2)
- Positive Predictive Value 3 (PPV3)
PPV 2 and 3 are important in assessing performance benchmarks for diagnostic mammograms (Funaro et al., 2021).
What BI-RADS classification is related to biopsies?
The classification relating to biopsies in the BI-RADS system is BI-RADS 6 - Known biopsy proven malignant. Additionally, BI-RADS classifications 4 and 5 typically recommend tissue diagnosis as a follow-up, which can be conducted through a biopsy procedure (Sickles et al., 2013).
What is the usefulness of biopsies in interpreting the PPV2?
Because the PPV2 measures the number of biopsies recommended, it is a valuable metric of mammographic recommendations at the radiologist and facility levels. For example, a PPV2 substantially higher than published benchmarks indicates a high number of true positives in those studies recommended for biopsy, which may be a sign of poor performance because only lesions with a high likelihood of being cancer are recommended for biopsy, so smaller and more subtle malignancies may be getting missed (Understanding the Mammography Audit, 2021).
How is a biopsy performed?
Depending on the specific procedure the medical professional has chosen, there are several different methods of performing a biopsy on breast tissue. All biopsy methods allow access to the suspicious tissue to remove a portion of it for laboratory testing.
Why is a biopsy performed?
Here are several reasons biopsies are performed, according to Johns Hopkins Medicine in 2021:
- "To check a lump or mass that can be felt (is palpable) in the breast
- To check a problem seen on a mammogram, such as small calcium deposits in breast tissue (microcalcifications) or a fluid-filled mass (cyst)
- To evaluate nipple problems, such as a bloody discharge from the nipple
- To find out if a breast lump or mass is cancer (malignant) or not cancer (benign)."
Where can the biopsy procedure be completed?
Typically, biopsies are performed at a doctor's office or hospital. Nevertheless, a Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) will perform the procedure.
Sources:
FDA Breast Cancer Surveillance Consortium. (2021). BCSC Standard Definitions, Version 3. BCSC. https://www.bcsc-research.org/application/files/6916/1429/6964/BCSC_Data_Definitions_v3__2020.09.23.pdf
Funaro, K., Ataya, D., & Niell, B. (2021). Understanding the Mammography Audit. Radiologic Clinics of North America, 59(1), 41–55. https://doi.org/10.1016/j.rcl.2020.09.0099
Johns Hopkins Medicine. (2021, August 8). Breast Biopsy. HopkinsMedicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/breast-biopsy
Mayo Foundation for Medical Education and Research. (2023, August 25). Breast Biopsy. MayoClinic. https://www.mayoclinic.org/tests-procedures/breast-biopsy/about/pac-20384812
Sickles, EA, D'Orsi CJ, Bassett LW, et al. (2013). ACR Bl-RADS Mammography. In: ACR Bl-RADS Atlas, Breast Imaging Reporting and Data System. American College of Radiology. https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/Bi-Rads#Mammography