Role of Mammotome in Breast Lesions

Introduction

The incidence of breast cancer is rising steadily worldwide. Unfortunately, despite increasing awareness and early screening measures, breast cancer is still the leading cancer in women contributing to high morbidity and mortality rates. However, early diagnosis of breast lesions is crucial for enhanced treatment and better patient prognosis. Ultrasound and mammography are the most common screening tools for diagnosing breast cancer. However, it is essential to analyze the tissue for tumor cells to obtain a confirmatory diagnosis. This procedure is known as a biopsy. A biopsy of the tissue sample provides a final diagnosis which determines the line of treatment and the prognosis of the patient.

What Is a Breast Biopsy?

A lump or any abnormality in the breast needs to be evaluated. Ultrasound is the most commonly used imaging technique substantiated along with mammography. However, a breast biopsy is usually done to confirm the diagnosis and, more importantly, to differentiate a benign tumor (non-cancerous) from its malignant (cancerous) counterpart. A breast biopsy is an invasive diagnostic procedure in which a tissue sample is removed from the breast and sent for laboratory analysis. The tissue will be assessed for the presence of abnormal cells, their type, origin, and grade (if malignant).

What Are the Various Types of a Breast Biopsy?

There are various types of breast biopsies. They are described below:

• Fine-Needle Aspiration Biopsy: This type of biopsy is usually used in palpable breast lesions. A hollow and thin needle is inserted into the lump, and the fluid or small tissues are removed and sent for pathological analysis.

• Core Needle Biopsy: A larger needle is used, and a core of the sample tissue is removed.

• Surgical Biopsy: In a surgical biopsy, an incision or a cut is made, and a bigger tissue sample is removed. Surgical biopsy is highly beneficial in smaller lesions where the entire lesion can be removed.

What Are the Specialized Biopsy Techniques?

With the increasing demand for more esthetic-friendly surgical procedures, biopsy techniques underwent some novel changes. A conventional surgical biopsy had certain drawbacks, such as postoperative scarring, increasing cost, and the need for additional biopsy due to improper sampling. Hence there was a demand for minimally invasive techniques to facilitate the biopsy procedure. This was achieved with the help of certain devices and advanced imaging techniques. The specialized biopsy techniques are described in detail below:

• Image-Guided Biopsy: The biopsy is conducted under the guidance of any imaging technique, usually an ultrasound. Image-guided biopsies are more precise as the desired site to be biopsied can be accurately identified through ultrasound. This would result in reduced scarring, better esthetic results, and quick postoperative wound healing.

• Stereotactic Biopsy: This biopsy is done based on a three-dimensional reconstructed image of the breasts. Based on the mammogram reports, a three-dimensional image of the breast is constructed on the computer. This image facilitates and guides the biopsy. Site precision is the significant advantage of this technique.

• Vacuum-Assisted Biopsy: This is the most recent and advanced technology used in breast biopsy. A vacuum-assisted device is used to perform the biopsy procedure.

What Is a Mammotome Biopsy?

Mammotome is a vacuum-assisted biopsy technique. It is a safe and minimally invasive procedure that is well tolerated by patients. In this procedure, a biopsy needle is inserted through the skin and advanced to the core of the lump. This can be done under an imaging procedure such as an ultrasound or a mammogram. Next, a vacuum-powered device is used to retrieve several small tissue samples from the lesion. The vacuum pulls the tissue towards the center of the needle, which is then cut with the help of a rotary cutting device. These samples are then sent for laboratory investigation. Mammotome devices are beneficial in non-palpable lesions identified on a regular screening check.

What Are the Indications of a Mammotome Biopsy?

A mammotome biopsy is indicated under the following conditions:

• An ultrasound or mammography reveals a suspicious mass.

• A lump in the breast or the armpits.

• Disfigured breasts.

• Discharge from the nipple.

How Should Patients Prepare for a Mammotome Biopsy?

• Patients who are on blood thinners like Aspirin should inform the doctor. The medicine must be stopped five to seven days before the procedure to prevent the risk of unnecessary bleeding.

• Ladies who are or could be pregnant should notify the doctor as a mammogram involves a minimal radiation risk.

• Patients should wear loose, comfortable clothes and remove their jewelry and other valuables before the procedure.

• Patients should carry their previous test reports and prescription medicines for the procedure.

• On the day of the procedure, patients should avoid using talcum powder or deodorants on their breasts or under their armpits.

• Any history of allergy to medications or latex should be informed to the doctor.

How Is a Mammotome Biopsy Done?

• The mammotome biopsy is usually done on an outpatient basis and takes about an hour.

• The patient will be asked to change into a hospital gown and lie on the examination table. The breast to be biopsied will be exposed.

• A mammogram or an ultrasound will be used to image the breasts. Patients must be very still while the images are being captured. Any slight movement could alter the image, leading to an improper biopsy site.

• The area to be biopsied will be cleaned and sterilized using an antiseptic solution. Then, a local anesthetic would be injected to numb the area.

• A small incision (about one-fourth inch in size) is made. The biopsy needle will be inserted into the site through the incision. A vacuum-assisted mammotome device will be used to retrieve a sample tissue. The tissue is immediately placed in a formalin bottle and sent for pathological investigations.

• The wound site would be covered in a sterile dressing.

What Are the Benefits of a Mammotome Biopsy?

The benefits of a mammotome biopsy are as mentioned below:

• The incision requires no sutures; hence, they are more aesthetically pleasing than an open surgical biopsy.

• Image guidance helps to locate the abnormal tissue site precisely.

• The recovery is quick, and patients can return to normal activities immediately.

• Minimally invasive.

• The procedural time is less compared to a surgical biopsy.

• The tissue samples retrieved via mammotome procedure are more reliable and accurate.

• It can be beneficial even for benign breast tumors.

What Are the Risks Associated With the Procedure?

• Mild discomfort or tenderness at the biopsy site.

• Rare chances of infection.

• Bleeding.

• Discharge from the biopsied area.

• Bruising.

• Rarely, insufficient tissue samples could lead to a repeat biopsy.

When to Seek Medical Advice?

• A high temperature.

• Persistent bleeding or discharge from the wound site.

• Increasing pain.

If the patient experiences any of the symptoms mentioned above, they should immediately visit their healthcare provider as they could be signs of infection.

What Are the Limitations of the Procedure?

• Lesions located near the chest wall.

• Widespread lesions.

Conclusion

Mammotome biopsy is an effective alternative to conventional breast biopsies. For smaller and benign tumors, mammotome can also be used as a diagnostic and therapeutic tool. In addition, negligible scarring increases patient satisfaction, and easy recovery makes the mammotome the most preferred technique for breast biopsy. However, the increasing cost hinders its widespread availability, making core biopsy more inaccessible.