Surgical Biopsy Techniques for Breast Cancer Treatment

Surgical biopsy techniques for breast cancer?

Hello Doctor, my mother had a breast ultrasound at the clinic on January 17, which showed a tumor in her right breast.
The doctor performed a surgical biopsy to remove a portion of the tissue for testing, and the report indicated that it is HER2 positive.
She was then referred to a hospital, where the doctor mentioned that since the clinic used surgical methods, the original tumor characteristics are unknown.
Therefore, it was suggested that she undergo surgery on February 10 to remove the tumor, followed by chemotherapy.
However, the information I found indicates that chemotherapy before surgery may provide better insight into the effectiveness of the treatment.
I would like to ask for your recommendation on which approach is better.
Given that it is the Lunar New Year, I am concerned that if we go to another hospital for examination, the delay caused by having already performed a biopsy might lead to tumor progression.
Is it necessary to remove the tumor as soon as possible after the surgical biopsy? Thank you.

Tin, 30~39 year old female. Ask Date: 2022/02/03

Dr. Chen Sirong reply Oncology

Tin / 31 years old / Female
Hello,
1.
It is recommended to follow the decision made by your attending physician: A) to perform surgery to remove the tumor on February 10, and B) to proceed with chemotherapy afterward.
You may not fully understand whether the physician means a biopsy or complete tumor removal when they refer to "removing the tumor."
2.
However, information in the literature indicates that performing chemotherapy before surgery may provide better insight into the effectiveness of the chemotherapy.
A: Based on your description, your mother requires both surgery and chemotherapy.
Should chemotherapy be done before or after surgery? The doctor should have made this decision after careful assessment.
Your letter does not provide me with all the necessary information, so I will choose to trust the attending physician's judgment.
3.
Is it necessary to remove the tumor as soon as possible after a surgical biopsy? A: If treatment follows the biopsy, it can proceed with either chemotherapy or complete tumor resection.
Wishing your mother a smooth treatment process.
Taoyuan Hospital
Chen Si-Rong

Reply Date: 2022/02/03

More Info

Understanding the surgical biopsy techniques for breast cancer treatment is crucial for making informed decisions about patient care. In your mother's case, the initial ultrasound indicated a tumor in the right breast, and a surgical biopsy was performed to obtain tissue for pathological examination. The report indicated HER2 positivity, which is an important factor in determining the treatment plan.

Surgical Biopsy Techniques
1. Types of Biopsies: There are several types of biopsies used in breast cancer diagnosis, including Fine Needle Aspiration Cytology (FNAC), Core Needle Biopsy (CNB), and surgical biopsy. Surgical biopsy, which involves removing a portion of the tumor, provides a larger tissue sample and is often more definitive than FNAC or CNB. This method is particularly useful when the tumor is not easily accessible or when a more extensive evaluation is needed.

2. Timing of Treatment: The timing of surgery versus chemotherapy can significantly impact treatment outcomes. Traditionally, the approach to breast cancer treatment has been to perform surgery first, followed by chemotherapy, especially if the tumor is operable. However, in some cases, neoadjuvant chemotherapy (chemotherapy before surgery) is preferred. This approach can shrink the tumor, making it easier to remove and allowing for a better assessment of the tumor's response to treatment.

3. Impact of Surgical Biopsy: Performing a surgical biopsy can sometimes alter the tumor's characteristics, particularly if the biopsy is extensive. However, it is essential to balance the need for accurate diagnosis with the potential risks of delaying treatment. If the biopsy has already been performed, the next steps should be carefully considered based on the tumor's characteristics and the patient's overall health.

Recommendations
1. Consultation with Oncologist: It is crucial to discuss the results of the biopsy and the HER2 positivity with an oncologist. They can provide tailored recommendations based on the specific characteristics of the tumor and the patient's health status. HER2-positive breast cancer often requires targeted therapies, such as trastuzumab (Herceptin), in addition to chemotherapy.

2. Consider Neoadjuvant Chemotherapy: If there is a concern about the tumor's aggressiveness or if it is large, neoadjuvant chemotherapy may be a viable option. This approach allows for the assessment of how well the tumor responds to chemotherapy before surgery, potentially leading to a less extensive surgical procedure.

3. Timing and Urgency: While it is understandable to be concerned about delays in treatment, it is essential to prioritize obtaining a comprehensive treatment plan. Rushing into surgery without a complete understanding of the tumor's characteristics may not be in the best interest of the patient. If the surgical biopsy has already been performed, it is advisable to wait for the oncologist's guidance on the next steps.

4. Monitoring for Spread: After a biopsy, there is always a concern about the potential for tumor spread. However, the risk of metastasis due to a biopsy is generally low. The focus should be on ensuring that the subsequent treatment is well-planned and executed.

Conclusion
In summary, the decision regarding whether to proceed with surgery or chemotherapy first should be made in consultation with a multidisciplinary team, including surgeons and oncologists. They will consider the tumor's characteristics, the patient's overall health, and the potential benefits and risks of each approach. It is essential to have open communication with the healthcare team to ensure that the best possible treatment plan is developed for your mother.

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