Biopsy and Tests


biopsy is a sample of tissue taken from the body in order to examine it more closely. A doctor should recommend a biopsy when an initial test suggests an area of tissue in the body isn’t normal. Biopsies are most often done to look for cancer. But biopsies can help identify many other conditions. There are some types of biopsy the most appropriate of which can be chosen by your doctor.

Fine Needle Aspiration Biopsy (FNA Biopsy)

Fine Needle Aspiration (FNA) Biopsy is a simple procedure that involves passing a thin needle through the skin to sample fluid or tissue from a cyst or solid mass, as can be seen in the picture below. The sample of cellular material taken during an FNA is then sent to a pathology laboratory for analysis. Fine needle aspiration biopsies are often performed when a suspicious lump is found, for example a breast lump or enlarged lymph node, or if an abnormality is detected on an imaging test such as x-rayultrasound or mammography. Fine needle aspiration is a relatively non-invasive, less painful and quicker method when compared to other methods of tissue sampling such as surgical biopsy. This is why usually local anesthetic is not required. A cyst aspiration can also be achieved with a FNA, where the fluid is drained from a cyst with no need for analysis.

If doctor cannot reach the expected result from FNA, he may apply other ways of biopsy.

İnce İğne Aspirasyon Biyopsisi (İİAB)

Tru-Cut Biopsy (Core Biopsy):

The niddle used in tru-cut biopsy is thicker than the one of FNA. It is used to take some pieces of tissue. Tru-cut biopsy is applied with local anesthetic.

Kalın iğne biyopsisi – trucut biyopsi – kor biyopsi

Surgical Breast Biopsy:

If other tests show you might have breast cancer, your doctor may refer you for a breast biopsy. Most often this will be a core needle biopsy (CNB) or a fine needle aspiration (FNA) biopsy. But in some situations, such as if the results of a needle biopsy aren’t clear, you might need a surgical (open) biopsy. During this procedure, a doctor cuts out all or part of the lump so it can be checked for cancer cells.

In this method, lump and some normal tissue are removed in a surgery and are analyzed under microscope. Surgical biopsy does not require hospital and is applied with local anesthetic. Please ask your doctor about next steps you will face.

Cerrahi biyopsi

Vaccum Biopsy:

Special niddle and equipment is used in this method. It helps doctor to take more sample tissue according to tru-cut biopsy.

Vakum biyopsisi

Breast Laboratory Tests:

If you are diagnosed with breast cancer, your doctor may order additional lab tests to assist with prognosis. The two most common lab tests are the hormone receptor test and the HER2/neu test. Results from these tests can provide insight into which cancer treatment options may be most effective for you.

Many breast cancer tumors contain hormone receptors, often in large numbers. When hormone receptors are present, estrogen and/or progesterone can fuel the growth of the cancer. Such hormone-dependent cancers often respond well to hormone therapy, which differs from hormone replacement therapy (HRT). If neither estrogen receptors (ER) nor progesterone receptors (PR) are present, the cancer is said to be “hormone-receptor-negative,” and hormone therapy would likely be ineffective. Knowing whether the cancer cells have hormone receptors can be valuable to your medical team and your treatment plan.

Findings will be included in a pathology report given to your doctor. If the cancer is deemed “estrogen-receptor-positive” (ER+), its cells have receptors for the estrogen hormone. That means that the cancer cells likely receive signals from estrogen to promote growth. About two out of every three breast cancers contain hormone receptors. If the cancer is progesterone-receptor-positive (PR+), its cells have receptors for progesterone. This hormone could then promote the growth of the cancer. The cancer cells being estrogen and/or progesterone receptor-positive (hormone positive) is a good prognostic factor to have, usually leading to a better prognosis.

Genetic Tests:

We all carry certain genes that are normally protective against cancer. These genes correct any DNA damage that naturally happens when cells divide. Inheriting faulty versions or “variants” of these genes significantly raises your risk of developing cancer, because the altered genes cannot repair the damaged cells, which can build up and form a tumour.

BRCA1 and BRCA2 are examples of genes that raise your cancer risk if they become altered. Having a variant BRCA gene greatly increases a woman’s chance of developing breast cancer and ovarian cancer. They also increase a man’s chance of developing male breast cancer and prostate cancer.  BRCA genes are not the only cancer risk genes. Researchers recently identified more than 100 new gene variants associated with an increased risk of breast, prostate and ovarian cancer. Individually, these new gene variants only slightly increase the risk of cancer, but a combination could mean a high risk overall. If you have a high-risk cancer gene, such as an altered version of BRCA1, it can be passed on to any children you have.

Tests Applied For Determination of Cancer Spread:

Chest X-Ray:

This test can show whether the cancer is spread into lungs or not.

Skeletal Scintigraphy (Bone Scan):

Skeletal scintigraphy is a special type of nuclear medicine procedure that uses small amounts of radioactive material to diagnose and assess the severity of a variety of bone diseases and conditions, including fractures, infection, and cancer.

In this method, bone is irrediated by radioactive beam. Radiation is absorbed by bone and hot spots are observed on the film. These hot spots may be cancer, but it can be resulted by other probleems such as arthritis. In this case CT scan of hot spots should be taken.

CT Scan (Computed Tomography):

CT scans show a slice, or cross-section, of the body. The image shows your bones, organs, and soft tissues more clearly than standard x-rays. CT scans can show a tumor’s shape, size, and location. They can even show the blood vessels that feed the tumor – all without having to cut into the patient. Doctors often use CT scans to help them guide a needle to remove a small piece of tissue. This is called a CT-guided biopsy. CT scans can also be used to guide needles into tumors for some types of cancer treatments, such as radiofrequency ablation (RFA), which uses heat to destroy a tumor. By comparing CT scans done over time, doctors can see how a tumor is responding to treatment or find out if the cancer has come back after treatment.

MRI (Magnetic Resonance Imaging):

MRI helps doctors find cancer in the body and look for signs that it has spread. MRI also can help doctors plan cancer treatment, like surgery or radiation. MRI is painless and you don’t have to do anything special to get ready for this test. But, it’s very important to tell your doctor and the technologist (the person who does the test) if you have any metal in your body. MRI creates cross-section pictures of your insides. But MRI uses strong magnets to make the images, not radiation. An MRI scan takes cross-sectional slices (views) from many angles, as if someone were looking at a slice of your body from the front, from the side, or from above your head. MRI creates pictures of soft tissue parts of the body that are sometimes hard to see using other imaging tests. MRI is very good at finding and pinpointing some cancers. Using MRI, doctors can sometimes tell if a tumor is or is not cancer. MRI can also be used to look for signs that cancer may have metastasized (spread) from where it started to another part of the body. MRI images can also help doctors plan treatment such as surgery or radiation therapy.

PET (Positron Emission Tomography):

A positron emission tomography (PET) scan is an imaging test that uses a radioactive substance (called a tracer) to look for potential spread of breast cancer. This tracer can help identify areas of cancer that an MRI or CT scan may not show. PET scans, short for Positron Emission Tomography, can detect areas of cancer by obtaining images of the body’s cells as they work. First, you are injected with a substance made up of sugar and a small amount of radioactive material. Cancer cells tend to be more active than normal cells, and they absorb more of the radioactive sugar as a result. A special camera then scans the body to pick up any “highlighted” areas on a computer screen. This helps radiologists identify areas where cells are suspiciously active, which can indicate cancer. Once doctors know where to look, further evaluation can be done with other techniques. PET scans are not used to screen women for breast cancer. The test has only a limited ability to detect small tumors. PET scans can be useful for evaluating people after breast cancer has already been diagnosed.

Additional Tests:

If the diagnosis is cancer, doctor may request more laboratory tests which can help doctor to make the most correct decision. There are hormonal tests applied on females with breast cancer. Hormonal tests help your doctor to decide whether you need hormone therapy to stop cancer or not which guides doctor to plan the most appropriate treatment.