Biopsy Techniques
Ductal Lavage
Nomograms

Biopsy Techniques

A biopsy is normally the first surgical intervention in the treatment of breast cancer. For many years, exicsion biopsy  was the standard treatment for most lesions. This was performed with intravenous sedation and local anesthesia, and provided excellent diagnostic information. However, this type of biopsy has the potential to affect subsequent treatment, could result in a large scar, or result in a tumor being removed with inadequate or unknown margins.

Less invasive techniques for biopsies, such as Fine-needle aspiration (FNA) and core biopsy  have been developed. These have a great benefit to women specially those that  have multiple biopsies during their lifetimes, . Fine-needle aspiration (FNA) and core biopsy are both fast and simple techniques, requiring only local anesthesia.

Techniques such as Advanced Breast Biopsy Instrumentation (ABBI) system and several vacuum-assisted core-sampling devices  -Mammatome, and Minimally Invasive Breast Biopsy (MIBB) are now commercially available. They  increase diagnostic accuracy by increasing the size of the tissue samples and at the same time provide a relatively non-invasive approach. These techniques are best deployed when used along with  stereotactic or ultrasound guidance for the diagnosis of non-palpable breast tumors.

Ductal Lavage

In ductal lavage, we retrieve cells via a microcatheter which is inserted into the milk duct through the orifices on the nipple surface. This technology is derived from the belief that Breast cancer may have its origins in the epithelial lining of the ductal or lobular systems of these milk ducts. This technique is still experimental. However, initial studies indicate that it is safe and may be a useful technique for the analysis of intra- ductal breast pathology.

Breast Cancer Nomograms

A nomogram is a prediction tool that is based on a Cox regression model and that incorporates factors included in any staging system. It can also add other clinical and pathologic factors known to have an impact on outcome. In simple terms, a nomogram is a mathematical device or model that shows relationships between things. The Memorial Sloan-Kettering Cancer Center (MSKCC), have developed nomograms can be used to calculate: (1) the likelihood that breast cancer has spread to the sentinel lymph nodes (Sentinel Lymph Nodes Metastasis Nomogram); (2) the likelihood that breast cancer that has spread to the sentinel lymph nodes, under the arm, has also spread to additional non-sentinel lymph nodes under the arm