Stony Brook University Breast Care Center - Services & Procedures

This procedure is performed under local anesthesia. The surgeon uses a fine hollow needle that is attached to a syringe to extract fluid from a cyst or cells from a solid lesion. The needle used in this procedure is very small (smaller than those used to draw blood). Several insertions are usually required to obtain an adequate sample. The procedure takes a few minutes and is often done in a doctor's office.

If the lump cannot be felt, ultrasound may be utilized to help the physician guide the needle into the breast and to the lesion. Stereotactic mammography may also be used. This mammography utilizes a computer to pinpoint the mass or cyst. Mammograms are taken from two angles and the computer maps the precise location of the lesion.

There is no incision and a very small bandage is put over the site where the needle entered. Fine needle aspiration is the easiest and fastest method of obtaining a breast biopsy, and is very effective for women who have fluid filled cysts. However, the pathological evaluation can be incomplete because the tissue sample is very small. When used alone, about 10% of breast cancers may be missed. The effectiveness of this procedure depends on the skill of the surgeon or radiologist who performs it.

This procedure is similar to fine needle aspiration, but the needle is larger, enabling a larger sample to be obtained. It is performed under local anesthesia and ultrasound or stereotactic mammography is used if the lump cannot be felt.

Three to six needle insertions are needed to obtain an adequate sample of tissue. A clicking sound may be heard as the samples are being taken and the patient may feel some pressure, but should not feel pain. The procedure takes a few minutes and no stitches are required.

Core needle biopsy may provide a more accurate analysis and diagnosis than fine needle aspiration because tissue is removed, rather than just cells. This procedure is not accurate in patients with very small or hard lumps.

This procedure, also called advanced breast biopsy instrumentation (ABBI), is an alternative for patients who prefer a less invasive procedure than surgery. Large core biopsy is able to remove a sizeable specimen or an entire lesion using a surgical device and stereotactic mammography. It combines wire needle localization and the ability to remove a tissue specimen and allows the sample to be removed in one piece.

After the region is numbed using a local anesthetic, the localizing needle is guided to the lesion. A very small incision is made and a cannula (i.e., a tube and a cutting device) is passed through the incision. Breast tissue is removed through the tube.

The procedure takes 30 minutes to 2 hours, but it generally takes less than an hour. A few stitches may be required to close the opening in the skin.

Sentinel node biopsy is a less invasive procedure and carries a lower risk of complications than axillary node dissection. The sentinel node is the first lymph node that filters fluid from the breast. Many cancer experts believe that malignant cells reach the sentinel node first and that this lymph node is more likely to contain cancer cells.

Based on this assumption, the node most likely to contain malignant cells should be removed and analyzed. If the sentinel is free of cancer cells, then it is highly unlikely that the other nodes are positive. This technique, combined with lumpectomy, is easily performed as an outpatient procedure and causes less pain and deformity than an axillary node dissection.

Sentinel node biopsy involves injecting a radioactive tracer and/or blue dye into and around the tumor. In some cases, a numbing medication (local anesthesia) or a sedative is administered prior to the tracer injection. When anesthesia is not used, patients may experience a burning sensation during the injection. With a small, hand-held Geiger counter, the surgeon tracks the path the tracer takes as it travels away from the breast and under the arm to the first lymph node. Once located, the sentinel node is removed through a small incision and sent to the laboratory for diagnosis.

If the results are negative, it is assumed that the cancer has not spread and there is no need for further surgery. If the sentinel node is positive, the surgeon may perform an axillary node dissection to assess how many other lymph nodes are affected.

The axillary lymph nodes are located under the arm. Axillary node dissection is performed to determine if cancer has spread beyond the breast. Cancer cells found in the lymph nodes suggest that it may have spread to other parts of the body and the patient may need more aggressive treatment. The results of this test help the patient and physician plan the best course of therapy.

An axillary node dissection may be done at the same time as a lumpectomy or a mastectomy. It may be scheduled following a positive biopsy.

Axillary node dissection is performed under general anesthesia (agent that renders the patient unconscious) at a hospital. The surgeon makes an incision under the arm and removes a pad of fat in which 10 to 20 lymph nodes are embedded. The incision is sutured and a drain may be put in to remove excess fluid. The procedure takes between 1 and 2 hours.

This procedure can be performed whether or not the breast mass is palpable and is usually performed under local anesthesia (i.e., the patient remains awake during the procedure). The area is numbed with a local anesthetic and a sedative is usually administered. A small incision of about 1 to 2 inches is made as close to the lump as possible. The surgeon removes a piece of tissue, or if it is small, the entire lump and the incision is sutured. The biopsy usually takes about an hour to perform.

If the lump cannot be felt, the procedure is slightly more involved and time consuming. Because it cannot be felt, it must be located by a process called needle localization. The patient goes to radiology and a mammogram is used to pinpoint the lump. A wire needle is inserted into the breast, marking the location of the lump. The wire is left inside the breast and taped to the skin, and the patient is taken to the operating room to have the biopsy.

Treatment is administered to the tissue surrounding a tumor after a lumpectomy has occurred. After surgery, an inflatable balloon is inserted with a catheter. The balloon fills the region that the tumor occupied. A treatment schedule often consists of 2 treatments a day over a span of 5 days. During this time high doses of radiation are given to a very specific region while not threatening healthy tissue.

Intensity Modulated Radiation Therapy (IMRT) is a specialized 3D conformal radiation treatment plan where thousands of tiny beams from several beam angles are used to target a tumor. The radiation intensity of these beams is modulated, or controlled, with a system of movable leaves called a multi-leaf collimator (MLC). The leaves conform to the shape of the tumor and block out unwanted radiation. With sophisticated dose calculation methods each leaf can move independently to create tiny beamlets of radiation that specifically target a tumor. This treatment technique provides the means to escalate tumor doses while significantly sparing normal tissue. Less radiation to normal tissues translates into fewer complications for patients. IMRT is ideal for stationary tumors situated near critical structures such as the spinal cord, heart and eyes. Some typical treatment sites include the prostate, brain and breast. As with 3D conformal treatments, IMRT is planned by our radiation oncology team using the advanced Eclipse treatment planning system.