Expert: Claes-Gustaf Nordquist, M.D. - 11/27/2005

Question
I am a 39 about to turn 40 year old female without a history of breast cancer in my family.  I found a couple of lumps a few months ago and finally decided to go to my obgyn for an examination.  I was sent for a bilateral diagnostic mammogram.  Since my breasts are very dense I was also sent for an ultrasound after the radiologist couldn't tell much from the mammogram.
The ultra sound technician said it appeared that I had numerous cysts.  The radiologist's report that I received a few days later said there were no signs of cancer.  

I had a follow up appointment with a surgeon the next week who recommended taking out two lumps that were palpable. She did a fine needle aspiration on both of them.  She wasn't able to get any fluid out of these lumps when she did the FNA.  She only got cells out that were then sent off to the pathologist for review.  There was another palpable lump that the doc said she had the most concerns about since from the ultrasound pictures showed white spots on it and didn't appear to look like a simple cyst like the radiologist's report said.  She said she couldn't get to it by FNA and recommended an ultra sound guided biopsy.  

I am concerned that the surgeon recommended automatic removal of the two lumps she tried to aspirate with the fine needle without a less invasive biopsy alternative being offered.  We still don't even know what the pathologists report says from the FNA.  If the lumps turn out to be fibroadenomas I don't know why they have to be removed if they're not growing.  In addition, I've read of new less invasive biopsy techniques such as the vacuum assisted biopsy (mammotone, etc).  Ideally, I would prefer to have a less invasive biopsy technique such as core needle or vacuum assisted biopsy vs. surgery and then if it turns out to be a fibroadenoma I would like to have the cyroblation therapy that I've recently read about. This technique actually freezes the tumor to remove it without surgery.  What do you think about the less invasive techniques vs. automatic recommendation for a surgical biopsy?  I'm a small breasted women and I'm concerned about the risk of infection, scarring and interference with future mammograms that could occur with a surgical biopsy.  

Answer
Since you have firm breasts that are not ideal for only x-ray mammography I do recommend that apart from such mammography & ultrasound also MRI-mammography should be performed. I see no reason why an ultrasound assisted fine needle biopsy of the remaining lump should not be done. It is also my firm opinion (and I have an almost 40 years experience with fine needle biopsies since the technique was developed here in Sweden by among others a previous boss of mine Professor, Dr. Sixten Franzén, M.D., Ph. D., Sc.D.) that unless there is some uncertainty in the results of the thin needle biopsies and the radiological images (x-ray mammography, ultrasound & MRI-mammography) there is NO need for any surgical biopsies and surely the results of the fine needle biopsies should be in before any decisions should be made!
I am not sure any advantages are offered by the techniques you mention over fine needle biopsies. Please do keep me posted! Good luck!