Agora Centre for Women’s Health, is a purpose built centre designed by a woman for women. The centre has its own breast ultrasound and therefore Dr Thornton is able to undertake fine-needle aspirations and core biopsies of breast lumps in order to diagnose breast cancer. This can be performed at the initial consultation and the histopathology result will be rapidly returned, usually within 24 hours. The biopsies will be reported by a specialist breast cancer pathologist.
For convenience all of the procedures can be done on site in the rooms in a warm and caring environment. This allows rapid delivery of results to the patient thus reducing patient anxiety and ensures that all future treatments will be streamlined. This is particularly relevant for country patients as the result can be turned around within a short period of time. A breast care nurse will be available to provide additional support to patients and their families.
All members of the breast cancer multidisciplinary team are on site and further investigations can usually be arranged on the day of consultation. Agora Centre for Women’s Health is conveniently located with rapid access to radiologists, medical and radiation oncologists in the same building.
The centre has a unique location as it is co-located in the same building as the radiology department, operating theatre, a state of the art medical day oncology unit, and the surgical and medical wards. The centralisation of resources and rapid access to exceptional medical facilities is extremely beneficial to patients that are often facing many months of treatment.
The friendly and caring staff at Agora are always available to help patients navigate their way through the hospital and warmly welcome patients and their families to the centre during and after their treatment.
If a lump or an imaging abnormality is seen in the breast a core biopsy may be required. This is a procedure that samples a tiny “core”’ of breast tissue using local anaesthetic. The tissue is sent to the specialist breast pathologist to examine under the microscope.
Local anaesthetic will be placed in the skin and a very small incision will be made on the skin and a small cylindrical sample of breast tissue will be removed using a special core biopsy needle – a cutting needle device or a Tru-Cut or spring loaded needle. If a palpable lump is small or difficult to palpate, an ultrasound-guided core biopsy is preferred to freehand technique.
A core biopsy will help to differentiate between benign and malignant disease and will also enable cancers to be graded and will assist in establishing the estrogen and progesterone receptor and HER2 receptor status of the tumor.
Occasionally, the ultrasound is required to direct the needle to the appropriate area.
Patients may also be required to have a core biopsy performed in the radiology department with the use of ultrasound or mammographic guidance. The procedure usually takes about 20 minutes but the biopsy itself only takes a couple of seconds.
It may be associated with minor discomfort; however, it is unusual for the pain to be severe.
The tissue samples are sent immediately to the pathologist after the procedure and a report will be issued, usually within 48 hours.
There may be some discomfort and tenderness at the site of the core biopsy after the procedure and it is important that significant pressure is applied to the site of the biopsy for several minutes after the biopsy in order to minimise bruising. A small waterproof dressing will be applied after the core biopsy to the incision site.
It is important to inform the doctor if you are taking any blood thinning medication, for example warfarin or clopidogrel, or if you have a bleeding disorder. After the core biopsy, we suggest that you avoid strenuous exercise for 48 hours and, in particular, avoid lifting of heavy weights. There may be minor discomfort for 2-3 days after the core biopsy.
A small ice pack can be used at the site of the biopsy. It is also suggested if there is pain that regular paracetamol is taken. It is important to avoid aspirin as the blood thinning effect of aspirin may increase bruising. Bruising is very common after core biopsy and usually resolves in 1-2 weeks. Very rarely a haematoma can be associated with the core biopsy. If the patient notices any significant bruising or a lump/swelling in the breast, this may indicate bleeding and a haematoma. Haematoma can be quite painful. It is rare that an evacuation of haematoma would be required in the operating theatre and usually, a haematoma or lump will resolve spontaneously after approximately 6 weeks. There is no permanent damage to the breast if this occurs.
Infection is also uncommon. The symptoms may include redness, swelling, pain, and tenderness. Occasionally, antibiotics may be required. A pneumothorax is a very rare but dangerous condition that occurs if the needle punctures the chest wall. Symptoms may include significant shortness of breath and pain with inhalation. Urgent medical attention should be sought if this occurs.
If the skin over the breast or skin of the nipple and areola is thought to be involved with cancer, a small punch biopsy under local anaesthetic will be undertaken to achieve a histological diagnosis.
When a lump is found in the breast it is usual practice for a ‘triple’ assessment of the lump to be undertaken. The results of the core biopsy or FNA will provide one of the components of the triple test. The results of the triple assessment will be calculated using a 5‑point scale. Each component of the triple assessment (clinical assessment, imaging, and biopsy) will be assigned a number; 1 normal, 2 benign, 3 indeterminate, 4 suspicious, and 5 malignant (cancer). A score of 3 or above on any of the triple assessment parameters will often mandate an open-excisional biopsy. It is important that a multidisciplinary triple assessment is carried out on all patients presenting with a breast lump. This will enable the diagnosis of breast cancer in 99% of suspected cases. However, the absolute sensitivity of 100% will never be achieved and this means that there will always be a few false negatives from a triple assessment; this is usually in younger patients and may lead to delay in diagnosis and treatment.
Therefore, if there is any doubt regarding the triple assessment, an excisional biopsy is required. Regular multidisciplinary team meetings provide a forum for reviewing results of the triple assessment and the postoperative histology. The MDM will allow all of the members involved in the specialist breast team (breast surgeon, pathologist, radiologist, breast care nurse, medical oncologist, radiation oncologist, and geneticist) to formulate a management plan for the patient.