A cut above

Every woman dreads finding a lump during a breast examination, or being told that a mammogram has revealed something unusual. Yet not every breast abnormality is a growth and not every growth is a cancer. Further examination can identify what the abnormality is and how it should be dealt with. A new biopsy tool, funded by a generous donation from James Tye, organised by Barts and The London Charity, is significantly improving the power of diagnosis and guiding the choice of treatment.

Typically, after referral, radiologists at the Breast Care Centre at Barts and The London take a biopsy of suspect breast tissue which pathologists then analyse. Any number of abnormalities may be detected, some requiring no treatment, others providing advance warning of a cancer or, in the worse cases, a full blown malignant growth. On the basis of these results, a personal treatment plan can be drawn up. Biopsies are taken using a slim needle that is inserted into the breast tissue, under local anaesthetic, and guided to the area under suspicion using ultrasound or X-ray imaging. Once in the correct location, a small amount of tissue is sliced off and withdrawn for analysis.

Although a range of biopsy tools exist, they have several drawbacks. Perhaps the most frustrating is that even when several samples are taken from the same tissue mass, pathological examination often does not provide a definitive assessment, particularly when the breast has a lot of fatty tissue in it. As a result, a surgical biopsy may have to be carried out. The new tool represents a considerable advance. It is a ‘vacuum-assisted’ device – tissue samples are gently sucked out by vacuum action. It is lighter, less cumbersome, easier to manoeuvre and provides a larger sample than previous devices. It can even be used as a surgical instrument, extracting small benign growths that may not be medically harmful but may be upsetting to patients. In practical terms, it is much easier for radiologists to use, particularly as it does not require set up of a dedicated horizontal table for X-rays. In the future, it is likely to be used increasingly with magnetic resonance imaging equipment, which provides highly detailed views of breast tissue.

Perhaps most strikingly, though, the new device has had a significant effect on the results returning from the pathology labs. Far fewer samples come back as indeterminate. As a result, more precise surgical interventions can be planned for those testing positive. Perhaps just as important, more women gain reassurance that their growth is nothing to worry about.