Best diagnostic method for breast lump is -
- First investigation is → FNAC
- Best & the definitive investigation is → open biopsy
- Preferred method → core needle biopsy
- The diagnosis of breast cancer depends ultimately upon examination of tissue or cells removed by biopsy or FNAC (also known as FNA biopsy). The treatment should never be undertaken without a confirmed diagnosis of cancer. Thus a biopsy (biopsy includes all kinds of biopsy including FNA biopsy, also known as FNAC) should be done of all suspicious masses found on physical examination and in the absence of a mass of suspicious lesions demonstrated by mammography.
- A breast mass should not be followed without a biopsy. Exception to this is perhaps in the premenopausal woman with a nonsuspicious mass presumed to be fibrocystic disease. A lesion such as this could be observed through one or two menstrual cycles. However if the mass does not completely resolve during this time, it must be biopsied.
- For biopsy, FNAC (or FNAB) is the simplest method
- Schwartz writes - “The combination of diagnostic mammography, ultrasound or sterotactic localization and fine needle aspiration biopsy is almost 100% accurate in the diagnosis of breast cancer. However while FNA biopsy permits cytological evaluation, core-needle or open biopsy also permits the analysis of breast tissue architecture and allows the pathologist to determine whether invasive cancer is present. Core-needle biopsy is preferred over open biopsy for nonpalpable breast lesions because a single surgical procedure can be planned based on the results of the core biopsy. The advantages of core-needle biopsy include a low complication rate, avoidance of scarring, and a lower cost.”
- CSDT writes- “Open biopsy under local anesthesia as a separate procedure prior to deciding upon definitive treatment is the most reliable means of diagnosis.”