Breast Cancer Puncture: a Critical Step in Definitive Diagnosis

Breast Cancer Biopsy: a Key Step to a Clear Diagnosis I. Introduction Breast cancer, a malignant tumor with a high incidence among women around the world, threatens the health of women at all times. When suspicious symptoms such as abnormal breast lumps and nipple discharge are found, how to accurately judge whether breast cancer is a crucial issue. Among the numerous means of examination, breast cancer puncture plays an extremely important role, which has an irreplaceable necessity for early diagnosis and precise treatment of breast cancer. Next, let’s take a closer look at breast cancer screening and why it’s so necessary. 2. What is breast cancer puncture? Simply speaking, breast cancer puncture is a method of extracting cells or tissues from suspicious breast lesions through fine or thick needles, and then conducting pathological analysis. According to the different needles used and the different amount of tissue obtained, it is mainly divided into fine needle aspiration cytology (Fine Needle Aspiration Cytology, referred to as FNAC) and coarse needle aspiration biopsy (Core Needle Biopsy, referred to as CNB). (1) Fine needle aspiration cytology (FNAC) FNAC usually uses a thin needle, usually 21-25 gauge needle, under the guidance of ultrasound, molybdenum target or palpation, to accurately penetrate the suspicious lesion site, extract a small amount of cell suspension, and then smear these cells on the slide, after fixation, staining and other treatments. The morphological and structural characteristics of cells are observed under the microscope to determine whether there are cancer cells and the types of cancer cells. (2) Coarse needle biopsy (CNB) CNB uses relatively thick needles, such as 14-18 needles, to penetrate the lesion site under the guidance of ultrasound, molybdenum target and other imaging equipment to obtain a small tissue sample, which is more than FNAC. The obtained tissue will be processed by paraffin embedding and sectioning, and then made into pathological sections for detailed histological observation under the microscope, which can not only determine whether it is cancer tissue, but also understand more detailed information such as the histological type and grade of the tumor. 3. Necessity of breast cancer puncture examination (1) Clear diagnosis 1. Distinguish between benign and malignant lesions. When abnormal conditions such as breast mass occur, it may be benign lesions, such as breast fibroadenoma, breast hyperplasia, etc., or malignant lesions, namely breast cancer. Only through palpation, breast ultrasound, mammography and other means of examination, although the existence, approximate location, shape and other information of the lesion can be found, it is difficult to accurately determine whether it is benign or malignant. Puncture can directly obtain the cells or tissues of the lesion for pathological analysis, which is the “gold standard” for the diagnosis of breast cancer, and can clearly distinguish whether the lesion is benign or malignant, thus providing the most critical basis for subsequent treatment decisions. 2. To determine the type of tumor, even if it has been determined to be breast cancer, there are great differences in the treatment and prognosis of different types of breast cancer. For example, hormone receptor-positive breast cancer may be more suitable for endocrine therapy, and human epidermal growth factor receptor 2 (HER2) -positive breast cancer may require targeted therapy. Puncture can not only confirm the diagnosis of breast cancer, but also further determine the specific types of tumors, such as invasive ductal carcinoma, invasive lobular carcinoma, and the receptor status of tumor cells (estrogen receptor, progesterone receptor, HER2, etc.), which is essential for the development of personalized treatment. (2) Guiding the formulation of treatment plan 1. Choosing the appropriate surgical method If breast cancer is diagnosed, the results of puncture examination have an important impact on the choice of the appropriate surgical method. For example, for some early breast cancer with small tumors and no axillary lymph node metastasis, if the puncture examination shows that the tumor cells are well differentiated and relatively less invasive, it may be more suitable for breast-conserving surgery, combined with follow-up radiotherapy and other adjuvant therapies; If the tumor cells are poorly differentiated and aggressive, it may be necessary to consider more radical or modified radical mastectomy for breast cancer. 2. Determine whether adjuvant therapy is needed. In addition to the choice of surgical methods, the results of puncture examination can also determine whether the patient needs adjuvant therapy and what kind of adjuvant therapy is needed. For example, estrogen receptor-positive breast cancer patients need to consider endocrine therapy after puncture examination, while HER2-positive breast cancer patients may need targeted therapy. In addition, for patients with high tumor stage and axillary lymph node metastasis, the results of puncture examination are also helpful to determine whether adjuvant treatment such as chemotherapy is needed. (3) The prognosis of breast cancer patients with different types and grades is different. The information of tumor histological type and grade obtained by puncture examination can help doctors to make a preliminary assessment of the prognosis of patients. Generally speaking, breast cancer patients with well-differentiated and low-grade tumor cells have a relatively good prognosis, while those with poorly differentiated and high-grade tumor cells have a relatively poor prognosis. Through the information provided by puncture examination, patients and their families can have a clearer understanding of the development trend of the disease, so as to prepare for it psychologically and in terms of living arrangements. (4) Avoid unnecessary surgery. Before the diagnosis is confirmed by puncture examination, if breast cancer is suspected only on the basis of clinical signs and imaging examination, the following two situations may occur if surgical resection is performed rashly: First, the resected lesion is actually benign, which leads to unnecessary surgical trauma and risk for patients; Second, even for breast cancer, it may not be possible to choose the most suitable surgical method and follow-up treatment plan without knowing the specific type of tumor, receptor status and other key information in advance, thus affecting the therapeutic effect. Puncture examination can accurately judge the nature of the lesion and related information before surgery, effectively avoiding these unnecessary situations. 4. Safety of breast cancer puncture examination Many patients worry that puncture examination will lead to adverse consequences such as the spread of cancer cells. In fact, there are some misunderstandings about this concern. (1) Fine needle aspiration cytology (FNAC) The fine needle used in FNAC has very little damage to the tissue during the operation, and the cell suspension is extracted, which will hardly cause the spread of cancer cells. A large number of clinical studies have shown that FNAC is a very safe method of examination, and the risk of cancer cell spread is very low and negligible. (2) Thick needle biopsy (CNB) Although CNB uses relatively thick needles, modern thick needle biopsy technology has been quite mature. During the piercing process, the needle will quickly pass through the tissue and obtain the tissue sample, and then quickly pull out, the whole process takes less time. Moreover, current research also shows that the risk of cancer cell spread caused by CNB is also very low, as long as it is operated by professional doctors in regular medical institutions, there will generally be no cancer cell spread and other problems. In addition, both FNAC and CNB will take proper care of the puncture site after puncture, such as keeping it clean and avoiding infection, to ensure the safety and comfort of patients. 5. Precautions for breast cancer puncture examination (1) Preparation before examination 1. Patients need to inform the doctor of their medical history in detail, including whether they have a history of breast disease, family history, allergy history, etc., so that the doctor can better assess the necessity and risk of the examination. 2. Generally, routine blood tests, such as blood routine and coagulation function, are needed before the examination to ensure that the patient’s physical condition can tolerate the puncture examination. (2) Cooperation during examination 1. In the process of puncture, patients need to keep relaxed and cooperate with doctors as much as possible. If the patient is too nervous, it may lead to muscle tension, affect the accuracy of the doctor’s operation, but also increase their pain. 2. Adjust your body position according to the doctor’s instructions so that the doctor can perform the puncture operation smoothly. (3) Nursing after examination 1. After puncture, patients need to take proper care of the puncture site. Generally speaking, the puncture site should be kept clean and dry, and water should be avoided to prevent infection. 2. Pay attention to observe whether there are abnormal conditions such as bleeding, swelling and pain at the puncture site, and inform the doctor in time if there are any abnormalities. 3. Some patients may have slight pain or discomfort after puncture, which is a normal phenomenon and will generally relieve spontaneously within a few hours to a few days. If the pain is severe or persistent, it is also necessary to inform the doctor in time. 6. Conclusion Breast cancer puncture examination is very necessary in the diagnosis, treatment plan formulation and prognosis evaluation of breast cancer. It can clearly distinguish the benign and malignant lesions, determine the tumor type and receptor status, guide the choice of surgical methods and adjuvant therapy, evaluate the prognosis of patients, and avoid unnecessary surgical trauma and risk. Moreover, modern puncture examination technology has been quite mature, high safety, as long as patients in accordance with the requirements of the doctor to do a good job of pre-examination preparation, cooperation during the examination and post-examination care, they can safely accept the puncture examination. For patients with suspected breast cancer, puncture examination is undoubtedly a key step to make a definite diagnosis and open the way to correct treatment, which deserves the attention of every patient.