In the last decade, the biopsy needle and supported the fine needle aspiration (FNA) is the main tool for the diagnosis of lesions detected or image palpable. Although this technique is that a biopsy sample, breast tissue samples are removed from individual cells and in the FNA and, therefore, the pathologist has more information to make an accurate diagnosis.

Once a biopsy is performed and a diagnosis is made, there are several things may happen:

1) The diagnosis is entirely benign, and correlates with the radiology therefore not needed further surgery. Here are some examples:

• Fibrocystic changes without atypia
• Sclerosing adenosis
• Columnar cell change without atypia
• Fibroadenoma

2) To express the cancer is found, or pathologist finds an unusual injury of sufficient data in the literature shows that excision is necessary to exclude an injury More importantly, like a cancer. Here are some examples:

• Fibro-epithelial lesions With the stromal cell
• Atypical ductal hyperplasia (see my blog entry focal ADH)
• Ductal carcinoma in situ
• rel = "nofollow" href = "http://www.breastpathologyconsults.com/blog/sbpc_library/about-invasive-carcinoma/"> invasive carcinoma

3) The conclusions the pathologist did not correlate with the results of radiology and surgical excision is necessary for clarify the discrepancy.

4) The biopsy has a "gray" area where the controversial results of the literature did not universal agreement as surgery or not be done. Numerous studies have shown that these lesions should be removed, but other studies say otherwise. Here are some examples:

• Lobular neoplasia (ALH / LCIS)
• Papilloma without atypia
• Radial SCAR / complex sclerosing lesion
• Flat epithelial atypia

It is unfortunate that we still have these gray areas, where doctors are unable to reach universal agreement on the need for surgery. This is mainly because most studies are small and an institution so it is difficult to generalize the results to the public. Larger prospective studies in May to help to identify these "zones" gray better, so I can finally determine whether patients with these findings in a biopsy need to go to surgery.

For more information on breast pathology visit SBPC.

Thomas J. Lawton MD

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