Sandbox breast cancer biopsy
Mirdula Sharma, MBBS 

# Overview
Breast biopsy may be helpful in the diagnosis of breast cancer.

# Biopsy
- During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. 
- A breast biopsy is the only definite way to diagnose breast cancer. Most biopsy samples taken from breast lumps are found to be benign (non-cancerous).
- The type of biopsy will depend on whether the lump can be felt (palpable) or not (non-palpable). Ultrasound or computed tomography (CT) scan may be used to guide the biopsy. The types of biopsy that may be used are:
- fine needle aspiration (FNA)
- core needle biopsy
- stereotactic core needle biopsy
- wire localization biopsy
- surgical biopsy to remove part of or all of a breast lump or abnormal area
- A biopsy is also done if inflammatory breast cancer is suspected, often including a skin biopsy. A biopsy of the nipple is taken if the doctor suspects Paget disease of the nipple.

# Scintimammography
- Scintimammography uses a radioactive material (known as a radioactive isotope) and a special camera to take pictures of the breast. It is done:
- to check breast lumps that do not show up clearly on a mammogram because of:
- scar tissue from previous surgery or radiation therapy
- dense breast tissue
- breast implants
- when multiple tumours are seen in the breast
- to scan the lymph nodes in the armpit (axilla) to see if they contain cancer
- Scintimammography is not commonly used. It does not replace mammography, which is still the standard imaging test used to diagnose breast cancer. At present, scintimammography is considered a second-line diagnostic tool. It may be used in some women to assess breast abnormalities after a mammogram.

# Lymph Node Biopsy
A lymph node
lymph node
A small, bean-shaped mass of lymphatic tissue along lymph vessels (tubes through which lymph fluid travels in the body). Lymph nodes store lymphocytes (a type of white blood cell that fights germs, foreign substances or cancer cells) and filters bacteria and foreign substances (including cancer cell biopsy removes lymph nodes during a surgical procedure so they can be examined under a microscope to find out if they contain cancer.
With breast cancer, lymph nodes from under the arm (axilla) are removed. Breast cancer cells can travel through the lymph system, and the first place they may spread is to these lymph nodes. The number of lymph nodes that have cancer helps to determine the stage
stage
A description of the extent of cancer in the body, including the size of the tumour, whether there are cancer cells in the lymph nodes and whether the disease has spread from its original site to other parts of the body. of breast cancer.

# Axillary Lymph Node Dissection
Axillary lymph node dissection (ALND) is a surgical procedure to remove the lymph nodes under the arm.
- Most breast cancers require staging with ALND.
- Axillary lymph node dissection is the standard method of checking lymph nodes.

# Sentinel Lymph Node Biopsy
- The sentinel node is the first lymph node in a chain or cluster of lymph nodes that receives lymph fluid from the area around a tumour. Cancer cells will most likely spread to these lymph nodes. Sentinel lymph node biopsy (SLNB) is the removal of the sentinel node so it can be examined to see if contains cancer cells.
- Sentinel lymph node biopsy may be offered to women with breast tumours smaller than 5 cm, and the axillary lymph nodes cannot be felt during an examination by the doctor.
- Sentinel lymph node biopsy may not be suitable for women:
- who had breast surgery or radiation therapy in the past
- with axillary lymph nodes the doctor can feel
- with locally advanced or advanced breast cancer (tumours greater than 5 cm in size)
- with tumours in more than one area in the breast (multifocal tumours)
- with metastatic breast cancer
- inflammatory breast cancer
- who have had breast reduction surgery, or have breast implants

# Bone Scan
- A bone scan uses bone-seeking radioactive materials (radiopharmaceuticals) and a computer to create a picture of the bones. It is used to see if breast cancer has spread (metastasized) to the bones.
- A bone scan may be done if:
- alkaline phosphatase in the blood is increased
- there are lymph nodes in the armpit (axillary lymph nodes) that can be felt
- the primary breast tumour is larger than 5 cm
- the woman has aches and pains that may be caused by bone metastases
- A bone scan is not done in women who have stage I breast cancer.

# Liver Ultrasound
If the blood chemistry tests show increased levels of liver enzymes, a liver ultrasound may be done to check if the cancer has spread to the liver (liver metastases). 

# Hormone Receptor Testing
- Hormone receptor testing determines the amount of estrogen receptor (ER) and progesterone receptor (PR) in the breast cancer cells. This information will help doctors determine the woman's treatment plan. 

# Chest X-Ray
An x-ray uses small doses of radiation to make an image of the body's structures on film. A chest x-ray may be done to find out if breast cancer has spread to the lungs.