GUEST COMMENTARY PHILLIP G. SUTTON, M.D., F.A.C.S. Breast Surgery and General Surgery Certified by the American Board of Surgery

"Doctor, if there is something in my breast,
Why not just cut it out?"
July 2001

In my practice of breast surgery, this is a question I hear every day. The most common events to precipitate such a question are abnormal mammograms and/or palpable abnormalities in the breast found by the patient or her physician. Until recent years, the breast surgeon would typically recommend a surgical biopsy to remove tissue in these situations. The current, state-of-the-art approach, however, is to establish a tissue diagnosis prior to operative procedures whenever possible.

The methods employed to obtain a tissue specimen from the breast involve the use of needles. This is, in fact, a type of biopsy. There are two basic types of needle biopsies: 1) FNA, or fine needle aspiration, and 2) Core needle biopsy. The needle biopsies are an office procedure, and they are performed utilizing a local anesthetic. The surgeon or the radiologist may perform this type of biopsy. Imaging devices such as an ultrasound unit or specialized mammography unit may be used to guide the needle into the precise location of the abnormality.

The FNA uses a small needle similar to the one used for drawing blood samples. This procedure removes groups of cells that are then placed on a glass slide. This process of analysis is the same as a PAP smear. The pathologist calls this a cytological analysis.

The Core needle biopsy uses a larger needle that is designed to remove an actual piece of tissue. The amount removed is about ½ inch in length, and it is about the diameter of a pencil lead. The pathologist is now able to provide a histological diagnosis.

There are several reasons why this is the preferred approach. If the abnormality was discovered by mammography, and the core needle biopsy resulted in a benign (harmless) histological diagnosis, the patient can safely avoid having a surgical procedure performed. If a benign abnormality is causing symptoms for the patient, it may need complete surgical removal. In such cases, when the surgeon knows that the lesion is benign, less tissue will be removed since there was no evidence of cancer in the needle biopsy specimen.

The majority of breast cancers can be diagnosed using one of the needle techniques. In our breast center, over 75% of the breast cancer patients know that they have a cancer diagnosis before ever going into the operating room. This allows the surgeon to present treatment options to the patient that are based on an established pathologic diagnosis. For patients who wish to have surgical treatment without removing the breast (breast conservation), it is very important that the surgeon removes a rim of normal tissue around the cancer. The surgeon, therefore, has a definite advantage if he/she knows that a cancer is present when performing the operative procedure.

When the needle biopsy has resulted in a benign diagnosis, the patient can safely avoid an operation. This also provides considerable savings in the patient's time away from her daily activities and responsibilities, and it provides financial savings for her as well.

In order to have complete confidence in a needle biopsy diagnosis, it is necessary to have a team approach. This requires that all of the pieces of the puzzle (physical exam, imaging studies of the breast, and pathology analysis of the needle biopsy) must fit together. This will be discussed in a future article.


About Dr. Sutton
Dr. Sutton has been in private practice in Houston, Texas, since 1979.

After graduating from The University of Texas Medical School in Galveston, he completed a surgical residency at the University of Texas Health Science Center in San Antonio and served as chief surgical resident in 1978-1979.

The American Board of Surgery certified Dr. Sutton in 1980, and he became a fellow of the American College of Surgeons in 1982. He is also a member of the American Society of Breast Surgeons.

The primary focus of Dr. Sutton's surgical practice is the diagnosis and surgical treatment of breast disease and breast cancer, and he has been selected as a provider for the M.D. Anderson Cancer Network. For additional information, Dr. Sutton may be contacted via e-mail at psuttonmd@dbmed.net.


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