Diagnostic Surgery

There are many ways to detect or confirm a suspicion of the presence of a cancer. Microscopic examination of biopsy samples is the ideal way that a positive diagnosis of cancer can be made. This procedure involves physically removing all or part (tissue, cells, or fluid) of a suspected tumor and examining this material under a microscope. The purpose of a biopsy is to identify the histologic type of cancer and possibly stage of disease.

Any organ in the body can be biopsied utilizing a variety of techniques. Some may require major surgery, while others may not even require local anesthesia. Types of biopsies include incisional biopsy, excisional biopsy, endoscopic biopsy, colposcopic biopsy, bone marrow biopsy, fine needle aspiration biopsy, stereotactic biopsy, and core biopsy, to name a few. Biopsies typically leave gross tumor in the body.

A pathologist performs the microscopic examination of the biopsied material. After careful evaluation, a benign or malignant diagnosis can usually be established. A written report prepared by the pathologist is sent to the doctor who treats the cancer patient. This doctor will then make decisions regarding treatment based on the information found in this report.

Take breast cancer for example: If a breast abnormality is detected with mammography or physical exam, the patient will typically be referred for additional breast imaging with diagnostic mammography, ultrasound, or other imaging tests. While all of these methods of diagnosis can help detect a breast abnormality, biopsy followed by pathological (microscopic) analysis is really the only definitive way to determine if cancer is present.

The method of biopsy chosen will depend on,

• How suspicious the abnormality appears
• The size, shape, and location of the abnormality
• The number of abnormalities present
• The patient's medical history
• The patient's preference
• The training of the physician who is performing the biopsy
• The breast imaging center or surgical center where the biopsy is performed.

Side effects and risks of biopsy do exist, depending on the type of biopsy performed and certain biopsy techniques. Cytology procedures, needle biopsies, and core biopsies, sometimes may not even come up with a positive cancer diagnosis due to inadequate quantities of cells or tissue removed from the patient. In rare cases, an incorrect diagnosis could be made in the situation where the needle misses the tumor and removes only healthy or non-cancerous tissue. As with the case of preventive surgery, patients are strongly encouraged to discuss the advantages and disadvantages of the different biopsy methods with their physician(s) prior to undergoing the procedure(s).

A biopsy that removes only a fragment or portion of the tumor, primary or metastatic, is recorded in the abstract as non-cancer-directed treatment.