https://www.mayoclinic.org/tests-procedures/breast-biopsy/about/pac-20384812

Precision BiopsyKev txiav txim siab-Ua raws li kev kuaj pom thiab kuaj pom

Percutaneous mis biopsy tsis yog ib qho kev tswj xyuas cov txheej txheem cais tab sis qhov kawg ntawm qhov kev txiav txim siab dav dav - ua haujlwm ua ke nrog kev ntsuas hluav taws xob, kev soj ntsuam palpation thiab tus neeg mob- cov yam ntxwv tshwj xeeb. Nws lub hauv paus ntsiab lus qhia yogkev qhia tsim nyog kom tsis txhob dhau -biopsy, kom ntseeg tau tias txhua qhov kev ntsuas qhov ntsuas tau raug kuaj pom tseeb.

Kev xaiv cov qauv kev taw qhia cov duab yog qhov txuas tseem ceeb hauv cov kev txiav txim siab kho mob. Ultrasound, mammography (X-ray) thiab MRI ntawm lub mis yog peb lub ntsiab lus tseem ceeb rau kev ntsuam xyuas kab mob ntawm lub mis, txhua qhov muaj txiaj ntsig zoo rau kev taw qhia. Tiag -lub sij hawm tau, xoom ionizing hluav taws xob, multiplanar scanning muaj peev xwm thiab ntshiab vascular delineation ua ultrasound kev taw qhia thawj - kab kev xaiv rau palpable masses thiab sonographically pom lesions, nrog tshwj xeeb superiority nyob rau hauv ntom fibroglandular ob lub mis. Stereotactic X-ray-coj biopsy yog yuav tsum tau rau mammography-tsuas yog cov kev tshawb pom suav nrog cais microcalcifications, architectural distortion thiab asymmetric parenchymal opacity. Thaum lub sij hawm stereotactic cov txheej txheem, cov neeg mob tuav txoj hauj lwm nyob rau hauv siab biopsy rooj nrog compressed thiab immobilized mis cov ntaub so ntswg; lub khoos phis tawj suav peb- qhov chaw ntawm qhov chaw ntawm qhov chaw sib koom ua ke los ntawm dual- lub kaum sab xis radiographic projections rau steer koob cannulation. MRI- qhia txog kev kuaj ntshav yog tshwj xeeb rau MRI-occult txhim kho nodules thiab delineation ntawm kab mob multifocal/multicentric, txawm tias cuam tshuam los ntawm cov khoom siv siab, kev ua haujlwm zoo thiab kev siv nyiaj kho mob ntau.

Kev xaiv ntawm biopsy modality sib npaug diagnostic txaus tiv thaiv txheej txheem invasiveness. Fine-Needle Aspiration Biopsy (FNAB) yog qhia rau cyst aspiration thiab decompression, cytological ntsuam xyuas ntawm cov qog nqaij hlav tsis txaus ntseeg, lossis kev soj ntsuam ua ntej sai hauv cov peev txheej- txwv chaw. Txawm li cas los xij, nws qhov tsis muaj peev xwm ua kom tau qhov tsis zoo histologic architecture lossis ua molecular subtyping txwv nws lub luag haujlwm hauv kev lees paub mob qog noj ntshav mis. Core Needle Biopsy (CNB) tseem yog tus qauv kub rau cov khoom hauv lub mis, ua kom cov ntaub so ntswg txaus rau tag nrho - spectrum pathological workup nrog rau histologic typing, grading thiab immunohistochemical profiling (ER, PR, HER2, Ki-67) nrog kev kuaj mob siab. Vacuum-Assisted Biopsy (VAB) bears irreplaceable kho mob tus nqi nyob rau hauv peb qhov xwm txheej tseem ceeb:

Kev ntsuam xyuas microcalcification: bulk sib law liag cov ntaub so ntswg sau guarantees ua tau zoo retrieval ntawm tej yam txawv calcifications;

Indeterminate B3 borderline lesions (piv txwv li, atypical ductal hyperplasia [ADH], lobular carcinoma nyob rau hauv situ [LCIS]): loj-cov ntaub ntawv ntim txo qis kev kwv yees thiab tsis tsim nyog qhib phais excision nyob rau hauv xaiv;

Diagnostic and therapeutic excision of benign-pob qhov txhab tsawg dua los yog sib npaug li 3 cm xws li fibroadenoma.

Kev npaj tus kheej yog qhov tsis tseem ceeb nyob rau hauv cov xwm txheej tshwj xeeb. Rau cov poj niam cov neeg mob hluas, kev xaiv kev kho mob tseem ceeb tshaj plaws ntawm kev siv tshuaj tua kab mob kom khaws cia lub mis cosmesis thiab kev ua haujlwm lactation yav tom ntej. Biopsy nyob rau hauv cov poj niam cev xeeb tub thiab lactating poj niam xav tau kev ceev faj nrog ultrasound raws li cov kev xav thiab kev taw qhia modality tom qab multidisciplinary specialist ntsuam xyuas. FNAB tsis pom zoo rau qhov xav tias phyllodes qog ib qho chaw kho mob cov lus qhia vim qhov nce tsis tseeb - tus nqi tsis zoo; CNB yog qhov zoo dua, nrog cov ntaub ntawv qhia txog pathology yuav tsum tau piav qhia txog qhov tseem ceeb xws li stromal cellularity, nuclear atypia thiab mitotic suav los qhia txog kev npaj phais phais tom ntej. Rau kev kuaj mob tshiab theem IV metastatic mis mob qog noj ntshav, CNB lossis VAB ua haujlwm raws li tus qauv txheej txheem kom tau txais cov qog nqaij hlav thawj zaug rau histology thiab molecular subtyping; Tib lub sijhawm biopsy ntawm qhov chaw metastatic (lymph node, siab, pob txha) paub meej tias metastatic kis tau thiab txheeb xyuas qhov muaj peev xwm hloov phenotypic ntawm malignancy.

Los ntawm cov ntaub so ntswg Cores mus rau Pathology Reports: Hauv -Qhov tob Mining ntawm Diagnostic Value

High-cov ntaub so ntswg zoo yog cov cim thawj zaug xwb; standardized specimen processing, precise pathological interpretation and comprehensive molecular testing translate histologic specimens into actionable pov thawj rau kev tswj xyuas tus kheej.

Standardized specimen fixation ua raws li lub hauv paus ntawm kev soj ntsuam kev ntseeg tau. Raws li 2025 Suav Anti-Cancer Association (CACA) Cov Lus Qhia rau Kev Tshawb Fawb Kev Sib Koom thiab Kev Kho Mob ntawm Malignancies, tag nrho cov qog nqaij hlav qog nqaij hlav yuav tsum tau muab tso rau hauv qhov txaus 4% nruab nrab buffered formalin ntawm qhov tsawg kawg nkaus 1:10 fixative-rau- qhov sib piv ntawm ib teev{8}. Ntau cov ntaub so ntswg uas tau los ntawm VAB raug cais nrog cov ntawv lim los yog cov ntaub qhwv kom pab kom tsis txhob muaj teeb meem hauv kev nkag mus. Fixation ncua sij hawm yog tswj hwm nruj me ntsis ntawm 6 thiab 72 teev: kev kho tsis txaus yuav cuam tshuam qhov tshwj xeeb tom qab staining thaum lub sij hawm ntev immersion ua rau ntau cov nqaij mos sclerosis impeding microtome sectioning. Cov qauv tsim los rau kev soj ntsuam molecular yog aliquoted tam sim ntawd tom qab kuaj: ib qho aliquot ua raws li niaj hnub formalin fixation rau cov pa histopathology, thiab lwm yam yog snap- khov hauv cov kua nitrogen los yog khaws cia rau hauv cov khoom tshwj xeeb xws li RNAlater rau downstream tom ntej- tiam thiab kev sib txuas ntawm RNA.

Systematic, structured pathology qhia piav qhia txog lub mis niaj hnub pathology. Daim ntawv qhia txog biopsy ua tiav dhau qhov yooj yim benign- lossis -malignant dichotomy thiab suav nrog cov ntaub ntawv kuaj mob ntau yam. Rau cov kab mob qog nqaij hlav hauv lub mis, qhov yuav tsum tau tshaj tawm cov ntsiab lus npog: histologic subtype (piv txwv li, invasive ductal carcinoma, tsis muaj hom tshwj xeeb), Nottingham histologic qib, kwv yees cov qog loj los ntawm cov qauv qauv, cov txheej txheem phais kab mob (thaum muaj), lymphovascular ntxeem tau thiab core immunohistochemical receptor biogenesterone ER (ERest receptors), xwm txheej thiab Ki-67 proliferation index. Cov kev tshawb pom sib xyaw no ua rau cov qog nqaij hlav rau hauv cov kab mob hauv lub cev (Luminal A, Luminal B, HER2-enriched, triple-negative), ua lub hauv paus tseem ceeb rau kev tsim kho kev kho mob.

Kev tswj hwm ntawm ciam teb grey- thaj tsam qhov txhab ua rau pom kev kos duab ntawm kev kuaj mob. Kev txwv tsis pub coj mus kuaj ntawm percutaneous biopsy feem ntau ua rau kev kuaj mob B3 tsis muaj ciam teb. Piv txwv li, atypical ductal hyperplasia (ADH) yog qee zaus indistinguishable los ntawm qis-qib ductal carcinoma hauv situ (DCIS) ntawm CNB cov qauv. Cov ntaub ntawv qhia txog kab mob muaj lub luag haujlwm tau txais cov lus piav qhia ntawm "tsawg kawg ADH" thiab pom zoo kom ua tiav kev txiav txim siab rau kev kuaj mob. Ib yam li ntawd, rau papillary lesions thiab radial scars, pathologists qhia meej meej cov ntaub ntawv ntsuam xyuas tsis meej thiab malignant upgrade txaus ntshai los pab txhawb pov thawj- raws li kev txiav txim siab kho mob- ua.

Kev koom ua ke ntawm molecular pathology tsav lub mis kuaj mob rau hauv cov tshuaj niaj hnub. Niaj hnub nimno molecular profiling yog tam sim no ua tau rau ntawm qhov tsawg kawg nkaus invasive biopsy specimens. Fluorescence nyob rau hauv situ hybridization (FISH) validates HER2 noob amplification rau cov neeg mob nrog equivocal IHC 2+ tau. Tom ntej no -generation sequencing (NGS) kuaj pom kev hloov pauv ntawm cov noob, noob fusions thiab luam cov lej aberrations hla ntau ntau txog ntau pua tus mob qog noj ntshav-cov noob muaj feem cuam tshuam rau cov hom phiaj kho mob rau kev mob qog noj ntshav siab (xws li PIK3CA, ESR1 kev hloov pauv). Tsis tas li ntawd, kev tshuaj ntsuam xyuas ntau yam suav nrog Oncotype DX thiab MammaPrint siv biopsy{12}} muab cov ntaub so ntswg los ntsuas qhov kev pheej hmoo rov tshwm sim rau cov tshuaj hormones thaum ntxov{13}} mob qog noj ntshav zoo thiab qhia kev xaiv tshuaj kho mob ntxiv. Xws li molecular stratification hloov kev saib xyuas oncology los ntawm empirical uniform kev kho mob mus rau tailored ib tug neeg txoj kev tswj.

Kev sib txuas meej ntawm Biopsy Cov txiaj ntsig thiab kev kho mob kho mob

Cov txiaj ntsig zoo tshaj plaws ntawm kev kuaj ntshav biopsy yog nyob rau hauv cov kev taw qhia kho mob, nrog rau txhua tus kws kho mob piav qhia txog cov kab mob pathology qhia txog cov kev tswj xyuas kev kho mob sib txawv.

Ua raws li-Txog thiab soj ntsuam rau Benign Histology

Cov neeg mob uas tau txais txiaj ntsig zoo (fibroadenoma, ib txwm muaj ductal hyperplasia, cyst yooj yim) feem ntau zam kev cuam tshuam kev ua haujlwm tsis tau xav tau kev saib xyuas ntev -. Cov neeg mob tau txais kev txiav tawm VAB tiav ntawm benign fibroadenoma tau qhia txog kev soj ntsuam ob xyoos ntawm ultrasound txhua txhua 6-12 lub hlis muab 2%-5% kev pheej hmoo rov tshwm sim hauv cheeb tsam ntawm qhov chaw ua ntej biopsy. Kev soj ntsuam luv luv mus rau 6- lub hlis ib ntus rau siab - cov kab mob benign xws li complex fibroadenoma thiab intraductal papilloma. Kev qhia meej rau tus neeg mob yog qhov tseem ceeb los qhia meej tias cov kab mob benign tsis sib npaug rau kev daws teeb meem kab mob mus ntev thiab ua raws li niaj zaus- nce ntxiv yog qhov tseem ceeb rau kev nyab xeeb mus sij hawm ntev.

Kev Tswj Tus Kheej rau Ductal Carcinoma Hauv Situ (DCIS, Theem 0 Mob Cancer)

DCIS kev tswj hwm lub hom phiaj tiv thaiv kev loj hlob mus rau qhov mob qog noj ntshav, nrog rau cov tswv yim kho mob kom haum rau qib nuclear, thaj tsam necrotic thiab qhov txhab loj. Kev soj ntsuam nquag tshwm sim los ua ib txoj hauv kev zoo rau kev pheej hmoo tsawg - DCIS, tshwj xeeb tshaj yog cov neeg laus cov neeg mob uas muaj ntau yam tsis zoo lossis cov kev phais poob qis. Kev kho tus qauv kho mob muaj lub mis- khaws cia dav hauv zos excision ntxiv rau adjuvant tag nrho- kev kho lub mis rau cov neeg sib tw ua haujlwm. Radiopaque localization clips tau xa tawm thaum lub sijhawm ua haujlwm biopsy ua kom muaj qhov tseeb ntawm qhov kev ua haujlwm tsis zoo rau cov kws phais mob, thiab cov qog qog nqaij hlav qog nqaij hlav feem ntau raug tshem tawm tshwj tsis yog tias microinvasion xav tias.

Multidisciplinary Care Initiation for Invasive Breast Carcinoma

Ib qho kev lees paub tias muaj kab mob phem ua rau muaj kev sib tham tam sim ntawm Pawg Neeg Ua Haujlwm Pabcuam (MDT). Biomarker profileing (ER, PR, HER2, Ki-67) los ntawm cov qauv kuaj ntshav biopsy ua rau tag nrho cov kev npaj khomob uas muaj xws li kev kho tshuaj khomob, kho endocrine thiab cov neeg ua haujlwm tsom. Preoperative biopsy cov ntaub ntawv ua kom yooj yim xam cov qog- mus rau - lub mis ntim piv los ntsuas qhov ua tau ntawm kev phais kom txuag lub mis. Rau cov neeg mob tau teem sijhawm rau kev kho neoadjuvant (preoperative chemo/targeted therapy), biopsy cov ntaub so ntswg yog ib qho muaj biospecimen rau kev kwv yees biomarker kuaj los ntsuas kev kho mob.

Tshaj tawm -Neoadjuvant Re-Biopsy rau Kev Ntsuam Xyuas Cov Lus Teb

Ib ntus lossis tom qab-neoadjuvant repeat biopsy ( teb-kev coj noj coj ua coj mus kuaj) muab cov txiaj ntsig tseem ceeb ntawm kev soj ntsuam los ntawm kev sib piv histologic thiab molecular profiling ua ntej- thiab tom qab- kho. Pathologic Complete Response (pCR), txhais tau tias yog tag nrho kev tshem tawm ntawm cov qog qog nqaij hlav ntawm cov cores rov ua dua, ua rau muaj txiaj ntsig zoo ntev -lub sijhawm kwv yees; persistent residual malignancy yuav tsum tau kho txoj cai tswj kev hloov kho. Xws li ntawm -kev kho mob rov ua piv txwv ua rau muaj kev hloov pauv, hloov kho tus kheej ntawm kev tiv thaiv kab mob qog noj ntshav.

Kaw Remark

Percutaneous mis biopsy txuas nrog cov duab pom tsis meej thiab qhov tseeb ntawm kab mob, txuas cov kev soj ntsuam soj ntsuam rau cov pov thawj-raws li kev txiav txim siab kho mob. Nyob deb dhau lub cuab yeej tshuaj ntsuam xyuas ib leeg, nws ua haujlwm raws li lub compass ntawm precision oncology: los ntawm cov ntaub so ntswg raug mob tsawg, qhov koob zoo no qhia txog kev kho tus kheej rau txhua tus neeg mob uas muaj kab mob hauv lub mis.