By Joel Benowitz M.D.

I advised her that she had three options: being observed carefully for six months, with a follow-up mammogram and ultrasound; open surgery; a core needle biopsy; or my strongest recommendation, a vacuum-assisted breast biopsy directed with ultrasound. She took my advice and chose the ultrasound directed vacuum-assisted biopsy. I’m pleased, but not surprised to report, that in less than 15 minutes, the mass was gone.

Like Ms. Greenhut, many women are finding out just how swiftly and effortlessly an abnormality in the breast can be eradicated, or at least reduced in size, with minimal pain and discomfort to the patient.

Of equal importance, the procedure provides doctors with an accurate pathological diagnosis of the patient’s breast abnormality, and a medical blueprint for any future care. This should significantly lower the number of unnecessary open surgical procedures in diagnosing and treating breast diseases, giving women a more medically sound and humane choice over the scalpel.

A startling 1.4 million women per year in the United States have a biopsy of the breast to rule out a malignancy. Fortunately, 80% of these abnormalities are benign. These statistics, however, points to the fact that the approach to diagnoses needs to be less invasive, faster, safer and easier than open surgical biopsy.

I believe that patients should have an understanding of all medical options open to them, including the choice between open surgical biopsy and minimally invasive biopsy procedures. But if you consider that 75% of the breast biopsies are done in the same open surgical procedure where the growth is removed, it should be clear most patients are undergoing open surgical biopsies unnecessarily.

A minimally invasive procedure can obtain an equally reliable breast biopsy and in many cases, the abnormality can be completely removed through this much less invasive technique. With this procedure, a patient can have her entire breast abnormality removed in a matter of minutes without open surgery, without pain and without compromising the probability of a better diagnosis on pathology.

This procedure is done under local anesthesia and in the convenience of a doctor’s office. My patients like the idea of walking out of my office in less than 30 minutes with only a Band-Aid on the puncture site.

If, however, an abnormality is discovered on the ultrasound, an ultrasound guided vacuum-assisted breast biopsy is performed. If the abnormality is on the mammography then what is called a “stereotactic directed biopsy” can be performed.

During this procedure, the abnormality is located by ultrasound or digital mammography. After the area is thoroughly cleansed, a local anesthetic is given to numb the area. A needle is inserted into the abnormality to gently collect some tissue, which is sent for examination under a microscope. Most patients experience minimal or no pain during the procedure.

A tiny “microclip” may be placed in the area of the abnormality to ensure that the area can be located in the future. The patient will not feel the clip at all and there are no side effects related to it. The pathology results can be obtained as quickly as 24 hours later. If the abnormality is benign then no further treatment is necessary, the patient will follow-up with normal breast screenings and self-examinations. If, unfortunately, the biopsy results return with pre-malignant or malignant disease then further staging and open surgical excision will be necessary.

My patients have often told me that they believe if more physicians used this approach for diagnosis of breast diseases, a greater number of women would go for the mammograms and would have lumps removed with no hesitation.

This procedure is a tremendous breakthrough for women’s health. This should take the fear out of breast biopsy procedures for the million women who would otherwise undergo needless diagnostic procedures with a scalpel.

Dr. Benowitz is the Director of Surgery at Long Beach Medical Center in Long Beach, New York. He is a diplomat of the American Board of Surgery and Fellow of the American College of Surgeons. Dr. Benowitz is a breast surgeon specializing in minimally invasive breast biopsies and certified in ultrasound by the American Society of Breast Surgeons.