The outcome of a triple assessment for a breast lesion dictates the surgical therapy that ensues. In some circumstances, the preoperative assessment may yield inconclusive or indeterminate results thus requiring an excision biopsy to confirm the histological diagnosis. Where a lesion is preoperatively proven to be benign, decision to excise the lesion may be due to patient preference, the size of the lesion (e.g a large (> 2cm) fibro adenoma) or suspicious clinical features. Both approaches involve an excision of the target lesion with minimal disruption of surrounding normal breast tissue.
Indications for an Excision Biopsy/Lumpectomy
- Excision of a proven benign lesion due to:
- Patient preference
- Large lesions resulting in a cosmetic defect
- Suspicious clinical history
- Lesions with indeterminate or atypical histology (B3) on preoperative assessment (e.g ADH, ALH, ductal hyperplasia of usual type) or suspicious clinical features.
- Presence of a radial scar (associated with the presence of atypia or malignancy).
Serious/Frequently Occurring Risks
- Infection
- Bleeding
- Poor cosmetic outcome
- Need for further surgery
Blood Transfusion Necessary
None
Type of Anaesthesia/Sedation
- General anesthesia (generally allows for faster lesion localization and better patient compliance).
- Local anesthesia feasible for small but easily palpable lesions (infiltration of local anesthesia may result in the lesion becoming difficult to find).
Follow-up or Need for Further Procedure
- Routine wound check in benign cases.
- Multidisciplinary review of histology, especially where preoperative assessment was suspicious or indeterminate.
- Further excision may be required if malignancy is confirmed and microscopic resection margins are deemed inadequate
