I heard that open biopsy is the initial prodecure for breast palpable breast mass lesions in most of our hospitals. Can you write down the initial or first procedure used for these women in your hospitals?

A. Fine needle aspiration biopsy

B. Core needle biopsy

C. Open biopsy

Hospitals in China

In most situation or in most cases.

Also what is the initial procedure for most non-palpable breast lesions.

Palpable lesions: one of A, B, C

Non-palpable lesions:one of A, B, C. 

Thanks,

cz

 It varies depending on the breast surgeons preference.  One breast surgeon I worked closely with will do the following:

For palpable masses, if she strongly suspects cancer, she would do core biopsy direct in her office, becaue she would like to know the ER/PR/ her 2 fast.  Although we can do these ancillary studies with FNA cell block or direct smears, sometimes the IHC is not successful due to lack of enough cells and it takes longer times than core biopsy to know the results.  If we use direct smears for IHC, we have to lift up the cover slip, de-stain and restain.

If she is not strongly suspect cancer, but cannot exclude it, she would ask us to do a FNA as the initial work up.

For non-palpable lesions, she varies depending upon radiographic findings, sometimes core biopsies directly, sometimes FNA first.

 Dear Dr. Zhao,

Nice meeting you and communicating with you at this wonderful platform. I will not attend the USCAP conference at boston this year because that specific week was marked off by one of my colleagues.  Our staffing status cannot allow 2 pathologists taking off at any giving time.  But I will go to Boston to see my old friends, becaue my home is only 2 hours away.  I will be very delighted to see you there.  I will probably  go to the Wash U Alumini reception, i think on Saturday night, right? 

 Hi, Dr. Yu.

I am sure we will meet somedays. Thanks, cz

 I am preparing a breast cytopathology related talk and hope to know the imformation in China. Wish people can help me.

Could some one help to put this into all other sections?

Thanks,

cz

赵老师帖子：What is the initial procedure in palpable brest lesions 如果摸到乳腺包块，第一步如何做？I heard that open biopsy is the initial prodecure for breast palpable breast mass lesions in most of our hospitals.我听说我们许多医院一摸到乳腺包块就手术切开取活检， Can you write down the initial or first procedure used for these women in your hospitals?大家都能说出自家医院的处理方法吗？

A. Fine needle aspiration biopsy   A、细针吸活检，

B. Core needle biopsy     B、粗针活检

C. Open biopsy          C、手术切开除活检，

mingfuyu 帖子：It varies depending on the breast surgeons preference.如何处理取决于外科医生的不同选择，  One breast surgeon I worked closely with will do the following:与我有密切接触的外科医生会处理如下：For palpable masses, if she strongly suspects cancer, she would do core biopsy direct in her office,如果摸到乳腺包块非常可疑癌，她会做粗针活检。 becaue she would like to know the ER/PR/ her 2 fast.主要是她想更快的知道ER/PR/ her 2结果。  Although we can do these ancillary studies with FNA cell block or direct smears, sometimes the IHC is not successful due to lack of enough cells and it takes longer times than core biopsy to know the results. 如果我们做传统的细针吸活检，取细胞块或直接细胞涂片，做出来的免疫组化不一定能满意，要想知道免疫组化结果会非常慢。 If we use direct smears for IHC, we have to lift up the cover slip, de-stain and restain.如果用涂片做免疫组化，必须去掉盖玻片，需要去染和复染。If she is not strongly suspect cancer, but cannot exclude it, she would ask us to do a FNA as the initial work up.如果外科医生不是特别怀疑癌，也不排除癌的话，我们可以第一步先做细针吸活检，For non-palpable lesions, she varies depending upon radiographic findings, sometimes core biopsies directly, sometimes FNA first.摸不清楚的包块，如何处理取决于放射科医生的意见，有时粗针，有时细针吸活检。 None of our surgeons would do open biopsy directly for breast masses, to my experience..在我的印象里，我们医院没有一例外科医生直接手术切开取活检。

       这是一个非常好的帖子，尽管如此简单，大家没有太多的回帖，主要是不知道什么是最标准的处理方法。我们医院也是因人而异，比如一个病人摸起来非常象乳腺癌，就直接手术，手术台上做冰冻切片，证实癌直接做大手术，保乳的人非常少，有些癌很小我让外科医生保乳，他们问病人，病人坚决不保，也就不保了。还有些特殊类型的癌，如胶样癌，小管癌，我坚持让病人保乳，也是费半天劲，不落好。有时也保不住乳腺。

     如果摸的包块不很象癌，就做细针吸活检细胞学诊断，如果有问题再做手术大切，没有做粗针活检的习惯。

     如果是摸不清的乳腺包块，基本是都是观察， 不做病理检查。

     有一个医生可疑乳癌，喜欢切开取活检，我说他好几次，现在也没有这样的人了。     请赵老师讲一讲粗针活检的优点。也想问mingfuyu 老师，为什么要快速知道PR ER HER2的结果？一般内分泌治疗都是在化疗放疗半年后，早知道免疫组化结果有什么治疗用途？