In this sense, techniques like vacuum-assisted biopsy (VAB) mean that patients with benign lesions or lesions suspected of being or that may turn into breast cancer can undergo a very simple ambulatory procedure, with local anesthesia and taking just between 5 and 30 minutes, depending on the size of the lesion. "It takes longer to prepare the patient, administer local anesthesia and explain the procedure than to perform the technique," explains Dr. Silvia Perez Rodrigo, Radiologist with the Breast Unit at MD Anderson Cancer Center Madrid.
The technique, which consists of piercing the breast lesion with an aspiration needle, differs from a conventional biopsy, the so-called core needle biopsy (CNB), in several aspects. First of all, the most important difference is that, with CNB a cut is made in the lesion for further analysis, while with VAB an aspiration is performed allowing the complete removal of the lesion without removing the needle from the breast, resulting in less bleeding "without losing sight of the lesion at all", says Dr. Perez Rodrigo. In fact, the procedure is always image-guided using the technique by which the lesion can be seen more clearly and in better detail, although ultrasound is the technique that offers greater comfort for both the patient and the medical professional.
Another difference between VAB and CNB is the thickness of the needle. While with CNB it can vary between 1 and 2 millimeters, with VAB it is somewhat thicker and can be between 3 and 4 millimeters. In addition, Dr. Perez Rodrigo points out, "VAB avoids scarring inside the breast usually caused by conventional surgery". As she explains, these scars can be difficult to distinguish from a carcinogenic lesion in radiological tests and mammograms to which this patient is subjected in the future, so VAB offers another important advantage.
Whether VAB is carried out for diagnostic purposes or therapeutic purposes, the patient can go home the same day, after the procedure, with just a pressure pad on the wound and some simple recommendations that, in the following 24 hours, certain precautions should be taken - resting the arm, applying cold to the area affected and using a good bra.
Currently, VAB is only indicated in women with benign lesions (fibroadenomas, adenomas ...) or premalignant lesions or those of undetermined significance, that is, benign lesions where full removal is recommended so that the pathologist can carry out an exhaustive analysis to ensure the benignity of the lesion, as they could become malignant over time. But, as Dr. Perez Rodrigo states, the Spanish Society of Breast Imaging (SEDIM), of which she is a research member, will soon begin a clinical trial to determine whether VAB could be effective in patients with triple negative or Her 2+ breast cancer who have a complete response to neoadjuvant chemotherapy, i.e., to chemotherapy administered before surgery.
Comités de Enfermedad Metastásica
Metastatic Disease Committees
Although most hospitals already have a Breast Cancer Committee, the reality is that they are almost always focused on the decisions affecting cases of patients with early stages of the disease. For this reason, Dr. Laura Garcia Estevez, head of the Breast Tumors Section of the Medical Oncology Service at MD Anderson Madrid, has just launched the Metastatic Disease Committees, committees at which the Radiology, Medical Oncology, Radiation Oncology and Clinical Trials services meet to analyze what steps to take in cases of patients with more advanced disease.
"In these meetings, which are held at the center every Monday, we decide whether the patient is a candidate for a biopsy, whether she can join any of the hospital's clinical trials or if another approach to the disease is possible", explains Dr. Garcia Estevez, who points out that setting up regular meetings in cases of this type "is something new at MD Anderson Madrid".
The patient, at the center of her illness: Patient Included Committee (PIC)
Likewise, MD Anderson Madrid has just launched a pilot project, led by Dr. Garcia Estevez, that intends the patient to be truly at the center of her illness: the Patient Included Committees (PIC). To this end, she has organized a series of Committees composed of Surgical Oncology / Gynecology, Radiology, Medical Oncology, Nursing and the patient herself. When facing a diagnosis of breast cancer, the patient has many doubts and the aim is to answer any questions the patient has in a meeting with all the professionals in charge of her treatment. Thus, the professionals can explain to the patient what the images of her tumor mean and what treatment they believe is the most suitable for her disease after the evaluation of all the tests.
"The patient can also ask the specialists directly about whatever doubts she may have", says Dr. Garcia Estevez, who, through these meetings, seeks to make the newly diagnosed breast cancer patient in an initial stage feel more secure, to help her understand that she is the true center of the approach to her disease so that she knows the people who are going to take care of her treatment.