Bill Klaproth (Host):  There's a new way to get a breast biopsy that's less invasive than surgery. Here to help us learn more is Dr. Craig Brackett, director of Tidelands Health Breast Health Program. Dr. Brackett thanks for your time today. So, what is a minimally invasive breast biopsy?

Dr. Craig Brackett (Guest):   Well, in the past, when a lady would have an abnormal mammogram, ultrasound, or physical exam, we would take those patients to the operating room and put them to sleep and make an incision in the breast and take out the mass to see what it was. That was fine 20 years ago, but today we kind of like to know what we're operating on. The other thing is that 80% of biopsies are benign. So, with these minimally invasive techniques, which are really image-guided, we use mammogram, ultrasound or MRI to identify an abnormality that has been seen and using image-guidance to place a needle into the breast, through a very small nick in the skin that we do in our office, really, and to figure out what's going on. If it's benign, she just goes home and she's fine and you just do a follow up mammogram. But, if she has a cancer, then we can plan her cancer treatment through this biopsy.

Bill:  So, this sounds like it's a very quick procedure. So, the benefits of this over surgery are, certainly less time, correct? Less scarring? What are the other benefits?

Dr. Brackett:   Well, the main benefit is that it's done in our imaging center. So, they can drive themselves to the biopsy and then drive themselves home. There's no deformity of the breast, there's no anesthesia, there's very minimal recovery, there's very minimal pain, there's absolutely no scarring and there are no problems looking at future mammograms. When we do open breast biopsies, we leave scar tissue that makes future reading of those studies a little clouded or more complicated.

Bill:  Dr. Brackett, who is a good candidate for this, then?

Dr. Brackett:  Just about anybody who has an abnormal imaging. There are a few locations of the lesion, body habitus, if they have neurological issues, but almost every single patient should be biopsied or attempted to have a minimally invasive breast biopsy. In our program, over 96% of our cancers are diagnosed with a needle, and that's really important. But, the most important thing is the 1.6 million biopsies done in our country this year and only about half of them are done minimally invasive. Eighty percent of these are benign, so we'd really like to do this through a small nick in the skin and save women the deformity and the discomfort and the complication that can occur with an open surgical biopsy. So, almost anybody can have a minimally invasive breast biopsy.

Bill:  This sounds so good it seems like there would never be a need to do a surgical biopsy, but you say only half the biopsies done are by minimally invasive breast biopsy.

Dr. Brackett:  I don't know why that is because we started doing stereotactic before needle biopsies 20 years ago and we were actually the third hospital in the state to start doing stereotactic, which is a mammographically directed biopsy. And then, we started doing ultrasound-guided, which is using ultrasound to help put the needle in to sample it, in the late 1990s. Now, we're doing MRI-guided breast biopsies, which is using MRI to help us see or biopsy things that are only seen on MRI, and we're the only facility on the Grand Strand that can offer that biopsy as well.

Bill:  So, can you describe the procedure a little bit more for us? I know you said there's no anesthesia; women can drive themselves to the doctor. Is this done as an outpatient service?

Dr. Brackett:  Yes. It's done at the imaging center where our office is and, for example, for a stereotactic biopsy which is mammographically directed, the woman will have a mammogram like she normally does, we'll take an x-ray, we'll see area that we're concerned about, we'll prep the breast, we use a little bit of lidocaine to anesthetize the skin and make a 2 mm nick in the skin, we then put more lidocaine into the breast, and then under the guidance of the machine and the computer, we'll put the needle right where it needs to be. We'll then check our picture and if everything looks good, the biopsy takes 30 seconds. That quick and then we put a little clip to mark the place we biopsied so we can always have a reference point, a localization point, so if we need to take it out, we know exactly where we were. The whole procedure takes about 10 minutes and then they go home that day with a little Steri-strip on their breast.

Bill:  That is amazing. So, the recovery time is basically--there is no recovery time?

Dr. Brackett:  Most people can go back to work the next day. Occasionally, you can get some bruising, but most women have very little discomfort. Occasionally, we'll give a valium or a little bit of pre-med to take and you'll have to have a drive but, generally, they’re pretty much back to normal activity the next day and that's the same for ultrasound-guided biopsy or the MRI-guided biopsy. Again, all of which we do in this building.

Bill:  Now, once the tissue is collected, is the analysis timeframe the same as a traditional biopsy?

Dr. Brackett:  Well, we're kind of spoiled here with Dr. McGinley and Dr. Vallery because we do so much of this. We'll send the specimens over and usually we can get the results back within about 48 hours. The timeframe is about the same, but they turn it over very quickly for our patients which really them with the anxiety portion of all this, you know?

Bill:   Absolutely. It certainly is a very anxious time for women. At Tidelands, it sounds like you've really got this down to a science. You do the minimally invasive breast biopsy and then you're able to check relatively quickly to get that answer to that woman.

Dr. Brackett:  That's correct.

Bill:  Dr. Brackett, what have I missed? What else can you tell us about minimally invasive breast biopsy and what should all women know about this?

Dr. Brackett:  The thing that's really important is that if a patient sees a physician who says she needs an open breast biopsy, she needs to question that immediately. It is the standard of care in the United States of America that any abnormality seen on a mammogram or ultrasound or MRI should be done with a minimally invasive technique. For the reasons we discussed are, again, 80% are benign. So, if you can find out a lesion is benign and does not need to be surgically removed, you can do that with a little nick of the skin and in 30 seconds. But, more importantly, if you find a cancer through the minimally invasive technique, it allows you to make a surgical plan before you ever get to the operating room. So, when I go to the operating room, I know exactly what I'm doing and why I'm doing it, where the cancer is, and what I need to do to treat her. If you go up front and do it openly, you've already kind of burned your bridge a little bit. So, it's really important to know before you get into an operating room whether the lesion is "good or bad." It really helps with the surgical planning by doing these minimally invasive breast biopsies.

Bill:  That certainly makes a lot of sense. Dr. Brackett, why should a woman choose Tidelands Health for her breast health needs?

Dr. Brackett:   I think the main thing is that we are an accredited program, one of only ten in the state and we have a team that works together. The surgeons, the radiation oncologists, the medical oncologists, the pathologists, the radiologists--we've all been working together for years. We have a tumor board where we present every case, too, where we sit in a conference room with a big screen TV and review every aspect of a woman's history and her case and then come up with an individualized, tailored treatment plan for her cancer. And what this does, it really insures communication among the physicians, because we're in the classroom together; it leads to educational opportunities for the doctors because we all keep up with stuff and it's an opportunity to teach each other things that we've learned; and it really is shown to improve outcome, improve survival. It really, really gives the patients a lot of reassurance, and it's really the right way to do it. In most communities in our country who are serious about their breast care, will have a tumor board and an accredited-type program.

Bill:  Well, it sounds like a complete coordination of care for the woman, then.

Dr. Brackett:   Exactly. And that's really important--that communication among the physicians because it's not like very single cancer is treated the same way. The way you seek which treatment: surgery, radiation, chemo, endocrine therapy; it's almost different for every patient. So, by presenting the case to a tumor board before you’ve even operated, you can figure out what you need to do first and the order in which you need to do things. We're always working together. We're all in the same building, so that also helps us a lot.

Bill:  Dr. Brackett, thank you so much for your time today, we appreciate it, and thanks for your fine work at Tidelands Health. For more information on Tidelands Health, physicians, services, and facilities, visit tidelandshealth.org. That's tidelandshealth.org. This is Better Health Radio. I'm Bill Klaproth, thanks for listening.