Breast Biopsy
What is a breast biopsy?
A breast biopsy is a surgical procedure that is done to remove a sample of tissue from the breast to determine whether the tissue is benign (noncancerous) or malignant (cancerous). Most biopsies are benign (noncancerous), but it is always better to have a definite diagnosis.
When is a breast biopsy recommended?
A breast biopsy is recommended when mammograms, ultrasound, MRI, or physical exam by your doctor finds an area of concern and it is necessary to determine whether the abnormality is benign or malignant. The surgeon removes a sample of tissue and sends the specimen to a pathologist to study under the microscope. There are several different biopsy techniques that can be used to obtain the tissue. These include: fine needle aspiration biopsy, core (large needle) biopsy with image guidance, and surgical biopsy.
The choice of which biopsy to use depends on your specific situation. The size of the area of concern, where in the breast it is located, whether it can be felt or seen only on imaging studies (such as mammography, ultrasound or MRI), other medical problems you may have, and personal preferences, are some of the factors in selecting the type of biopsy. Your surgeon will discuss with you which biopsy options are available to you, and their advantages and disadvantages.
Types of Biopsies
• Fine Needle Aspiration Biopsy (FNAB)
• Image-guided Biopsies – Core Needle Biopsy, Stereotactic Guided Biopsy, Ultrasound-guided Biopsy or MRI-guided Biopsy
• Surgical Biopsy
Fine Needle Aspiration Biopsy
Your surgeon can do a fine needle aspiration biopsy to draw out a few cells or fluid from a lump. The fine needle is often used for lumps that can be felt and can also be used with ultrasound guidance. If the lump is solid, you surgeon will first numb your breast with lidocaine and then use a special needle to remove cells to send to cytology. If there is fluid in the lump, the fluid is removed. If the fluid is clear, it will be discarded. If the fluid is bloody or looks infected, it will be sent to the lab for analysis of the cells. This procedure is done in the office and usually takes about 20 minutes. The results are returned within 48 hours. Your surgeon will call you with the results. Sometimes a fine needle aspiration cannot give us an answer and a tissue biopsy is needed.
Core Needle Biopsy
A core needle biopsy can either be done with image guidance on a breast lump that can be felt or an abnormality that can be seen under ultrasound, mammogram, or MRI. A core needle takes a much larger sample of tissue than a fine needle. Your surgeon will numb your breast with lidocaine. Usually with the core needle your surgeon will make a tiny cut in your skin to insert the needle, and then take out several samples of tissue to send to pathology for evaluation. This usually takes about 30 minutes. The results are returned within 48 hours.
Image-Guided Biopsies
Ultrasound: Ultrasound is a valuable tool to specifically target an area of concern found by mammography or which can be felt. Ultrasound uses high-frequency sound waves to outline the area being studied. A computer picks up the image that is displayed on a computer screen. The surgeon can then use this image to guide his biopsy needle directly into the area of concern and remove tissue or fluid to be sent to the lab for analysis. This is done in the office under local anesthesia. The results are usually returned within 48 -72 hours.
Mammography: Mammography is also used as a tool to guide the surgeon to an area of concern that needs to be biopsied. A stereotactic biopsy is used when microcalcifications or a mass can be seen on mammography but cannot be located by touch or ultrasound. You will lie face down on a special table that has a hole that your breast will be positioned in for the biopsy. The computerized equipment on the table will map the location of the area of concern, to be used as a guide for your surgeon to biopsy the area. Your breast will be compressed during part of the procedure and special mammogram films will be taken to verify the exact area for placement of the needle. Your surgeon will numb the area with lidocaine and make a tiny incision to guide the needle through.
Two commonly used needles are devices such as the Mammotome needle (a vacuum assisted core biopsy) or Neothermia needle, which takes one larger sample of tissue. The sample will be taken to send to pathology for analysis. Once completed, your surgeon will close the wound with a steri-strip. Most women find they have mild pain or swelling after this procedure which is easily relieved with ice, Tylenol and wearing a support bra.
Surgical Biopsy: A surgical biopsy involves removing all or part of the area or lump for examination. This biopsy may be done in the outpatient office or outpatient surgical unit. There are two types of surgical biopsies:
• Incisional Biopsy – removes part of a lump
• Excisional Biopsy – removes all of the lump
If the lump or area is too small to be felt, the surgeon may use ultrasound or mammography to place a small wire into your breast to localize the area or guide the surgeon to the area of concern. These procedures use both local anesthesia to numb the breast and, if done in the hospital, medication to make you sleepy. The biopsy results will take approximately 48 hours. Your surgeon will call you with the results.
What are the risks of a biopsy?
All surgery involves some risk. Your surgeon will discuss any specific risks with you prior to you signing the consent for your surgery. General risks and complications associated with breast surgery include:
• Wound infection – not common, but when they occur, they are treated with antibiotics.
• Poor wound healing – although not common, blood or clear fluid can collect in the breast/wound area, requiring drainage.
• Bleeding: Bleeding during or after the surgery can occur. We try to minimize this by asking that you do not take blood thinning products (like aspirin) for 7 days prior to your biopsy procedure.
• Reaction to the anesthesia – this is a low risk but some people can have a reaction to a medication.