What is a Breast Biopsy?

Once a breast lump or breast abnormality has been detected, your doctor may want to conduct a breast biopsy.

A breast biopsy involves taking sample tissue from the suspicious area to determine whether the breast lump is cancerous or benign. While the thought of having a breast biopsy might be frightening, the results can provide reassuring peace of mind. Remember, the vast majority of breast biopsies do not turn out to be breast cancer1 and a biopsy helps to achieve an accurate diagnosis.

What Happens During a Breast Biopsy?

Vacuum-Assisted Breast Biopsy

In a breast biopsy performed with a minimally invasive Mammotome vacuum-assisted breast biopsy device, a small probe is inserted into the breast through an incision about the size of a match head. Vacuum is used to gently draw, cut and collect tissue in the probe’s hollow chamber. This biopsy technique enables several samples to be acquired, aiding in a highly accurate breast cancer diagnosis. Since multiple tissue samples are obtained without removing and reinserting the probe, there is less internal scarring, which minimizes interference with future monitoring and diagnosis of breast abnormalities.

Following a breast biopsy, the patient is typically sent home with a small adhesive bandage to cover the incision. The breast biopsy can be completed in less than one hour and is performed in an outpatient setting or doctor’s office without general anesthesia or stitches.

Core Needle Biopsy

In a core needle biopsy, the physician makes a small skin incision through which a needle is inserted into the lesion to obtain sample tissue. The hollow spring-loaded device is “fired” repeatedly into the abnormality to collect a sufficient amount of breast tissue for analysis. Usually 4 to 6 samples are taken (4 to 6 insertions). This biopsy procedure is performed in an outpatient setting or doctor’s office without general anesthesia or stitches.

Open Surgical Biopsy

Open surgical biopsy is an accurate procedure; however, it is the most invasive biopsy procedure and often results in both external and internal scarring. Most patients recover quickly from breast biopsy surgery, although some may experience post-operative pain or minor disfiguring of the breast2. This is considered general surgery, which requires an operating room, general anesthesia (in some cases), and stitches. Because of the hospital and surgical resources needed to perform the operation, open surgical biopsies are more costly than other breast biopsy methods. Because most breast biopsies are for small breast abnormalities that cannot be felt (non-palpable lesions), open surgical biopsies are sometimes viewed as excessive.

Open surgical procedures often involve a two-step process. First, a radiologist identifies the area to be biopsied. Through a process known as wire localization, a wire is positioned in the abnormal breast tissue to identify the area to be cut out and removed during the breast biopsy surgery. Next, the patient is taken to the operating room where she is placed under general anesthesia or a local anesthesia with sedation. A surgeon makes a 1 to 2-inch incision in the breast and removes the localization wire and a large section of tissue, typically about the size of a golf ball. The incision in the breast is then closed with stitches and covered with a protective bandage.

Fine Needle Aspiration

Fine Needle Aspiration (FNA) is a biopsy procedure that uses a thin needle on a syringe to draw fluid and/or cellular material from a breast abnormality. Thus, Fine Needle Aspiration provides information about cellular material, whereas the three biopsy procedures discussed above allow tissue within the abnormality to be compared to surrounding tissue for a more accurate diagnosis. Fine Needle Aspiration is most often used to aspirate, or drain fluid, from benign (non-cancerous) fluid-filled cysts. The extracted fluid can then be examined by a pathologist to confirm whether the abnormality is benign or requires further testing.

Fine Needle Aspiration biopsy procedures are generally performed by a physician in his or her office. If the breast lump is small and cannot be felt, the procedure can be performed using stereotactic or ultrasound imaging guidance. During the procedure, a long, thin needle is inserted through the breast into the abnormality for sample extraction. Because the needles used for Fine Needle Aspiration biopsies are smaller than needles used to draw blood, local anesthesia is not required.

If the breast abnormality turns out to be solid or the fluid collected looks suspicious, your doctor will likely recommend an additional biopsy. The larger samples collected through other biopsy methods allow tissue within the abnormality to be compared to surrounding tissue for a more accurate diagnosis.

Biopsy Results

Many patients say that waiting for their results is the most stressful part of a breast biopsy. Some of this time is due to the process in which your tissue sample is prepared for the pathologist. The solution of chemicals used to preserve the tissue takes a number of hours to work depending on the type of tissue. Other tests and special stains, like those to determine hormone receptor status, can take an additional day or more. Some of the wait is due to the sending and receiving of your results between the lab and your physician. Be sure to ask your doctor when you should expect your biopsy results and how you will be notified.

While each individual will have their own way of coping with the wait, it might be helpful to remember a few facts about breast biopsies and cancer3:

1. https://www.ncbi.nlm.nih.gov/books/NBK368367/

2. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/breast-biopsy/surgical-breast-biopsy.html

3. National breast cancer foundation, ACS, FDA