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Obtaining a tissue sample for a breast biopsy can be done using one of several methods. Your doctor may recommend a particular method based on the size, location and other characteristics of the breast abnormality. If you don't understand why you're having one type of biopsy instead of another, ask your doctor to explain the reasons in more detail.
Types of breast biopsy include:
- Fine-needle aspiration biopsy. This is the simplest type of breast biopsy and is most often used to evaluate a lump that can be felt during a clinical breast exam. For the procedure, you lie on a table. While steadying the lump with one hand, your doctor uses the other hand to direct a very fine needle — one more slender than that used to obtain a blood sample — into the lump. The needle is attached to a syringe that can collect a sample of cells or fluid from the lump. Fine-needle aspiration is a quick method to distinguish between a fluid-filled cyst and a solid mass and, possibly, to avoid a more invasive biopsy procedure. If, however, no fluid can be withdrawn and the mass doesn't resolve on its own, you may need further evaluation with a diagnostic mammogram or ultrasound or surgery to remove it.
- Core needle biopsy. This type of breast biopsy may be used to assess a breast lump that's visible on a mammogram or ultrasound or that your doctor feels (palpates) during a clinical breast exam. A radiologist or surgeon uses a thin, hollow needle — but not quite as thin as the needle used in fine-needle aspiration — to remove tissue samples from the breast mass. Several samples, each about the size of a grain of rice, are collected and analyzed in a pathology lab to identify features indicating the presence of disease. Imaging techniques, such as mammography, ultrasound or MRI, are often used to guide the positioning of the needle used in a core needle biopsy.
- Stereotactic biopsy. This type of biopsy uses breast X-rays (mammograms) to pinpoint the location of suspicious areas within the breast. For this procedure, you generally lie facedown on a padded biopsy table with one of your breasts positioned in a hole in the table. You may need to remain in this position for 30 minutes to 1 hour. The table is raised several feet, and the radiologist performing the procedure sits below the table. Your breast is firmly compressed between two plates while mammograms are taken to show the radiologist the exact location of the area for biopsy. A small incision — about one-quarter-inch long (about 6 millimeters) — is made into your breast. A radiologist inserts either a needle or a vacuum-powered probe and removes several samples of tissue to ensure an adequate sample. The tissue sample is sent to a pathologist for analysis.
- Ultrasound-guided core needle biopsy. This type of core needle biopsy involves ultrasound — an imaging method that uses high-frequency sound waves to produce precise images of structures within your body. During this procedure, you lie on your back on an ultrasound table. You may be asked to raise the arm on the same side as the breast to be biopsied, to stretch your soft tissues and get a better quality image. The radiologist locates the mass within your breast on ultrasound, makes a tiny incision to insert the needle and takes several core samples of tissue to be sent to a pathologist for analysis.
- MRI-guided core needle biopsy. This type of core needle biopsy is done under guidance of MRI — an imaging technique that captures multiple cross-sectional images of your breast and combines them, using a computer, to generate detailed, 3-D pictures. During this procedure you lie facedown on a padded scanning table. Your breasts fit into a hollow depression in the table. The MRI machine provides images that help determine the exact location for the biopsy. A small incision of about one-quarter-inch long (about 6 millimeters) is made to allow the core needle to be inserted. Several samples of tissue are taken and sent to a pathologist for analysis.
- Surgical biopsy. During a surgical biopsy, only a portion of the breast mass is removed for examination (incisional biopsy), or the entire breast mass (excisional biopsy, wide local excision or lumpectomy) may be removed. A surgical biopsy is usually done in an operating room, with sedation and a local anesthetic. If the breast mass can't be felt, your radiologist may use a technique called wire localization to map the route to the mass for the surgeon. During wire localization, the tip of a thin wire is positioned with mammographic guidance within the breast mass or just through it. This is usually done right before surgery.
During surgery, the surgeon will attempt to remove the entire breast mass, along with the wire. The surgeon may have the tissue X-rayed before it goes to the pathologist to check the edges (margins) of the sample. If the margins have cancer cells (positive margins), some cancer may still be in the breast and more tissue must be removed. If the margins are clear (negative margins), it's more likely that all the cancer has been removed.
At the time of the breast biopsy, a tiny stainless steel marker or clip is usually placed in your breast at the biopsy site. This is done so that your doctor or surgeon can easily find the area biopsied, for future monitoring or in the event that a follow-up procedure is needed to remove more tissue.
After a breast biopsy
With all types of breast biopsy except a surgical biopsy, you'll go home with only bandages and an ice pack over the biopsy site. Although you should probably take it easy for the rest of the day, you'll be able to resume your normal activities within a day. Bruising is common after core needle biopsy procedures. To ease pain and discomfort after a breast biopsy, you may take a nonaspirin pain reliever containing acetaminophen (Tylenol, others) and apply a cold pack as needed to reduce swelling.
If you have a surgical biopsy, you'll likely have stitches (sutures) to care for. Be sure to keep the healing incision dry during bathing until the sutures are removed. You'll be instructed to avoid strenuous activities for a few days to prevent bleeding. If you experience swelling or bruising, it should go away in a few weeks. Scar tissue that forms after the biopsy site heals can make breast self-exams challenging, so ask your doctor how you'll be able to tell the difference between the feel of scar tissue and the feel of new breast changes.
- For women facing a breast biopsy. American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_4_6x_For_Women_Facing_a_Breast_Biopsy.asp?sitearea=. Accessed June 11, 2009.
- Biopsy. Breastcancer.org. http://www.breastcancer.org/symptoms/testing/types/biopsy.jsp. Accessed June 11, 2009.
- Valea FA, et al. Breast diseases: Diagnosis and treatment of benign and malignant disease. In: Katz VL, et al., eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby; 2007. http://www.mdconsult.com/das/book/body/142893743-12/0/1524/96.html?tocnode=53759192&fromURL=96.html. Accessed June 11, 2009.
- James JJ, et al. Women's imaging. In: Adam A, et al., eds. Grainger & Allison's Diagnostic Radiology. 5th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2005:1173.
- Stereotactic (mammographically guided) breast biopsy. The American College of Radiology and The Radiological Society of North America (RSNA). http://www.radiologyinfo.org/en/info.cfm?pg=breastbixr. Accessed June 11, 2009.
- Your pathology report. Breastcancer.org. http://www.breastcancer.org/symptoms/path_report/. Accessed June 11, 2009.
