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6 Types of Breast Biopsy: What To Expect With Each

Posted on September 08, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Maureen McNulty

  • Doctors use biopsies to collect cells from a suspicious lump or mass in your breast.
  • The cells are then examined to determine whether they’re cancerous and, if so, to learn details about how they are growing.
  • Several types of breast biopsies are used to collect cells, depending on the size and location of the mass.

A breast biopsy is usually a part of the breast cancer diagnosis process. This test, which helps identify cancer cells within a breast sample, involves removing a small amount of tissue or fluid for study under a microscope. During this procedure, your doctor may also biopsy your lymph nodes — small structures in your breast, chest, or armpit that may trap cancer cells.

Your doctor may want to biopsy a lesion (a lump or mass) that was detected during a breast imaging test. The biopsy results will help diagnose the lesion as either malignant (contains cancer cells) or benign (noncancerous). If cancer is detected, your doctor will use the biopsy results to help determine receptor status, which guides selection of the various breast cancer treatments.

It is important to note that needing a biopsy doesn’t necessarily mean you have cancer — about 4 in 5 people in the U.S. who have breast biopsies are not diagnosed with cancer. As one MyBCTeam member wrote about biopsy, “No matter what the results are, the knowledge is going to give you a clear idea of what to do next. Try hard not to worry — all the worry in the world won’t change the outcome. The biopsy’s going to give you the information to deal with it appropriately.”

There are six main types of breast biopsy procedures. The one your doctor recommends for you depends on the size and location of the mass.

1. Fine-Needle Aspiration Biopsy

    Fine-needle aspiration biopsy may be recommended if you have a mass under the skin that can be felt using fingers. (CC BY-SA 4.0/BruceBlaus)

    A fine-needle aspiration (FNA) biopsy is a simple procedure in which your doctor inserts a small needle into your breast lesion. An FNA biopsy may be recommended if you have a palpable mass (one that can be felt with the fingers) under the skin.

    Before the procedure, your doctor may numb the biopsy site with an anesthetic. However, FNA biopsy needles are so thin that they don’t typically cause much pain, so this is not always necessary. During the biopsy, your doctor may use a breast ultrasound to more clearly see the mass.

    FNA biopsies may help doctors quickly tell the difference between a solid mass filled with cells and a cyst filled with fluid. Additionally, FNA biopsies are less invasive than other types and typically won’t leave a scar.

    However, FNA biopsies have limits. They remove only a small number of cells, so they may not give your doctor enough information to make an accurate diagnosis. There’s a chance that the results will say you don’t have cancer when you do. Therefore, doctors don’t use this procedure very often.

    Potential Side Effects of a Fine-Needle Aspiration Biopsy

    You may notice a small amount of bruising or bleeding after getting an FNA biopsy. Additionally, the biopsy area may swell up, making your lump feel bigger than it was before. Talk with your health care team if you have any concerns.

    What MyBCTeam Members Say

    When MyBCTeam members discuss FNA biopsies, they generally agree that although no one enjoys needles, this procedure does not tend to be particularly painful.

    “Not much pain from the two needle biopsy procedures today,” wrote one member. But another shared, “You wouldn’t be normal if you didn’t have some anxiety regarding the needle biopsy.” “Who looks forward to a fine-needle biopsy?” asked another member.

    2. Core Needle Biopsy

    A core needle biopsy (CNB) is a common type of biopsy used to detect breast cancer. It requires a hollow, slightly larger needle than that of an FNA biopsy and can remove small, cylinder-shaped pieces of breast tissue called cores.

    When you get a CNB, your doctor will start by numbing your breast tissue. This is often accomplished by injecting pain-preventing medications with a thin needle. In some cases, very small incisions — about a quarter of an inch — are necessary to place the needle within the right location in the tissue.

    Your doctor may perform a CNB by feeling for the location of the lump. More often, they will use imaging tests so that they can accurately guide the needle to the right location. Multiple small samples are usually taken from the area of concern.

    After removing samples of breast tissue, your doctor will likely place a biopsy clip in the area. This tiny piece of metal marks the exact biopsy location in case doctors need to take more tissue samples, surgically remove a mass, or provide other treatments. The clip won’t affect your body, and you won’t be able to feel it.

    CNBs allow doctors to collect more samples, which helps ensure that cancer cells will be detected. Additionally, core needle biopsies are usually outpatient procedures — you can get them in a doctor’s office rather than a hospital, they don’t usually take long, and you can go home right afterward.

    Vacuum-Assisted Core Biopsy

    A vacuum-assisted core biopsy may require a small incision, which allows the doctor to insert a small tube. (Medical Images)

    In some cases, a variation of a CNB is performed with the help of a vacuum that suctions out the pieces of tissue. This procedure, also called Mammotome or minimally invasive breast biopsy, may require a small incision so that the doctor can place a small tube into the tissue. This helps the doctor collect the samples as they are cut.

    Side Effects of a Core Needle Biopsy

    CNBs may lead to swelling, bruising, or bleeding. You can help relieve these issues with ice packs and pain-relieving drugs that don’t contain aspirin. Your doctor should tell you how to take care of any incisions and may recommend that you avoid vigorous activity for the next day or two.

    Side effects of a CNB are usually minor and go away quickly, but let your health care provider know if you experience any ongoing or worsening problems after this procedure.

    What MyBCTeam Members Say

    Members share different experiences with CNBs. “I had a core biopsy and felt nothing,” one MyBCTeam member said. “My core needle biopsy was the worst thing out of everything! Worse than the lumpectomy,” stated another. Others have offered advice. “Don’t worry about the core biopsy — I had one and felt nothing. The numbing needle felt weird, but that was it. Just be prepared for a loud *click* sound when the needle takes the sample. No one warned me, and I jumped about a foot off the table!”

    Some members have shared that vacuum-assisted biopsies were harder to get through. “Vacuum biopsy was a little different from the core needle one … definitely more painful,” wrote one member.

    3. Ultrasound-Guided Core Needle Biopsy

    Ultrasound can be used to guide the needle to the exact site during a breast biopsy. (Adobe Stock)

    This procedure is a type of CNB that can be used to test many types of breast masses. Your doctor will use ultrasound (a procedure that creates images using painless sound waves) to determine exactly where to guide the needle.

    An ultrasound-guided CNB usually involves lying on your side or back. The procedure, recovery, and side effects are similar to those of other forms of CNB.

    What MyBCTeam Members Say

    Members haven’t shared as many specifics about ultrasound-guided biopsies. “I’m sick of these biopsies,” said one member who underwent this procedure. “My boob is so bruised and sore.”

    4. MRI-Guided Core Needle Biopsy

    MRI produces detailed, three-dimensional images of your breast that can help determine needle placement for biopsy. (Medical Images)

    Doctors may also use MRI to see where to place the needle during a CNB. MRIs provide your doctor with detailed three-dimensional images of your breast tissue.

    During this procedure, you will typically lie on a table on your stomach with your arms above your head. Your breast will hang through a shallow hole in the table, and your doctor will remove tissue samples while you get MRI scans.

    What MyBCTeam Members Say

    Most members have reported more pain and discomfort from MRI-guided biopsies compared with needle biopsies and ultrasound-guided procedures:

    • “It hurts a bit more than the needle core biopsy did.”
    • “MRI biopsies are a little more uncomfortable than the US-guided ones. Ice packs help.”
    • “It was a lot more painful than the ultrasound biopsy ... I am hurting big time!”

    Still others experienced minimal pain. “It doesn’t hurt, but it’s not fun,” wrote one member. “My ultrasound-guided core biopsy hurt more than the MRI-guided biopsy,” shared another. “They used more of a vacuum needle for the MRI biopsy, and I barely felt it.”

    5. Stereotactic Breast Biopsy

    During a stereotactic biopsy, a mammogram is used to look for calcium deposits and pinpoint the suspicious area. (Adobe Stock)

    A stereotactic biopsy uses a mammogram to help make a three-dimensional picture of your breast tissue. This type of biopsy is most often used for calcifications — abnormal collections of calcium in the breast.

    During a stereotactic biopsy, you will likely need to lie on your stomach on a padded table. The table will contain a hole that your breast can fit through, and plates will squeeze your breast to obtain mammogram images. In some cases, you may be able to stay seated.

    Your doctor will use the mammogram to determine the location of the suspicious area and remove samples. Sometimes, a stereotactic biopsy is a type of CNB in which a doctor uses a needle. In other cases, this procedure may require an incision.

    What MyBCTeam Members Say

    Members have had little to say about stereotactic biopsies. “You don't feel anything except pressure,” reported one. “For me, it was more uncomfortable than painful,” wrote another.

    6. Surgical Biopsy

    A surgical biopsy involves a larger incision. You might go home the same day the surgical biopsy is done, or you might require an overnight stay. (National Cancer Institute/Linda Bartlett)

    During a surgical biopsy, also called an open biopsy, a doctor makes a larger cut in your breast to take out any abnormal areas. If the mass is deep within the tissue, your doctor may use a very thin wire to guide the needle into position (called wire localization).

    You may be given either local anesthetic (to numb the breast tissue) or general anesthesia (to make you fall asleep) during a surgical biopsy. Your doctor will make an incision, surgically remove any potential problem areas, and then close the incision using stitches or adhesive strips.

    If you were given local anesthesia, you will likely be able to go home the day of your procedure. General anesthesia may require a longer recovery time, and whether you stay in the hospital or go home may depend on your health and how the surgical biopsy went.

    Side Effects of a Surgical Biopsy

    Your doctor will tell you how to take care of your incision and when you are allowed to remove the bandage and bathe. You may also have to avoid certain activities for several days after surgery.

    The main side effect to watch out for is an infected incision. Tell your doctor if you notice pain, swelling, redness, or bloody discharge near your cut. Other signs of infection include fever and chills.

    What MyBCTeam Members Say

    Although surgical biopsy is a more invasive procedure than other types, MyBCTeam members in general haven’t reported greater discomfort. “I’m a little sore, and like a pokey feeling in the surgical cut, but I hope that’s normal,” shared one member. However, others have experienced more discomfort. “I had a surgical biopsy, and it filled with blood and fluid. Painful!” wrote another.

    Talk With Others Who Understand

    MyBCTeam is the social network for people with breast cancer and their loved ones. On MyBCTeam, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

    Are you living with breast cancer? Which type or types of breast biopsy have you undergone? Share your experiences in the comments below, or start a conversation by posting on your Activities page.

    All updates must be accompanied by text or a picture.
    Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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