When a breast exam or mammogram indicates thickened skin or a suspicious mass, cyst, or lesion, doctors will often want to examine a tissue sample from the area in question. This is to identify whether the tissue is malignant (cancerous). The process of taking such a sample is called a biopsy.
A doctor may perform a lymph node biopsy from the chest and/or under arm at the same time as a breast biopsy. If so, the lymph node tissue is checked for cancer cells that may have metastasized (spread) from your breast.
This article explores the most common types of needle biopsies used to diagnose breast cancer and what to expect if your doctor schedules one for you.
There are many different types of breast biopsy procedures. Needle biopsies are currently the preferred method for diagnosing breast cancer.
In the past, doctors preferred a method called a fine-needle aspiration (FNA), because it’s relatively fast and inexpensive. However, an FNA generates a small sample size, which increases the risk of a potential tumor being missed. This, in turn, could lead to false-negative test results.
Surgical biopsy was more common in the past. Although this method provides excellent accuracy, it may leave a scar. Additionally, depending on how much tissue is removed, it might change the shape of your breast.
Currently, the main method of needle biopsy used for breast cancer diagnosis is a CNB.
A CNB involves a large, hollow needle that gathers a sample of suspicious breast tissue. A doctor will first feel for the lump or mass to be biopsied and then insert the needle in that area. Next, the doctor reinserts the needle from new entry points and angles to retrieve the best possible samples. Multiple insertions increase the chance of obtaining a good tissue sample from the mass in question.
A CNB is an outpatient procedure. It is performed using a local anesthetic, which means you’ll be awake during the procedure, but your breast will be numbed so you won’t feel pain. If your radiologist doesn’t use imaging guidance for the biopsy, the procedure will likely be quicker. However, imagine guidance typically makes a biopsy more accurate and reduces the need for repeat biopsies.
The two main types of CNB are image-guided CNB and vacuum-assisted biopsy.
With an image-guided CNB, your doctor uses an ultrasound, mammogram (X-ray of the breast), or MRI to guide the biopsy.
For an ultrasound-guided CNB, you lie on your back and the radiologist places an ultrasound device on your breast. Sound waves create an image that helps the doctor find the area to sample. The breast ultrasound helps guide where to insert the biopsy needle.
For an MRI-guided CNB, your radiologist will first inject contrast dye, which allows the suspicious area to be seen clearly with an MRI. The contrast dye is usually delivered intravenously (through a vein).
Once the contrast dye is in your system, you’ll lie stomach down on a table designed with an opening for your breast. Next, your breast is compressed (similar to what occurs during a mammogram), and the radiologist will take several breast MRI images. Later, a radiologist or surgeon will use the images to determine precisely where to take a biopsy sample.
A stereotactic biopsy is a CNB that involves mammography (X-rays of the breast). You’ll lie face down on a table with a mammogram machine. Images are captured and then analyzed by a computer to determine the exact biopsy site.
Next, a radiologist or surgeon samples the high-risk tissue based on the image findings. This kind of CNB is best for biopsies of tiny, abnormal calcium deposits, or suspicious areas that can’t be detected with a breast ultrasound.
A vacuum-assisted biopsy (VAB) is another type of CNB, which is always guided by imaging. Although this method is more invasive than others, the suction used in a VAB allows your doctor to get a large tissue sample by inserting the needle once, rather than several times as other procedures require.
In a VAB, the doctor inserts a special biopsy needle through a small incision in your breast, and a vacuum pulls tissue into the needle. A tiny, rotating blade slices the sample. Then, the doctor rotates the probe (but doesn’t remove it entirely) to get another sample from the area of concern. This can be repeated up to 10 times to thoroughly sample the suspicious region. VAB is another outpatient procedure and also uses local anesthesia.
In biopsies that involve local anesthesia, you will be instructed to remain still during your procedure. Remaining still when your doctor is using guided imagery allows the imaging device to get the clearest possible picture of your breast tissue.
To numb your breast before the procedure, the doctor administers a local anesthetic through a thin needle. Then, the doctor inserts the biopsy needle into the suspect breast tissue to collect the tissue sample.
For an image-guided CNB or VAB, your doctor will first make a small incision for the needle to enter. You will likely feel pressure (and, possibly, some discomfort) as the needle goes in, but you shouldn’t feel intense pain. For a non-image-guided CNB, the doctor must withdraw and reinsert the needle for each biopsy sample they take.
After the biopsy, your doctor might insert a tiny marker (called a clip) into the area of tissue where your biopsy sample was taken. This clip marks the spot of the biopsy so future imaging tests can locate it if needed. You won’t be able to feel or see the clip, which is safe for MRIs and metal detectors.
When finished with your biopsy, your doctor will remove the needle and cover the sampled area with a sterile bandage. You may also receive an ice pack to help keep the area numb. You’ll likely be instructed to avoid strenuous activity (for example, lifting anything heavier than 5 pounds, or running or jogging) for a day or so after the CNB. Typically, you’re allowed to resume normal activities after this rest period. Your doctor will provide specific instructions for you, including how to care for your biopsy site.
It’s normal to experience side effects like bruising, swelling, and/or bleeding after a CNB. These should resolve in a few days. If you are concerned about anything regarding your biopsy site, contact your doctor. They will be able to answer your questions and guide you if, for any reason, you need to be seen.
Breast biopsy samples are sent to a pathology laboratory, where a pathologist will examine them under a microscope. A pathologist is a doctor trained to investigate the causes and effects of diseases by analyzing a sample of cells.
Analyzing breast tissue samples that are suspect for cancer usually takes 48 to 72 hours. The pathologist will determine if there are cancerous cells by looking at the cells in your biopsy sample. If they find cancerous cells, the sample of tissue removed during a CNB will provide your health care team with important information, including:
These details will allow your doctor to establish your treatment options and help you both decide on the best breast cancer treatment plan for you.
Depending on where your biopsy is performed, you’ll receive your results (and any pathology report) from your general practitioner, breast surgeon, or radiologist. Ask the doctor performing the biopsy who will be sharing your results with you.
If a needle biopsy is inconclusive (does not show a definite result), you may need to have a surgical biopsy. This procedure is highyl accurate at identifying cancerous tissue. A surgical biopsy requires general anesthesia (makes you sleep so you don’t feel pain).
During this procedure, the doctor uses a scalpel to cut into the suspicious breast mass and remove a small piece of its tissue. If a small piece of tissue is removed from the area of suspicion, it’s called an incisional biopsy. If a larger piece of suspicious tissue is removed, along with the rim of normal tissue surrounding it, it’s called an excisional biopsy. Both of these types of biopsies will leave a small scar. Depending on how much tissue is removed, they can also change the shape of your breast.
Before you undergo a surgical biopsy, feel free to get a second opinion. That means asking another pathologist with oncology expertise to go over your biopsy results and pathology report. If the second pathologist agrees with the results of the first, then you can confidently follow up with your doctor about having a surgical biopsy.
Needing a biopsy does not mean that you have cancer. Every year in the United States, more than 1 million women undergo breast biopsies. Of those, about 20 percent receive a diagnosis of breast cancer.
That statistic may sound encouraging, but it doesn’t mean you should skip a biopsy. Biopsies of any suspicious tissue are important, and the sooner cancer of any kind is found, the sooner it can be treated.
You don’t need to go through breast cancer alone. Whether you’re dealing with the roller coaster of finding breast lumps that need to be biopsied or navigating life after a cancer diagnosis, having a team by your side makes a world of difference.
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Have you had a breast biopsy? What was your experience like? Share your thoughts or experiences in the comments below or by posting on MyBCTeam.