When a routine breast exam or mammogram indicates the presence of thickened skin or a suspicious mass, cyst, or lesion, doctors will, in some cases, want to examine a tissue sample from the area in question. This is to identify whether or not the tissue there is cancerous (malignant). The process of taking such a sample is called a biopsy. Biopsies of lymph nodes from the chest and/or under the arm may also be conducted at the same time as a breast biopsy. If so, the lymph node tissue is checked for cancer cells that may have spread (metastasized) from the 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.
There are many different types of breast biopsy procedures, though needle biopsies are currently the diagnostic standard.
In the past, a method called fine needle aspiration biopsy (FNA) was often used because of its fast and inexpensive nature. However, the sample size procured with an FNA is small, which increases the risk of missing the potential tumor. Missing the tumor, in turn, could lead to false negative results. Surgical biopsy was also more prevalent in the past, and while this method provides excellent accuracy, it requires the person undergoing the procedure to pay for the doctor’s use of (and staff for) a surgical suite, for general anesthesia, and more — in other words, it is expensive.
Currently, the main method of needle biopsy used for breast cancer diagnosis is a core needle biopsy, which can be vacuum-assisted and guided by various imaging techniques.
Core needle biopsy (CNB) involves a large needle that samples suspicious breast tissue. A doctor feels for the lump or mass intended to be biopsied, and then inserts the needle in that area. The needle is then reinserted 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 local anesthetic, which means you will be awake during the procedure but your breast will be numbed so you won’t experience pain. If imaging guidance is not used to guide the biopsy, the procedure will likely be quicker than with it. However, imaging guidance will typically make a biopsy more accurate and reduce your need for repeat biopsies.
There are two main types of CND: image-guided core needle biopsy and vacuum-assisted biopsy.
With an image-guided CNB, your doctor is guided by ultrasound, mammogram (X-ray of the breast), or magnetic resonance imaging (MRI).
For ultrasound-guided CNB, a person with suspected breast cancer lays on their back, and a radiologist places an ultrasound device on their breast. Sound waves create an image that helps the doctor locate the area to sample and thus helps guide where they insert the biopsy needle.
For an MRI-guided CNB, a person with suspected breast cancer is given contrast dye, usually delivered via an IV (for intravenous delivery). Contrast dye allows the area in question to be seen clearly with an MRI. After the contrast dye is in the person’s system, they lie stomach-down on a table designed with an opening for their breast. Their breast is compressed (similar to what occurs during a mammogram), and several MRI images are taken. Later, a radiologist or surgeon will use the images to determine precisely where to biopsy.
Stereotactic biopsy is a CNB that involves mammography (X-rays of the breast). The person getting the procedure lies face-down on a table outfitted with a mammogram machine. The images captured are then analyzed by a computer to determine the exact biopsy site. A radiologist or surgeon next samples the tissue in question based on the image findings. This kind of CNB is best for biopsies of tiny, abnormal calcium deposits or suspicious masses that can’t be clearly detected with an ultrasound.
A vacuum-assisted biopsy (VAB) is another kind of core needle biopsy, and one that is always guided by imaging. While it is more invasive than other methods, the suction used in a VAB allows your doctor to obtain a large tissue sample with one insertion of the needle, rather than the several insertions other procedures necessitate.
In a VAB, a special biopsy needle is inserted through a small incision in the breast of a person with suspected cancer, and a vacuum pulls tissue into the needle. A tiny, rotating blade slices the sample. Then, the doctor rotates the probe (but doesn’t removing 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 one that also uses local anesthesia.
In biopsies that involve local anesthesia, the person with suspected breast cancer is instructed to remain still during their 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 begins, local anesthetic is administered through a small 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 go into. 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 needle must be withdrawn and reinserted for each biopsy sample taken.
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 be given an ice pack to help keep the area numb. You may be instructed to avoid any strenuous activity for a day or so after the CNB. Typically, you are 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 tissue samples.
Analysis of breast tissue samples that are suspect for cancer usually takes 48 to 72 hours. Looking at the cells in your biopsy sample, the pathologist will determine if there are cancerous cells present. If cancerous cells are found, the tissue removed during a core needle biopsy will provide your health care team with important information.
Such information can include:
These details will allow your doctor to narrow down your treatment options and will help you both decide on your best treatment plan.
Depending on where your biopsy is performed, the results (and any pathology report) will be given to you by your general practitioner, breast surgeon, or radiologist. Ask the doctor performing the biopsy who in particular will be sharing your results with you.
If your needle biopsy is inconclusive, you may need to have a surgical biopsy. This procedure is 99 percent accurate at identifying cancerous tissue. Surgical biopsy requires general anesthesia. 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.
Before you undergo a surgical biopsy, feel free to get a second opinion. That will mean getting another pathologist with oncology expertise to go over your biopsy results and pathology report. If the second patholigist agrees with the results of the first, then you can confidently follow up with your doctor about having a surgical biopsy.
No, needing a biopsy does not mean you have cancer. Every year in the United States, more than 1 million women have breast biopsies. Of those, about 20 percent recieve a diagnosis for breast cancer. With that in mind, even if your doctor calls for a biopsy, there is a decidely good chance yours won’t point to cancer. However, skipping a biopsy is not adviseable. Biopsies of any suspicious tissue are important, and the sooner cancer of any sort is detected, 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 lumps that need to be biopsied or navigating life after a cancer diagnosis, having a team by your side makes a world of difference. On MyBCTeam, the social network for people with breast cancer and their loved ones, more than 54,000 members come together to offer advice, share stories, and meet and support others who understand life with breast cancer.
Have you had a breast biopsy? Share your thoughts or experiences in the comments below or by posting on MyBCTeam.
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