Breast biopsy

Overview

A breast biopsy is a procedure to remove a sample of breast tissue for testing. The tissue sample is sent to a lab for testing.

Your healthcare professional may recommend a breast biopsy if you have a suspicious area in your breast, such as a lump or other signs of breast cancer. A breast biopsy also may be used if a mammogram, ultrasound or other breast exam shows any areas of concern.

The results of a breast biopsy can show whether the area is cancerous. The results also can help your healthcare team determine whether you need additional surgery or other treatment.

Types

Breast biopsy procedures include the following types.

Fine-needle aspiration biopsy is the simplest type of breast biopsy. It may be used to evaluate a lump that can be felt during a breast exam. Fine-needle aspiration uses a very small needle to remove a sample of fluid or tissue from the suspicious area.

Fine-needle aspiration is a quick way to tell a fluid-filled cyst from a solid mass. It also may help avoid a more invasive biopsy procedure. However, if the mass is solid, you may need a different procedure to collect a tissue sample.

Core needle biopsy may be used to assess a breast lump that's visible on a mammogram or ultrasound or that your healthcare professional feels during a breast exam. It uses a thin, hollow needle to remove tissue samples. The core needle is inserted into the mass through a small incision. Several samples, each about the size of a grain of rice, are collected and tested.

Imaging tests may be done during a core needle biopsy to help find the exact location of the mass. Tests may include ultrasound, MRI or X-ray.

Stereotactic biopsy uses mammograms to find the location of suspicious areas within the breast. Your breast is firmly compressed between two plates while mammograms are taken. These images show the exact location of the area for the biopsy. Then, a needle is inserted into the area through a small incision to collect samples of tissue.

Surgical biopsy involves removing some or all of a breast mass for testing. A surgical biopsy usually is done in an operating room while you're in a sleeplike state from general anesthesia. A surgical biopsy typically is done only if a needle biopsy isn't possible.

The types of surgical biopsy include:

• Incisional biopsy. This procedure removes a sample of tissue from the suspicious area.
• Excisional biopsy. This procedure removes the entire lump or suspicious area.
• Wide local excision. This procedure removes the entire lump or suspicious area and some healthy tissue around it, called a margin. A wide local excision also is known as a lumpectomy.

If the breast mass can't be felt, your healthcare professional may use a technique called wire or seed localization to map the route to the mass for the surgeon. These techniques place either a thin wire or small radioactive seed in the breast to guide the surgeon to the affected area. This is done before surgery.

Why it's done

Your healthcare professional may recommend a breast biopsy if:

• You have a lump or thickening in the breast.
• A mammogram, ultrasound or breast MRI shows a suspicious area in your breast.
• You have unusual nipple or areolar changes, including crusting, scaling, dimpling skin or a bloody discharge.

Risks

Risks of breast biopsy include:

• Bruising and swelling of the breast.
• Infection or bleeding at the biopsy site.
• Scarring or skin changes, depending on how much tissue is removed and how the breast heals.
• Additional surgery or other treatment, depending on biopsy results.

Contact your healthcare team if you develop a fever, if the biopsy site changes color or becomes warm, or if you have unusual drainage from the biopsy site. These can be signs of an infection that may need treatment right away.

How you prepare

Before the breast biopsy, tell your healthcare professional if you:

• Have any allergies.
• Have taken aspirin in the last seven days.
• Are taking blood-thinning medicines.
• Are not able to lie on your stomach for an extended period.

If the breast biopsy will be done using an MRI, tell your healthcare professional if you have a cardiac pacemaker or other electronic device implanted in your body. Also tell your healthcare professional if you are pregnant or think you may be pregnant. An MRI may not be the best test in these situations.

What you can expect

Before the procedure

You may be asked to remove some clothing or wear a gown for the breast biopsy. You also may be asked to remove jewelry, glasses or any other objects that could interfere with the procedure. Avoid wearing lotion, perfume, deodorant or powder under your arms or on your breasts on the day of the procedure.

During the procedure

Depending on the type of biopsy being done, you may sit in a chair or lie on a table, either face up or face down. If you're lying face down, your breasts hang freely through an opening in the table. Your breasts may be compressed and held in place throughout the procedure.

For many biopsies, you'll get an injection to numb the area of the breast being biopsied. For surgical biopsies, you'll be put in a sleeplike state.

Imaging tests such as ultrasound, MRI or X-ray may be used to help your healthcare team find the suspicious tissue. Once the area is located, a small incision is made in the skin to insert the biopsy needle. A vacuum-assisted device often is used to help remove samples of tissue. Most biopsy procedures take between three and 12 tissue samples for testing. If a surgical biopsy is being done, the surgeon will attempt to remove the entire breast mass.

A small metal clip usually is placed at the site of the biopsy. This helps the healthcare team find the area again if needed for future imaging tests, biopsies or treatments. These clips cause no pain and don't interfere with metal detectors, such as at an airport. The clips also don't interfere with future MRIs.

After a breast biopsy

With all types of breast biopsy except a surgical biopsy, you'll likely go home with only bandages and an ice pack over the biopsy site. The care team may tell you to take it easy for the rest of the day. Most people can resume their usual activities the next day.

Bruising is common after a breast biopsy. To ease pain and discomfort, a nonaspirin pain reliever may help. A cold pack applied to the area as needed may reduce swelling.

After a surgical biopsy, you may have stitches that will dissolve on their own. Wait 1 to 2 days before showering. Avoid exercise and putting the area under water for a week.

Results

After the biopsy procedure, the breast tissue goes to a lab for testing. The testing is done by a doctor who specializes in analyzing blood and body tissue, called a pathologist. It may be several days before the results of a breast biopsy are available.

The pathologist sends the results to your healthcare professional, who shares them with you. The results include the size and consistency of the tissue samples and the location of the biopsy site. The results also describe whether cancer, noncancerous changes or precancerous cells are present.

If you had a surgical biopsy, the results also show if the edges of the mass, called margins, are positive or negative for cancer cells. If cancer cells are present at the margins, you may need another surgery so that more tissue can be removed. If the margins are negative, then the cancer has been fully removed.

If the results of a biopsy differ from what is shown on a mammogram or other imaging test, another procedure may be done to confirm any findings.

If the results show that breast cancer is present, they include what kind of breast cancer you have. Your healthcare team uses this information to make a treatment plan.

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