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Breast biopsy
By Mayo Clinic staff
Original Article

•  Definition
•  Why it's done
•  Risks
•  How you prepare
•  Types of Breast Biopsy
•  After a Breast Biopsy
•  Results

Definition

A breast biopsy — removing a small sample of breast tissue for pathology analysis — is often the only way to be certain if a suspicious area in your breast is breast cancer. There are several types of breast biopsy.

A breast biopsy helps identify any abnormalities in the cells that make up breast lumps or other unusual breast changes. And, a breast biopsy can help determine whether or not you need surgery or other treatment.

Why it's done

Your doctor may recommend a breast biopsy if:

•  You or your doctor feels a lump or thickening in your breast, and your doctor suspects breast cancer.
•  Your mammogram shows a suspicious lesion in your breast.
•  An ultrasound scan reveals a possible tumor.
•  You have unusual nipple changes, including crusting, scaling, dimpling skin or bloody discharge.

Being told that you should have a breast biopsy might make you quite anxious. But consider this reassuring fact: in the U.S., 80 percent of women who undergo a breast biopsy learn that they don't have cancer.

Risks

Risks associated with a breast biopsy include:

•  Bruising and swelling of the breast
•  Infection or bleeding at the biopsy site
•  Altered breast appearance, depending on how much tissue was removed and how the breast heals
•  Additional surgery or other treatment, depending on biopsy results

Contact your doctor if you develop a fever, if the biopsy site becomes red or warm, or if you have unusual drainage from the biopsy site. These signs of infection may require prompt treatment.

How you prepare

Before the breast biopsy, tell your doctor if you:

•  Have any allergies
•  Have taken aspirin in the last seven days
•  Are taking blood-thinning medications (anticoagulants)
•  Are unable to lie on your stomach for an extended period of time

If your biopsy will be done using magnetic resonance imaging (MRI), tell your doctor if you have a cardiac pacemaker or other electronic device implanted in your body or if you're pregnant or think you may be pregnant. MRI generally isn't recommended under these circumstances.

Wear a bra to your appointment. Your health care team may place a cold pack against the biopsy site after the procedure, and the bra can hold the cold pack in place and provide support for your breast.

Be sure to follow any other special preparation instructions given to you in advance of the procedure.

A breast biopsy can be performed by a physician, radiologist or surgeon. 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 lesion. 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-and-easy 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 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 core needle biopsy. This type of core needle biopsy uses breast X-rays (mammograms) to guide needle placement for breast lesions that are only visible on mammogram. For this procedure, you generally lie facedown on a padded biopsy table with one of your breasts positioned in a hole in the table. 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 lesion for biopsy. A small incision — about one-quarter-inch long — is made into your breast to allow insertion of the biopsy needle. The radiologist removes several cores 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 of your body as the breast to be biopsied over your head, 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 — a breast-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 — about one-quarter-inch long — will be made to allow the core needle to be inserted. Several samples of tissue will be taken and sent to a pathologist for analysis.

Surgical biopsy. A surgical biopsy may remove only a portion of the breast mass for examination (incisional biopsy), or it could remove the entire breast mass (excisional biopsy, wide local excision or lumpectomy). 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 needs to be removed. If the margins are clear (negative margins), it's more likely that all the cancer has been removed.

If all or nearly all the suspicious breast mass is removed during a breast biopsy, a tiny stainless steel marker or clip may be 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 alleviate pain and discomfort after a breast biopsy, you may take a non-aspirin pain reliever containing acetaminophen (Tylenol, others) and apply a cold pack as needed to reduce discomfort and swelling.

If you have a surgical biopsy, you'll likely have stitches (sutures) to care for. Take care 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.

Results

It may take a few days before your biopsy results are available. After a pathologist studies the breast tissue removed during the biopsy, he or she writes up a detailed pathology report containing information about the tissue samples taken. The report includes details about the size, color and consistency of the tissue samples, the location of the biopsy site and whether cancer cells are present.

If your breast biopsy reveals normal results or benign breast changes, it's important to know whether both your radiologist and pathologist agree on the findings. Sometimes the opinions of these two experts don't match — for instance, your radiologist may find your mammogram results suggest breast cancer but your pathology report reveals normal breast tissue. In this case, you may need further testing and, possibly, surgery to treat the condition.

If breast cancer is present, the breast biopsy pathology report provides important information about the cancer itself, such as what type of breast cancer you have and whether the cancer is hormone receptor positive or negative. You and your doctor can then work through a treatment plan that best suits your needs.


Aug. 9, 2007

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