Breast Biopsy
A biopsy is the only way to know for sure if an area of concern — something suspicious found on a mammogram or MRI, for example — is breast cancer. Doctors do this by taking a sample of tissue from the suspicious area in the breast and examining it under a microscope.
Why is a breast biopsy done?
If your doctor feels anything suspicious in your breast, or sees something concerning on a mammogram or other imaging study, they will recommend a biopsy. The tissue sample is examined by a pathologist (a doctor who specializes in diagnosing disease) under a microscope to see whether or not cancer cells are present. If cancer is present, the pathologist then does more tests on the cells to figure out the cancer’s characteristics. The pathologist writes a report of the biopsy’s findings and makes a diagnosis in a pathology report.
How is a breast biopsy done?
There are several types of breast biopsies. For each of them, an incision is made in the breast and a sample of tissue is taken out. In some cases, a hollow needle or probe is put into the breast through the incision. The surgeon uses imaging, such as mammogram, MRI or ultrasound, to guide the needle or probe to the suspicious area. Once it’s placed correctly, a sample of tissue is pulled into it. In other cases, the surgeon uses a scalpel to remove the tissue.
A small clip or marker may be placed in your breast during certain types of biopsies to mark the site where tissue was removed. This is in case the tissue turns out to be cancerous and you need more surgery. The clip helps your medical team locate the exact biopsy site.
The clip or marker is made of stainless steel or titanium and is left inside the breast and is not harmful to the body. If the biopsy leads to more surgery, the clip usually is removed at that time.
The clip is so small you’re unlikely to feel it. Clips also won’t set off metal detectors.
Types of breast biopsies
Surgeons try to use the least invasive type of breast biopsy possible — the one that involves the smallest incision. But the type of procedure used depends on your individual situation.
Fine needle aspiration (FNA) is the least invasive method of biopsy, and it usually leaves no scar. You will be lying down for this procedure. First, an injection of local anesthesia is given to numb the breast. The surgeon or radiologist uses a thin needle with a hollow center to remove a sample of cells from the suspicious area. In most cases, they can feel the lump and guide the needle to the right place.
Although this is the simplest method of performing a breast biopsy, it is also the least accurate. If the results are inconclusive, the surgeon will recommend a different type of biopsy, such as a core needle biopsy.
In cases where the lump cannot be felt, the surgeon or radiologist may need to use imaging studies to guide the needle to the right location. This is called ultrasound-guided biopsy when ultrasound is used, or stereotactic needle biopsy when mammogram is used. With ultrasound-guided biopsy, the doctor will watch the needle on the ultrasound monitor to guide it to the area of concern. With stereotactic mammography, mammograms are taken from different angles to pinpoint the location of the breast mass. The doctor then inserts the hollow needle to remove the cell sample.
Core needle biopsy uses a larger hollow needle than the one used in fine needle aspiration. If you have this type of biopsy, you’ll be lying down. After numbing the breast with local anesthesia, the surgeon or radiologist uses the hollow needle to remove several cylinder-shaped samples of tissue from the suspicious area. In most cases, the needle is inserted about three to six times so that the doctor can get enough samples. Usually core needle biopsy does not leave a scar.
If the lesion cannot be felt through the skin, the surgeon or radiologist can use an image-guided technique such as ultrasound-guided biopsy or stereotactic needle biopsy, as they do with fine needle aspiration biopsy. The surgeon or radiologist may place a breast biopsy clip to mark the site of biopsy.
In addition to offering quick results without significant discomfort and scarring, both fine needle aspiration and core needle biopsy give you the opportunity to discuss treatment options with your doctor before having any surgery.
In some cases, needle biopsy can be done right in the doctor’s office, unless your doctor needs to use imaging equipment to guide the biopsy. However, needle biopsy has a higher risk of a false negative result — a result that suggests that cancer is not present when it really is. This is likely because needle biopsy removes a smaller amount of tissue than surgical biopsy does and may not pick up the cancer cells. Your doctor may recommend a surgical biopsy as a follow-up to — or instead of — a needle biopsy. Together you can decide what is best for your situation.
Vacuum-assisted breast biopsy is also known as MIBB (which stands for minimally invasive breast biopsy) or by the brand name Mammotome. Unlike core needle biopsy, which involves several insertions of a needle through the skin, vacuum-assisted biopsy uses a special probe that only has to be inserted once. The procedure also can remove more tissue than core needle biopsy does.
For vacuum-assisted breast biopsy, you’ll lie face down on an exam table with special round openings in it, where you place your breasts. First, an injection of local anesthesia is given to numb the breast. Guided by mammography (stereotactic-guided biopsy) or ultrasound, the surgeon or radiologist places the probe into the suspicious area of the breast. A vacuum then draws the tissue into the probe. A rotating cutting device removes a tissue sample and then carries it through the probe into a collection area. The surgeon or radiologist can then rotate the probe to take another sample from the suspicious lesion. This can be repeated eight to 10 times so that the entire area of concern is thoroughly sampled.
In some cases, the surgeon may place a breast biopsy clip to mark the site.
Incisional biopsy is more like regular surgery. After using local anesthesia to numb the breast and giving you a sedative to make you drowsy, the surgeon uses a scalpel to cut through the skin to remove a piece of the tissue for examination.
As with needle biopsy, if the surgeon cannot feel the lump or suspicious area, he or she may need to use mammography or ultrasound to find the right spot.
Your surgeon also may use a procedure called a seed localization, or less commonly a needle wire localization.
In seed localization, the surgeon uses either mammography or ultrasound to find the right spot and then inserts a tiny metal seed, about the size of a small sesame seed, into the abnormal area to mark the location.
During biopsy surgery, the surgeon uses a special device to find the seed and the abnormal area. The seed is removed along with the abnormal tissue during the biopsy.
In wire localization, a small hollow needle is placed through the breast skin into the abnormal area. A small wire is placed through the needle and into the area of concern. Then the needle is removed. The doctor can use the wire as a guide in finding the right spot for biopsy.
Your doctor may recommend incisional biopsy if a needle biopsy is inconclusive — that is, the results are unclear or not definite — or if the suspicious area is too large to sample easily with a needle. As with needle biopsy, there is some possibility that incisional biopsy can return a false negative result. However, you do get the results fairly quickly, usually within a few days. Incisional biopsy is more invasive than needle biopsy, it leaves a scar, and it may require more time to recover.
Excisional biopsy, the most involved form of biopsy, is surgery to remove the entire suspicious area of tissue from the breast. In addition to removing the suspected cancer, the surgeon generally will remove a small rim of normal tissue around it as well, called a margin.
If the surgeon cannot feel the lump or suspicious area, he or she may need to use mammography or ultrasound to find the right spot. Your surgeon also may use seed localization or needle wire localization to mark the right area for biopsy.
Excisional biopsy is the surest way to get a definitive diagnosis without getting a false negative result. Also, having the entire lump removed may provide you with some peace of mind. However, excisional biopsy is more like regular surgery, and it will leave a scar and require more time to recover. Like incisional biopsy, excisional biopsy is performed with local anesthesia.
Breast biopsy risks
Any time tissue is removed from the body, there is a small risk of infection or bleeding at the incision site. Other risks associated with a breast biopsy include:
bruising and swelling of the breast
a change in how the breast appears, depending on how much tissue is removed and how the breast heals
a need for more surgery or other treatments, depending on the results of the biopsy
Before your breast biopsy
Biopsies are not medical emergencies and can be scheduled at your convenience. But for peace of mind, most people want their biopsies done as soon as possible.
Before you have a breast biopsy, be sure to ask your doctor to:
review the results of your mammogram and any other imaging studies with you
show you the area in question
explain the type of biopsy that's recommended for you and explain why that type of biopsy is recommended; if surgical biopsy is recommended, ask if needle biopsy can be done instead
discuss how and why the biopsy will be performed
answer any of your questions
arrange for you to sign required consent forms
tell you when and how you can get the biopsy results
To prepare for a breast biopsy, tell your doctor:
about any allergies you have
about any blood-thinning medicines or vitamins you take
about any issues you have with lying on your stomach for an extended period of time
if you have a pacemaker or other electronic device implanted in your body
if you have any artificial joints or other metal in your body
Breast biopsy recovery
If you have fine needle, core needle, or vacuum-assisted breast biopsy, you won’t have any stitches — just a bandage over the incision site. Your doctor will tell you to put an ice pack on the area to reduce swelling. You should relax the rest of the day and will likely be able to get back to your usual activities within a day.
Bruising is common after needle or vacuum-assisted biopsies and your doctor will recommend a pain reliever based on your specific situation.
If you have incisional or excisional breast biopsy, you’ll have stitches. You usually go home the day of the procedure. Your doctor or another member of your medical team will tell you how to care for the stitches and whether they need to be removed or will dissolve. They’ll also recommend medicine to ease pain and swelling.
The area will be tender, but you can usually get back to most of your regular activities within a day or two.
Getting your breast biopsy results
A few days to a week after the biopsy, your doctor should have the biopsy results. The results are written in a pathology report, and will include information about the biopsy and tissue sample, including:
the type of biopsy done
the size of the sample
the consistency of the tissue
whether the cells are healthy, have benign (non-cancerous) changes, or cancerous changes
If the results say that breast cancer is present, the pathologist will include information about the characteristics of the cancer, including hormone receptor status and HER2 status.
You and your doctor will use the characteristics of the cancer to develop a treatment plan tailored to your unique situation.
— Last updated on March 9, 2024 at 11:08 PM