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There are several breast biopsy procedures used to obtain a tissue sample from the breast. Your doctor may recommend a particular procedure based on the size, location and other characteristics of the breast abnormality. If it's not clear 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 may be 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 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 If, however, no fluid can be withdrawn and the mass doesn't resolve on its own, you may need further evaluation with a diagnostic mammogram or ultrasound or surgery to remove it.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 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 biopsy. This type of biopsy uses mammograms to pinpoint the location of suspicious areas within the breast. For this procedure, you generally lie facedown on a padded biopsy table with one of your breasts positioned in a hole in the table. You may need to remain in this position for 30 minutes to one hour. The table is raised several feet. The equipment used by the radiologist is positioned beneath the table. Your breast is firmly compressed between two plates while mammograms are taken to show the radiologist the exact location of the area for biopsy. A small incision — about 1/4-inch long (about 6 millimeters) — is made into your breast. The radiologist inserts either a needle or a vacuum-powered probe and removes several samples of tissue. The samples are sent to a laboratory 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. Using ultrasound, the radiologist locates the mass within your breast, makes a small incision to insert the needle and takes several core samples of tissue to be sent to a laboratory for analysis.
- MRI-guided core needle biopsy. This type of core needle biopsy is done under guidance of MRI — an 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 of about 1/4-inch long (about 6 millimeters) is made to allow the core needle to be inserted. Several samples of tissue are taken and sent to a laboratory for analysis.
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Surgical biopsy. During a surgical biopsy, a portion of the breast mass is removed for examination (incisional biopsy), or the entire breast mass may be removed (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 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. To help ensure that the entire mass has been removed, the tissue is sent to the hospital laboratory to check the edges (margins) of the mass. If it's determined in the laboratory that cancer cells are present in the margins (positive margins), some cancer may still be in the breast and more tissue must be removed. If the margins are clear (negative margins), it's more likely that all the cancer has been removed.
At the time of the 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 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 ease pain and discomfort after a breast biopsy, you may take a nonaspirin pain reliever containing acetaminophen (Tylenol, others) and apply a cold pack as needed to reduce swelling.
If you have a surgical biopsy, you'll likely have stitches (sutures) to care for. Your health care team will tell you on how to protect your stitches.
- Valea FA, et al. Breast diseases: Diagnosis and treatment of benign and malignant disease. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed June 21, 2011.
- James JJ, et al. The breast. In: Adam A, et al. Grainger & Allison's Diagnostic Radiology. 5th ed. Philadelphia, Pa.: Elsevier Churchill Livingstone; 2008. http://www.mdconsult.com/books/about.do?about=true&eid=4-u1.0-B978-0-443-10163-2..X5001-5--TOP&isbn=978-0-443-10163-2&uniqId=259733166-219. Accessed June 21, 2011.
- For women facing a breast biopsy. American Cancer Society. http://www.cancer.org/acs/groups/cid/documents/webcontent/003176-pdf.pdf. Accessed June 21, 2011.
- MRI-guided breast biopsy. RadiologyInfo.org. http://www.radiologyinfo.org/en/info.cfm?pg=breastbimr. Accessed June 21, 2011.
- Ultrasound-guided breast biopsy. RadiologyInfo.org. http://www.radiologyinfo.org/en/info.cfm?pg=breastbius. Accessed June 21, 2011.
- Pathology reports. National Cancer Institute. http://www.cancer.gov/cancertopics/factsheet/detection/pathology-reports. Accessed June 21, 2011.
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