Breast Biopsy

What is a breast biopsy?

A breast biopsy is a procedure in which part or all of a suspicious breast growth is removed and examined, usually for the presence of cancer. The growth sample is suctioned out through a needle or cut out using a surgical procedure. The sample is then examined and evaluated under a microscope by a pathologist to identify non-cancerous (benign) or cancerous (malignant) tissue.

Words used to refer to the abnormal area or growth before and after diagnosis may include lump, mass, lesion, and tumor.

What is the purpose of a breast biopsy?

The basic aim of a breast biopsy is to determine whether or not a worrisome lump is cancer and, if it is cancer, what type it is. When no cancer is detected, the diagnosis of a benign or harmless lump is reassuring.

What specialties of physicians and practitioners do breast biopsies?

Many physicians and healthcare practitioners can be involved in evaluating a woman for a breast biopsy.

• For example, breast abnormalities during a physical examination might be noticed by a family physician, internist, gynecologist, or nurse practitioner. Women themselves are frequently the first to detect abnormalities in their breasts.
• Radiologists are specialists in interpreting x-rays such as mammograms, as well as other imaging studies. Radiologists or surgeons often perform the procedure to obtain the breast tissue sample.
• Anesthesiologists (specialists in administering anesthesia and monitoring a patient's vital signs) are sometimes necessary during surgical procedures.
• Pathologists are physician specialists who examine and identify under a microscope the type of cells in the samples and determine whether or not cancer is present. 

Who should have a breast biopsy?

Anyone, female or male, with a suspicious breast growth or other symptoms of breast cancer should undergo a biopsy. Ninety-nine percent of all breast cancers occur in females, however, males can and do get breast cancer. Therefore, men should regularly examine their breasts as females do for lumps or other cancer symptoms. (Males with the genetic disorder Klinefelter syndrome, which is associated with increased breast development, have approximately the same risk of developing breast cancer as females.)

In what setting is the breast biopsy done?

Breast biopsies are performed in the doctor's office, an outpatient facility, or a hospital operating room. The setting depends on the size and location of the growth, the patient's general health, and the type of biopsy performed. Because physicians can perform biopsies in a short time with minimal risk of serious complications, the patient usually does not need to remain hospitalized overnight unless an underlying health problem requires close monitoring.

What may a benign result indicate?

Among the most common benign growths in the breast are cysts (sacs filled with fluid or semisolid material), intraductal papillomas (small wart-like growths that project above a tissue surface), and lumps formed by fat necrosis (the death of tissue often as a result of trauma to the breast). A fibroadenoma is the most common type of benign (non-cancerous) breast tumor and is found in young women.

How is a suspicious breast growth discovered?

A suspicious breast growth may be found by a patient's self-examination, a physician's clinical examination, or a screening procedure such as a mammogram.
Patients who discover a lump in a breast should see a physician for testing. They should also see a physician if they find a lump in an armpit or above a collarbone (either of which could indicate the presence of spreading cancer). Finally, a physician should be consulted if they have:

• red or irritated breast skin,
• scaly skin on the breast,
• dimpling skin on the breast,
• swelling breast skin,
• nipple discharge other than milk,
• nipple retraction or inversion,
• nipple itching,
• a change in the size or shape of a breast, or
• breast pain.

It is important to remember that these signs and symptoms do not necessarily indicate the presence of cancer.

What should the patient tell the physician about the growth?

The patient should tell the doctor when the growth appeared, what its size was at the time of discovery compared to its present size, and where it is located. The patient should also outline any family history of breast cancer, as well as any personal history of breast problems of any kind.

How does a physician confirm the presence of a breast growth?

A physician confirms the presence of a growth by taking a medical history (and asking numerous questions), performing a clinical examination that includes palpating (feeling) the breast, and interpreting the results of a diagnostic mammogram and sometimes other imaging studies such as ultrasound or MRI.
Ultrasound sends sound waves into the breast that "bounce" back to receiver that can record an image on a computer screen to visualize interior structures. This technique can help distinguish between a cyst and a solid growth. The physician may also order the laboratory analysis of any nipple discharge (other than milk) for the presence of cancerous cells. After confirming the presence of a suspicious growth, the physician orders a biopsy.

Is anesthesia needed for a biopsy?

For non-surgical biopsies, the patient may need no anesthesia at all or just a local anesthesia (one that numbs the suspicious area only). Sometimes, a patient receives a sedative (calming drug) with the local anesthesia.
For surgical biopsies, the patient may receive a local anesthesia (with or without a sedative) or general anesthesia (one that induces sleep). Patients requiring general anesthesia may have to fast 8 to 12 hours before undergoing a biopsy.

What about pain and complications?

Except for a minor sting from the injected anesthesia, patients usually feel no pain before or during a procedure. After a procedure, some patients may experience some soreness and pain. Usually, an over-the-counter drug is sufficient to alleviate the discomfort.
The risk of complications, such as infection and bleeding, is small for non-surgical procedures and slightly higher for surgical procedures.

What are the advantages and disadvantages of non-surgical procedures versus surgical breast biopsies?

Generally, non-surgical biopsies are less stressful, do not disfigure the skin, leave no internal scar to interfere with the accuracy of future mammograms, and minimize the risk of complications.
However, non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis. For this reason, some patients who undergo a non-surgical biopsy must also undergo a follow-up surgical biopsy.

What are the different types of breast biopsy procedures and what do they involve?

Breast biopsy procedures include:

• fine needle aspiration biopsy (FNAB),
• core needle biopsy (CNB),
• vacuum-assisted breast biopsy, and
• excision biopsy (surgery).

How is a fine needle aspiration biopsy (FNAB) done?

A fine needle aspiration biopsy (FNAB) can be done in several different ways:

• Fine needle aspiration biopsy (FNAB) for palpable growths: A palpable growth is one that can be felt. The patient usually sits up while the doctor inserts a small hollow needle with a syringe to withdraw (aspirate) fluid and cells from the growth for testing. To guide the needle to the site, the doctor simply feels (palpates) the suspicious area. When the needle reaches the mass, the doctor suctions out a sample with the syringe. The doctor repeats this procedure several times. If the mass is a cyst, the withdrawn samples will consist mainly of fluid and the cyst may collapse, relieving any pain the patient feels. If the mass is solid, the samples will consist primarily of tissue cells.

By analyzing the samples immediately after their withdrawal, a doctor may be able to determine that they came from a cyst and simply discard them, diagnosing the growth as benign. In all other cases, fluid and tissue samples are placed on slides and then analyzed in a laboratory by a pathologist.

• Guided FNAB for Non-Palpable Growths: When a growth is too small or deep to palpate (feel), the doctor must locate it with one of several imaging techniques. First, the patient lies face down on a table with the breasts suspended through an opening. With stereotactic mammography, mammograms of the suspicious breast site are taken from different angles to form a virtual three-dimensional (stereotactic) image that precisely pinpoints the location of the suspicious area. The computer then uses a motor to guide a small hollow needle to the site to remove the samples. The withdrawn samples are then analyzed for the presence of cancer. Ultrasound and MRI are other imaging techniques that may be used to guide breast biopsies. 

How is a core needle biopsy (CNB) done?

A core needle biopsy (CNB) can also be done in several different ways:

• Core needle biopsy (CNB) for palpable growths: This procedure is similar to FNAB for palpable growths except that that the needle used has a wider diameter and is equipped with a cutter that removes cores of tissue up to a half-inch long. A key advantage of this procedure is that the samples are larger than in FNAB and thus enhance the possibility of making an accurate laboratory analysis.
• Guided CNB for Non-Palpable Growths: This procedure also uses a wide needle with a cutter that removes cores of tissue large enough to enhance the accuracy of laboratory analysis. However, because the growth is deep in the breast or otherwise not palpable, stereotactic imaging, ultrasound, or MRI is used to locate the growth.

How is a vacuum-assisted breast biopsy done?

Vacuum-assisted breast biopsy uses a special instrument and imaging guidance to remove samples of breast tissue through a single, small skin incision. This technique allows the surgeon to remove more tissue through a single incision than is possible with a traditional core biopsy and is a much less invasive procedure than an open surgical biopsy.
The vacuum-assisted biopsy involves the placement of a biopsy probe using radiology imaging studies for guidance. Stereotactic mammography, ultrasound, and MRI have all been successfully used to identify the abnormal areas to be sampled by vacuum-assisted breast biopsy. Once the biopsy probe has been positioned, a vacuum pulls the breast tissue through an opening in the probe into the sampling chamber of the device. Then a rotating cutting device in the instrument removes the tissue sample, which is carried through the biopsy probe to a tissue collection receptacle.
The surgeon or radiologist then turns a control knob on the biopsy probe that moves the sampling chamber to a new position. This procedure is repeated until all desired areas have been sampled. In this way, samples can be taken all around a suspicious area through a single insertion of the biopsy probe. With a traditional core biopsy, sampling of multiple areas would involve repeated insertions of the biopsy instrument.
The vacuum-assisted biopsy technique is performed under local anesthesia and leaves a small incision that does not require stitches for closure. It takes less than an hour to perform, and patients can usually return to normal activities soon after the procedure.

How is an excision biopsy of the breast done?

An excision (surgical) biopsy can also be done in different ways:

• Surgical biopsy of palpable growths (lumpectomy): This procedure removes part or all of a breast growth, or lump. The doctor makes an incision one or two inches (about 2.5 to 5 cm) across and removes the sample. If the lump is small and measures an inch (2.5 cm) or less across, the doctor usually removes the entire lump for testing. If the lump is large, the doctor usually removes only a portion of it for testing. If cancer is found, the rest of the lump can be removed at the time of the biopsy or at a later time.

The doctor closes the opening with sutures or clips which remain in place for about a week. Patients who receive general anesthesia rather than a local will require about an hour to recover from drowsiness after the surgery.

• Surgical biopsy for non-palpable lumps: This procedure is similar to lumpectomy except that the growth is first located by mammography or other imaging studies and then "marked." The doctor inserts a needle that conveys a wire with a hook on the end into the breast, all the while using the image as a guide. After anchoring the hooked wire to the lump, the doctor withdraws the needle and performs the surgery. Another option is to inject a dye to mark the spot rather than using a hooked wire.

What is the time frame for receiving the results of a breast biopsy?

For small biopsies and fine needle aspirations, the results may be available the next day. The results of most breast biopsies will be available within a few days. Sometimes special testing must be performed, and the results may take a bit longer. The radiologist or surgeon performing the procedure will be able to give you and idea of the approximate time frame that the result will be available. Your physician should also let you know how the result will be communicated to you.

Breast Biopsy At A Glance

• A breast biopsy procedure is usually done to determine whether a growth in the breast is cancerous or benign.
• A lump or other sign of breast cancer in a man or woman may warrant a breast biopsy.
• A breast biopsy can be done with a needle or by a surgical procedure.
• Non-surgical biopsies tend to be less stressful and minimize the risk of complications.
• Non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis.
• The biopsy may be done with imaging guidance.

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