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Breast biopsies

Types of breast biopsies

Your testing may indicate an abnormality that may need to be biopsied to determine if cancer is present. Most breast biopsies will be benign, or non-cancerous. If a biopsy is not done, however, and the abnormality is eventually found to be cancer, then the delay may worsen the prognosis of breast cancer.

Breast Biopsy: A small sample of breast tissue is taken of a suspicious area in your breast so that it can be sent to the lab for testing. The sample is then examined and evaluated under a microscope by a pathologist to identify non-cancerous (benign) or cancerous (malignant) tissue. 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.

Needle Biopsy: In 2005, the American College of Surgeons recommended that most breast biopsies should be done with a needle rather than a surgical excision. The needle biopsy is typically simple and leaves behind only a small scar. Most breast biopsies are benign, and no further procedures or surgery will need to be done. If the biopsy shows cancer, then the small needle biopsy helps plan the appropriate surgery, and causes minimal disruption of the breast tissue so that it is easier to check the lymph nodes at the time of the breast cancer operation.

Location of Biopsy: Breast biopsies are performed in the radiology department, the surgeon’s office, an outpatient facility or a hospital operating room. The biopsies are often aided by ultrasound machines, mammogram machines or MRI machines.

Types of Biopsies: 

There are many types of biopsies depending on what is suspicious in your breast and how it was identified:

  • A fine-needle aspiration biopsy puts a thin needle through the skin, into the lump and removes cells for further examination. Needle aspiration may be done to see if the lump is solid or fluid-filled (cyst). If the lump is a cyst, it will go away after the fluid is removed. If there is no fluid, another type of biopsy may be done.
  • A core needle biopsy using ultrasound uses a large needle fitted with a special tip. The needle goes through the skin and into the abnormal area and several cores of tissue are removed. Many times an ultrasound machine is used so that the physician can be certain that the correct area is biopsied. 
  • A stereotactic biopsy uses a mammogram during a core needle biopsy to find the area of the breast where the biopsy samples will be taken. This technique is used when the abnormality cannot be felt on breast examination or seen on ultrasound, but is seen on mammogram or MRI. A small incision is then made in the skin of the breast, and the core needle is guided by the X-ray to the biopsy site to take tissue samples. Stereotactic biopsy may not be appropriate for all types of breast lumps. 
  • A vacuum-assisted core biopsy is done with a hollow probe that uses a gentle vacuum to remove a sample of breast tissue. This method may be used for a core needle biopsy or a stereotactic biopsy. Vacuum-assisted biopsy can remove more tissue than a standard core needle biopsy. The single small incision does not require stitches and there is very little scarring.
  • An open biopsy makes a cut in the skin and removes a sample of the lump or the entire lump.
  • A needle or wire-localized breast biopsy is done by putting a small wire in the suspicious area during a mammogram or MRI done just before surgery. The wire then guides your doctor to the suspicious area to take a biopsy sample. *See picture below.

Sometimes an open surgical biopsy is recommended after your needle biopsy. A more extensive biopsy may be needed if problems are found during the first biopsy or if your doctor is concerned about a certain area of your breast. The needle biopsy may not have removed a sufficient sample or it may not match what the physician was expecting. If the tissue removed contains atypical cells or a papilloma, then more tissue may need to be removed because cancer is sometimes found near these areas.

How To Prepare

Tell your doctor if you:

  • Are taking any medicines.
  • Are allergic to any medicines, including anesthetic medications used to numb your skin.
  • Are allergic to latex.
  • Have any bleeding problems or take blood thinners, such as aspirin, heparin, warfarin (Coumadin), enoxaparin sodium (Lovenox) or clopidogrel bisulfate (Plavix).
  • Are or might be pregnant.

Risks: There is a risk of bleeding and infection with these procedures.