A breast biopsy involves removing a sample of breast tissue, cells, or fluid. While physical breast exams, mammography, breast ultrasound, and other breast imaging methods can help detect a breast abnormality, breast biopsy followed by pathological (microscopic) analysis is the only definitive way to determine if cancer is present.
There are several different types of breast biopsies detailed below. The biopsy method most suitable for a particular patient depends on a number of factors, including whether an abnormality can be felt or not, how suspicious the abnormality appears, the size, shape, and other distinct characteristics of the abnormality, and the number of abnormalities seen.
Many biopsy methods rely on imaging guidance to help the radiologist precisely locate the abnormality within the breast. Imaging guidance is necessary when a breast abnormality cannot be felt during an examination and is only detected in imaging studies such as mammography or breast ultrasound. It may also be necessary to use imaging to assure that a mass felt during an examination is, indeed, the same abnormality noted on a mammogram or breast ultrasound.
Fine Needle Aspiration Breast Biopsy (FNAB)
Fine Needle Aspiration Biopsy is done with a small needle that goes through the skin. This procedure samples fluid or cells from a mass. Usually, ultrasound is used to guide the needle to the correct location. FNAB does not require stitches and can be performed on an outpatient basis. A very small bandage is placed over the area after the procedure. Normal activities can usually be resumed on the same day.
Core Needle Breast Biopsy
Core Needle Biopsy is a procedure that involves removing small samples of tissue using a hollow “core” needle. Either ultrasound or stereotactic mammography guidance can be used, but most commonly, ultrasound is used to guide the needle to the correct location. Stereotactic means that the breast biopsy device is precisely guided to the correct location using x-ray imaging and computer coordinates.
First, the area is numbed with an injection of local anesthetic. A small skin nick is made and the needle is guided to the lesion using ultrasound or stereotactic mammography. Patients may experience slight pressure or “pinching,” but should not experience any significant pain. As tissue samples are taken, clicks may be heard from the needle and sampling instrument. The skin nick is closed with an adhesive bandage and covered with a small dressing and ice pack. Minimal bruising is usually seen. The samples are sent to the pathology laboratory for diagnosis and our radiologist will call you with the results, generally within 24 hours. Most normal activities may be resumed the next day.
Vacuum-Assisted Core Needle Biopsy
Vacuum-Assisted Core Needle Biopsy is a procedure that involves removing small samples of tissue using a special probe. This probe has a vacuum line that draws a tiny amount of breast tissue through the opening of the probe, into the sampling chamber of the device. The tissue sample is carried through the probe to the collection area where the tissue sample is then captured.
Either ultrasound or stereotactic mammography guidance can be used. Stereotactic mammography uses computers to pinpoint the exact location of the mass or calcifications based on mammograms taken from two different angles. The coordinates will help the radiologist to guide the needle to the correct area. With ultrasound, our radiologist will watch the needle on the ultrasound monitor to help guide it to the area of concern. The patient will either be laying on their back (for ultrasound) or on their stomach (for stereotactic).
Once a sufficient number of tissue samples have been collected, our radiologist will remove the probe and apply pressure to the biopsy site. In most cases, a tiny sterile metal clip will be placed to mark the location of the biopsy. The clip cannot be felt but is very important to mark the exact site of the biopsy.
An adhesive bandage will be used to close the small skin nick and covered with a small dressing and ice pack. Minimal bruising is usually seen. The tissue samples are sent to the pathology laboratory for diagnosis and the radiologist will call you with the results, generally within 24 hours. Most normal activities may be resumed the next day.
Needle/Wire Localization with Open Surgical Biopsy
This procedure is a pre-operative procedure immediately followed by a surgical biopsy. Using a mammogram or an ultrasound as a guide, our radiologist places a needle and/or a fine wire into the suspicious area.
The area is then removed by a surgeon the same day with an open surgical biopsy. Needle/Wire placement is performed when the area of concern was seen on a mammogram and/or ultrasound and cannot be felt. A traditional open surgical biopsy requires a small-inch incision in the breast and is performed by a surgeon.
When the area of concern is removed, the tissue is usually x-rayed to confirm that the area in question has been removed. When this is complete, the entire specimen will be taken to the laboratory to be examined by the pathologist. The incision will be closed with suture material. This biopsy is usually done as an outpatient procedure.