Breast Biopsy

When other tests show that you might have breast cancer, you will probably need to have a biopsy. Needing a breast biopsy doesn’t necessarily mean you have cancer—most biopsy results are not cancer-related, but a biopsy is the only way to find out for sure. During a biopsy, a doctor will remove cells from the suspicious area, so they can be looked at in the lab—this is done in order to see if cancer cells are present. Breast biopsies can be performed under mammography, ultrasound, or MRI.

There are various kinds of breast biopsies. Some use a needle, and some use an incision (a cut made in the skin). There are pros and cons to each method. The type of biopsy you may have depends on multiple factors, such as:

  • How suspicious the breast change looks.
  • How big it is.
  • Where it is in the breast.
  • If there is more than one.
  • Other medical problems you might have.
  • Your personal preferences.

Ask the doctor which type of biopsy you will have and what you can expect during and after the procedure. It’s important to ask questions if there’s anything you’re not sure about. Below is a detailed list of questions you may want to ask your doctor before getting a breast biopsy:

  • How long will the procedure take?
  • Will I be awake or asleep during the biopsy?
  • Will I need someone to help me get home afterward?
  • Will you put a clip or marker in my breast?
  • Will I have a scar? Where will it be? What will it look like?
  • Will I have bruising or changes in the color of my skin? If so, how long will it last?
  • Will I be sore? If so, how long will it last?
  • When can I take off the bandage?
  • When can I take a shower or bath?
  • When can I go back to work? How will I feel when I do?
  • Will my activities be limited? Can I lift things? Care for my children?
  • How soon will I know the biopsy results?
  • Should I call you or will you call me with the results?

If the doctor thinks you don’t need a biopsy, but you still feel there’s something wrong with your breast, follow your instincts. Don’t be afraid to talk to the doctor about this or go to another doctor for a second opinion. A biopsy is the only sure way to diagnose breast cancer.

Regardless of what type of biopsy you have, the biopsy samples will be sent to a lab where a specialized doctor called a pathologist will look at them. It typically will take at least a few days for you to find out the results.

Core Needle Biopsy

Your doctor may refer you for a Core Needle Biopsy (CNB). A CNB is an outpatient procedure most often done in the doctor’s office with local anesthesia (during which you’re awake, but your breast is numbed). The procedure itself is quick, although it may take more time if imaging tests are needed. During this procedure, the doctor uses a wide, hollow needle to take out pieces of breast tissue from the potential problem area. The needle may be attached to a spring-loaded tool that moves the needle in and out of the tissue quickly. This can be done with the doctor feeling the area or while using an imaging test to ensure the proper area is being tested. A small cylinder (core) of tissue is taken out in the needle. Several cores are often removed.

The doctor doing the CNB may put the needle in place by feeling the lump, however the needle is usually put into the abnormal area using some type of imaging test to guide it into the right place. Some of the imaging tests a doctor may use include:

  • Ultrasound
  • MRI
  • Mammogram

What to expect during a Core Needle Biopsy procedure:

You may be sitting up, lying flat or on your side, or lying facedown on a special table with openings made specifically to fit your breasts. You will have to be still while the biopsy is performed.

For any type of CNB, a thin needle will be used to numb your skin. Then a small cut (about one quarter of an inch) will be made in the breast. The needle or probe is put into the breast tissue through this cut to remove the tissue sample. You might feel some pressure as the needle is inserted. Again, imaging tests may be used to guide the needle to the right spot.

Typically, a tiny marker (called a clip) is put into the area of focus where the biopsy is done. This marker shows up on mammograms or other imaging tests so the exact area can be easily located for further treatment or followup. You can’t feel or see the marker, it can stay in place during MRIs, and it will not set off metal detectors.

Once the tissue is removed, the needle or probe is taken out. No stitches are needed afterward and the area is covered with a sterile dressing. Pressure may be applied for a brief time to help limit bleeding. You may be told to stay away from strenuous activity for a day or so, but you should be able to go back to your usual day-to-day activities after that. Your doctor or nurse will give you specific instructions on this after the procedure is complete.

A CNB can cause some bruising, but usually it doesn’t leave a scar. Your doctor or nurse will tell you how to care for the biopsy site and what you can and can’t do while it heals. All biopsies can cause bleeding and can lead to swelling—this can make it seem like the breast lump is larger after the biopsy, but more often than not, this is nothing to worry about and the bleeding, bruising, and swelling will all go away over time.

Stereotactic Core Breast Biopsy

For this procedure, a doctor uses mammogram pictures taken from different angles to pinpoint the biopsy site. A computer analyzes the X-rays of the breast tissue and shows exactly where the needle tip needs to be inserted into the abnormal area. This type of CNB is often used to biopsy suspicious microcalcifications (tiny calcium deposits) or small tumors that can’t be seen clearly on an ultrasound.

Typically, a tiny marker (called a clip) is put into the area where the biopsy is done. This marker shows up on mammograms or other imaging tests, so the exact area can be located for further treatment or follow up. You can’t feel or see the marker, it can stay in place during MRIs, and it will not set off metal detectors.

A stereotactic core breast biopsy can cause some bruising, but usually it doesn’t leave a scar. Your doctor or nurse will tell you how to care for the biopsy site after your procedure is complete and what you can and can’t do while it heals. All biopsies can cause bleeding and can lead to swelling. This can make it seem like the breast lump is larger after the biopsy—however, most often, this is nothing to worry about and the bleeding, bruising, and swelling go away over time.

Vacuum-Assisted Core Breast Biopsy

For a Vacuum-Assisted Biopsy (VAB), a hollow probe is put through a small cut into the abnormal area of breast tissue. The doctor guides the probe into place using an imaging test. A cylinder (core) of tissue is then suctioned into the probe and a rotating knife inside the probe cuts the tissue sample from the rest of the breast. Several samples can be taken from the same cut. This method usually removes more tissue than a core biopsy done with a regular needle.

Typically, a tiny marker (called a clip) is put into the area where the biopsy is done. This marker shows up on mammograms or other imaging tests, so the exact area can be located for further treatment or follow up. You can’t feel or see the marker. It can stay in place during MRIs, and it will not set off metal detectors.

A vacuum-assisted core breast biopsy can cause some bruising, but usually it doesn’t leave a scar. Your doctor or nurse will tell you how to care for the biopsy site and what you can and can’t do while it heals. All biopsies can cause bleeding and can lead to swelling. This can make it seem like the breast lump is larger after the biopsy. Most often, this is nothing to worry about, and the bleeding, bruising, and swelling go away over time.

Wire Localization to guide surgical biopsy:

If the change in your breast can’t be felt and/or is hard to find, a mammogram, ultrasound, or MRI may be used to place a wire in the suspicious area to guide the surgeon to the right spot. This is called “wire localization” or “stereotactic wire localization.”

After your breast is numbed, an imaging test is used to guide a thin, hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out and the surgeon uses the wire as a guide to identify the area to be removed.

What to expect if you have a surgical biopsy:

These procedures are performed in a hospital’s outpatient department. You are typically given local anesthesia with intravenous (IV) sedation—this means you’re awake, but your breast is numbed and you’re given medicine to make you drowsy. Another option is to have the biopsy done under general anesthesia, in which drugs are used to put you in a deep sleep and not feel pain during the procedure.

The skin of the breast is cut to allow the doctor to remove the suspicious area. You often need stitches after a surgical biopsy and pressure may be applied for a brief time to help limit any bleeding. The area is then covered with a sterile dressing. Your doctor or nurse will tell you how to care for the biopsy site and what you can and can’t do while it heals. All biopsies can cause bleeding and can lead to swelling—this can make it seem like the breast is larger after the biopsy. Most often, this is nothing to worry about and will go away over time.

It’s worth noting that a surgical biopsy may leave a scar. You might also notice a change in the shape of your breast, depending on how much tissue is removed.