Breast Biopsy

Procedure overview

What is a breast biopsy?

A biopsy is a procedure used to remove tissue or cells from the body for examination under a microscope. A breast biopsy is a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery to see if cancer or other abnormal cells are present.

Biopsies may be done under local or general anesthesia. There are several types of breast biopsy procedures. The type of biopsy performed will depend on the location and size of the breast lump or abnormality.

Types of breast biopsy procedures include, but are not limited to, the following:

• Fine needle aspiration biopsy. A very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision, or cut, is necessary. A fine needle aspiration biopsy may be done to help see if the suspicious area is a cyst (a fluid-filled sac) or a lump.

• Core needle biopsy. A large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.

• Surgical biopsy (also called an open biopsy). A surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are 2 types of surgical biopsies. During an incisional biopsy, a small part of the lump is removed. During an excisional biopsy, the entire lump is removed.In some cases, if the breast lump is very small and deep and is difficult to locate, the wire localization technique may be used during surgery. With this technique, a special wire is placed into the lump under X-ray guidance. The surgeon then follows this wire to help locate the breast lump.

There are special instruments and techniques that may be used to guide the needles and to assist with biopsy procedures. These include, but are not limited to, the following:

• Stereotactic biopsy. Stereotactic biopsy finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a 3-dimensional (3D) picture of the breast. A sample of tissue is removed with a needle that is guided to the right area using the 3D picture.

• Vacuum-assisted biopsy (also called Mammotome breast biopsy system or ATEC [Automated Tissue Excision and Collection]). A type of tube or probe is inserted into the breast lump or mass through a small cut made in the skin. The breast tissue is gently suctioned into the tube, and a rotating knife inside the tube removes the tissue. The ATEC system can be guided by MRI to be sure to get tissue from the area of concern.

• Ultrasound-guided biopsy. A technique that uses a computer and a transducer that sends out ultrasonic sounds waves to create images of the breast lump or mass. This technique helps to guide the needle to the exact biopsy site.

Other breast biopsy techniques are being studied, including ductal lavage. In this procedure, a small catheter is inserted through the nipple into a milk duct in the breast. Saline (salt-water solution) is gently flushed through the catheter into the duct. The saline is then withdrawn back through the catheter, collecting ductal cells in the fluid. The cells are examined in the lab to check for cancer or precancerous changes. This procedure is still considered investigational, but it may be used in women with no symptoms, but who are known to be at high risk for breast cancer.

Other related procedures used to evaluate and treat breast problems include mammogram, breast ultrasound, breast scan, breast-conserving surgery, and mastectomy. Please see these procedures for more information.

Anatomy of the breast

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk.

The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces between lobules and ducts.

There are no muscles in the breast, but muscles lie under each breast and cover the ribs.

Each breast also contains blood vessels and vessels that carry lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes, clusters of which are found under the arm, above the collarbone, and in the chest, as well as in many other parts of the body.

Reasons for the procedure

Breast biopsies may be performed:

• To evaluate a palpable (one that can be felt) lump or mass in the breast

• To investigate an abnormality seen on mammogram, such as microcalcifications (small calcium deposits in breast tissue) or a cyst (fluid-filled mass)

• To evaluate nipple abnormalities, such as a bloody discharge from the nipple

• To determine if a breast lump or mass is malignant (cancer) or benign (not cancer)

It is important to remember that a lump or other changes in the breast, or an abnormal area on a mammogram, may be caused by cancer or, more commonly, by other less serious problems.

There may be other reasons for your doctor to recommend a breast biopsy.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications of a breast biopsy may include, but are not limited to, the following:

• Bruising and discomfort at the biopsy site

• Prolonged bleeding from the biopsy site

• Infection near the biopsy site

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their doctor.

If you are pregnant, or think you may be pregnant, notify your health care provider.

If the biopsy is done using an X-ray, the amount of radiation used during the procedure is considered minimal; the risk for radiation exposure is very low.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• The doctor will explain the procedure to you and give you a chance to ask any questions that you might have.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• Generally, no preparation, such as fasting, is required for a biopsy done under local anesthesia (the skin of your breast is numbed but you are awake). If your biopsy requires general anesthesia (you are given drugs to put you into a deep sleep), you will need to fast for a certain number of hours before the procedure, generally after midnight.

• Do not use lotion, cream, powder, deodorant, or perfume on your arm or breast on the day of the procedure.

• If you are pregnant or think you may be pregnant, notify your health care provider.

• Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).

• Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. You may need  to stop these medications prior to the procedure.

• If you receive a sedative or general anesthesia, you will need someone to drive you home afterwards.

• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A breast biopsy may be performed in a doctor’s office, on an outpatient basis, or as part of your hospital stay. Some biopsy procedures only require local anesthesia, while others require general anesthesia. Procedures may vary depending on your condition and your doctor’s practices.

Generally, a needle breast biopsy will follow this process:

1. You will be asked to remove any clothing from the waist up, and will be given a gown to wear.

2. You will lie down or sit up, depending on the doctor’s preference and whether X-ray or ultrasound guidance will be used.

3. The skin over the biopsy site will be cleaned with an antiseptic solution.

4. When a local anesthetic is used, you will feel a needle stick when the anesthetic is injected. This may cause a brief stinging sensation. The procedure will not be started until the area is numb.

5. When ultrasound is used, the probe will be placed on the breast to locate the breast lump or suspicious area.

6. When stereotactic imaging is used, you will lie face down with your breast placed in an opening on the table. A computer will determine the exact location of the breast lump or suspicious area.

7. You will need to lie still during the procedure. But you will not need to hold your breath. 

8. The doctor will insert the needle either directly into the biopsy site or through a tiny incision to remove a sample of tissue and/or fluid. You may feel pressure when the doctor takes the sample.

9. Pressure will be applied to the biopsy site until the bleeding stops.

10. If necessary, the opening will be closed with sutures or adhesive strips.

11. A sterile bandage or dressing will be applied.

12. The tissues will be sent to the lab for examination.

Generally, an open breast biopsy will follow this process:

1. You will be asked to remove clothing and will be given a gown to wear.

2. An intravenous (IV) line may be started in your arm or hand.

3. You will be positioned on the operating table.

4. You may be given a sedative.

5. If local anesthesia is given, you will feel a needle stick to numb the breast tissue.

6. If general anesthesia is given, the anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

7. In some cases, a special wire will be placed into the lump under X-ray guidance to help the doctor locate the breast lump or abnormality prior to the biopsy procedure. Other X-ray-guided procedures may be used.

8. The skin over the surgical site will be cleansed with an antiseptic solution.

9. A small incision will be made in the skin and underlying breast tissues until the lump or breast abnormality is exposed.

10. A part of the lump or the entire lump will be removed.

11. The opening will be closed with sutures or adhesive strips.

12. A sterile dressing or bandage will be applied.

13. The tissue will be sent to the lab for examination.

After the procedure

The recovery process will vary depending on the type of biopsy performed and the type of anesthesia used.

If you received general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.

If you received local anesthesia, you will be discharged to your home after you have completed the recovery period.

Keep the biopsy area clean and dry if there are sutures. If sutures are used, they will be removed during a follow-up office visit. If there are no sutures, you may remove the bandage or dressing when instructed to do so, and bathe as usual.

The biopsy site may be tender or sore for several days after the breast biopsy. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications. Wearing a supportive bra may help with discomfort.

You may resume your normal diet unless your doctor advises you differently. You may be told to avoid strenuous physical activity for a few days.

Notify your doctor to report any of the following:

• Fever and/or chills

• Redness, swelling, bleeding, or other drainage from the biopsy site

• Increased pain around the biopsy site 

Schedule a Mamogram at Richmond University Medical Center

Early detection and treatment is the best strategy for a better cancer outcome. Schedule your mamogram at RUMC: Call 718-818-3280.

Kathy Giovinazzo is Director of Radiology at Richmond University Medical Center.

For More Information

For more information or to schedule an appointment, contact Dr. Thomas Forlenza at 718-816-4949. His office is located at 1366 Victory Blvd on Staten Island.

Dr. Forlenza is the Director of Oncology at Richomd University Medical Center.