Breast Cancer Diagnosis Diagnostic Mammography Breast Biopsy Breast Ultrasound Ductogram Less Common Diagnostic Procedures Staging

A breast biopsy involves removal of a sample of cells or tissue from the suspicious area for examination under a microscope by a pathologist. There are a number of different ways to perform a breast biopsy, depending on the characteristics of the breast abnormality that is being investigated. A woman should discuss the various biopsy options with her physician to determine the most appropriate method for her individual situation.

Biopsy options include fine needle aspiration biopsy (FNAB), core needle biopsy (CNB), vacuum-assisted biopsy, large core biopsy, or open surgical biopsy.

Breast biopsies can be performed with the patient in an upright or prone position.

Some breast abnormalities that require biopsy are large enough to be felt by the physician and can be located easily for biopsy. However, for abnormalities detected by mammography before they are palpable (can be felt), different methods are used to locate the precise area to be biopsied.

Ultrasound: Ultrasound uses pulses of high-frequency sound waves to outline a part of the body. In this procedure, sound waves are transmitted through the breast tissue and echoes of the sound waves are picked up and translated by a computer into an image displayed on a computer screen. The physician uses the image displayed on the screen to guide the biopsy needle into the precise area to be studied.

Stereotactic needle biopsy: This procedure uses computers to map the exact location of the mass or calcifications using mammograms taken from two angles. The computer then guides the placement of the needle in the appropriate spot.

Wire localization: This procedure is used to locate breast masses to be removed by large core biopsy or by open surgical biopsy. A very thin, hollow needle is placed in the breast after the area is numbed with a local anesthetic. x-rays are taken to pinpoint the abnormal area and to guide placement of the needle. When the needle is positioned appropriately, a thin wire is inserted through the center of the needle. With the wire held in place by a small hook at the end, the needle is removed and the physician uses the wire to locate the abnormal area to be removed.

Types of Breast Biopsies

Fine needle aspiration biopsy (FNAB): In this procedure, a thin needle (usually 22 or 25 gauge) is inserted into the suspicious area and tissue samples are extracted. If the mass cannot be felt, the needle is guided by ultrasound or stereotactic imaging. If the abnormality is a cyst, fluid is withdrawn. Clear fluid indicates that the lump is probably a benign cyst. Bloody or cloudy fluid usually indicates a benign cyst as well, although in rare instances can be a sign of a cancer. Bloody fluid is usually forwarded to a laboratory for analysis by a pathologist.

If the abnormality is a solid mass, tiny tissue fragments are removed for microscopic examination, which will usually tell whether the mass is benign or cancerous. In some instances, FNAB does not provide a clear answer and another type of biopsy is needed.

FNAB is usually done on an outpatient basis in a doctor's office or a clinic. Local anesthesia is not required. Stitches are not necessary; a small bandage is placed over the incision point and most women are able to resume normal activities the same day.

Core needle biopsy (CNB): This procedure uses a larger gauge, hollow needle that has a special cutting edge. The area of the breast containing the abnormal area is numbed with local anesthesia and the needle is inserted into the mass. If the mass is not palpable, the needle is guided by ultrasound or stereotactic imaging. Three to five small, cylindrical pieces of tissue are removed through multiple insertions of the needle. These samples are forwarded to the laboratory for analysis by a pathologist.

This procedure is usually done on an outpatient basis in a doctor's office or a clinic. The insertion point is closed with a small bandage and stitches are not required. Some bruising may occur, but it does not usually leave a scar.

Both FNAB and CNB depend on a small tissue sample on which to base a diagnosis of cancer. If the pathology result shows cancer, it is assumed to be correct. If the results are negative, however, there may be some concern about a missed diagnosis, because there is a small chance that the needle point may have missed the target. If there is some doubt about the diagnosis, the physician may recommend more aggressive screening for a period of time, or another type of biopsy.

Vacuum-Assisted Biopsy: This is a relatively new, minimally invasive procedure that uses a single insertion of a specimen probe to remove significantly more tissue than CNB or FNAB procedures. The procedure is performed under local anesthesia, usually in a doctor's office or clinic. Guided by ultrasound or stereotactic imaging, the probe is inserted into the abnormal tissue. A vacuum line draws the tissue into an opening in the side of the probe and a smaller inner sampling tool cuts 8 to 10 tissue samples in a pattern completely encircling the mass. The specimens are forwarded to a laboratory for analysis by a pathologist.

The insertion point is closed with a sterile bandage and no stitches are required. Some bruising and swelling may occur after the procedure.

Large core biopsy: In this procedure, the entire breast mass is removed in a single section, using stereotactic imaging and wire localization. The biopsy is done under local anesthesia, with the breast in compression. A narrow tube with a cutting device is inserted into the area containing the mass, using the wire as a guide. The mass is then removed with a looped wire and forwarded to a laboratory for analysis by a pathologist.

This procedure is usually done on an outpatient basis in a doctor's office or a clinic. Stitches are required to close the incision and several hours of recovery are recommended before the patient is released. The primary concerns expressed about the procedure are that an unnecessary amount of normal tissue is removed just to perform the biopsy. The margin of tissue around the mass cannot be definitively assessed by laboratory analysis.

Large core biopsy may also be known as ABBI, the brand name that stands for Advanced Breast Biopsy Instrumentation, manufactured by Tyco/United States Surgical Corporation.

Open surgical biopsy: For many years, open surgical biopsy was the only method of obtaining a tissue sample for analysis. The accuracy of diagnosis for open surgical biopsy is close to 100%, because the tissue sample is large: however, needle biopsies are less invasive and have fewer complications. It is important for women to thoroughly review the relative benefits and risks of all biopsy procedures with a physician so that an informed decision can be made based on each individual situation.

Open surgical biopsy is almost always done in a hospital, usually on an outpatient basis. General anesthesia is seldom used. An open surgical biopsy is usually performed under local anesthesia with IV sedation for the patient. If the mass cannot be palpated, wire localization is used to pinpoint the precise location of the abnormal area. The patient is then taken to the operating room, where a 1.5 to 2 inch incision is made. The mass is removed, along with a portion of tissue surrounding the mass. The specimen is forwarded to a laboratory for analysis by a pathologist.

The incision is closed with sutures and a sterile dressing is placed on the wound. An external scar is typical, and internal scar formation that may interfere with mammography may last several years.

There are some rare complications associated with open surgical biopsy, including:

• Abnormal bleeding



• Infection



• Difficult wound healing

This website provides general information only. A physician should be contacted if you need any medical advice or if medical decisions need to be made.