Breast Biopsy

Why It Is Done

A breast biopsy checks to see if a breast lump or a suspicious area seen on a mammogram is cancerous (malignant) or noncancerous (benign). Testing a biopsy sample is the only reliable way to find out if cancer cells are present.

How To Prepare

If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your test. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.

You will be asked to sign a consent form that says you understand the risks, benefits, and other options and agree to have the test done.

If a breast biopsy is to be done under local anesthesia, you don't need to do anything else to prepare for the biopsy.

If the biopsy is to be done under sedation (to help you relax) or general anesthesia (to make you sleep), follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has told you to take your medicines on the day of surgery, do so using only a sip of water. Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own. Arrange for someone to drive you home if you will be having general anesthesia or are going to be given a sedative.

Other tests, such as blood tests, may be done before your breast biopsy.

How It Is Done

Before the biopsy

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head. (It depends on which position makes it easiest to find the lump.) Or you may lie on your stomach on a special table that has a hole for your breast to hang through. A mammogram, an ultrasound, or an MRI may be used to find the exact site for the biopsy.

Fine needle breast biopsy

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. When the area is numb, a needle is put through your skin into your breast tissue to take a sample. The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on.

Ultrasound may be used to guide the placement of the needle during the biopsy.

The biopsy sample is sent to a lab to be looked at under a microscope.

Core needle biopsy

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. When the area is numb, a small cut is made in your skin. A needle with a special tip is put into the breast tissue. The doctor takes some samples and usually inserts a small clip to mark the biopsy site.

Pressure is put on the needle site to stop any bleeding. A bandage is put on.

Most core needle biopsies are done using imaging to find the exact area in the breast to sample. Types of image-guided core needle biopsies include:

• Ultrasound-guided biopsy. An ultrasound probe guides placement of the needle or vacuum device.
• Stereotactic-guided biopsy. X-ray images guide placement of the needle.
• Tomosynthesis-guided biopsy. Digital breast tomosynthesis (DBT) uses 3D X-ray images to guide placement of the needle.
• MRI-guided biopsy. A contrast agent may be used to see the abnormal area. MRI is used to guide the biopsy.

A core needle biopsy may also be done using a probe with a gentle vacuum to remove the samples.

Open biopsy

The biopsy may be done in a surgery clinic or the hospital.

Before surgery, a mammogram or ultrasound may be done to show the doctor where the abnormal breast tissue is. A small wire may be put in the area to be biopsied. During surgery, the wire will guide the doctor to the correct area.

Anesthesia will be used to keep you comfortable during your biopsy. You may have a local anesthesia, sedation, general anesthesia, or a combination of these. Depending on what kind of anesthesia you have, you may be asleep for your biopsy.

And then, after you are numb or asleep, your doctor makes a cut through the skin to remove part or all of the abnormal tissue. If a wire was placed to mark the biopsy site, your doctor will take tissue from that area.

Stitches or strips of tape are used to close the skin, and a bandage is put on.

How long the test takes

• A fine needle breast biopsy takes from 5 to 30 minutes.
• A core needle biopsy may take 15 minutes to 60 minutes, depending on how the procedure is done.
• An open biopsy takes about 60 minutes.

It also takes time to prepare before the biopsy. And you may be monitored for some time after the biopsy, depending on the type of biopsy you have.

How It Feels

You will feel only a quick sting from the needle if you have a local anesthetic to numb the biopsy area. You may feel some pressure when the biopsy needle is put in.

Risks

The possible risks from a breast biopsy include:

• An infection at the biopsy site. An infection can be treated with antibiotics.
• Bleeding from the biopsy site.
• Not getting a sample of the abnormal tissue.
• Dizziness and fainting.

Core needle breast biopsies may leave a small scar. Open biopsies usually leave a larger scar. But these scars will fade over time. A fine needle breast biopsy usually doesn't leave a scar.

Results

Normal

No abnormal or cancer cells are present.

Abnormal

An abnormal result can mean many things. It can mean that you have breast changes that are not cancer. These are called benign changes. Or you may have breast changes that are not cancer but may increase your risk for cancer. It can also mean that cancer cells are present.