a breast biopsy?
A breast biopsy is a surgical
procedure that is done to remove a sample of tissue
from the breast to determine whether the tissue
is benign (noncancerous) or malignant (cancerous).
Most biopsies are benign (noncancerous), but it
is always better to have a definite diagnosis.
When is a breast biopsy
A breast biopsy is recommended
when mammograms, ultrasound, MRI, or physical
exam by your doctor finds an area of concern and
it is necessary to determine whether the abnormality
is benign or malignant. The surgeon removes a
sample of tissue and sends the specimen to a pathologist
to study under the microscope. There are several
different biopsy techniques that can be used to
obtain the tissue. These include: fine needle
aspiration biopsy, core (large needle) biopsy
with image guidance, and surgical biopsy.
The choice of which biopsy to use
depends on your specific situation. The size of
the area of concern, where in the breast it is
located, whether it can be felt or seen only on
imaging studies (such as mammography, ultrasound
or MRI), other medical problems you may have,
and personal preferences, are some of the factors
in selecting the type of biopsy. Your surgeon
will discuss with you which biopsy options are
available to you, and their advantages and disadvantages.
Types of Biopsies
• Fine Needle Aspiration
• Image-guided Biopsies - Core Needle Biopsy,
Stereotactic Guided Biopsy, Ultrasound-guided
Biopsy or MRI-guided Biopsy
• Surgical Biopsy
Fine Needle Aspiration
Your surgeon can do a fine needle
aspiration biopsy to draw out a few cells or fluid
from a lump. The fine needle is often used for
lumps that can be felt and can also be used with
ultrasound guidance. If the lump is solid, you
surgeon will first numb your breast with lidocaine
and then use a special needle to remove cells
to send to cytology. If there is fluid in the
lump, the fluid is removed. If the fluid is clear,
it will be discarded. If the fluid is bloody or
looks infected, it will be sent to the lab for
analysis of the cells. This procedure is done
in the office and usually takes about 20 minutes.
The results are returned within 48 hours. Your
surgeon will call you with the results. Sometimes
a fine needle aspiration cannot give us an answer
and a tissue biopsy is needed.
Core Needle Biopsy
A core needle biopsy can either
be done with image guidance on a breast lump that
can be felt or an abnormality that can be seen
under ultrasound, mammogram, or MRI. A core needle
takes a much larger sample of tissue than a fine
needle. Your surgeon will numb your breast with
lidocaine. Usually with the core needle your surgeon
will make a tiny cut in your skin to insert the
needle, and then take out several samples of tissue
to send to pathology for evaluation. This usually
takes about 30 minutes. The results are returned
within 48 hours.
Ultrasound: Ultrasound is a valuable
tool to specifically target an area of concern
found by mammography or which can be felt. Ultrasound
uses high-frequency sound waves to outline the
area being studied. A computer picks up the image
that is displayed on a computer screen. The surgeon
can then use this image to guide his biopsy needle
directly into the area of concern and remove tissue
or fluid to be sent to the lab for analysis. This
is done in the office under local anesthesia.
The results are usually returned within 48 -72
Mammography: Mammography is also
used as a tool to guide the surgeon to an area
of concern that needs to be biopsied. A stereotactic
biopsy is used when microcalcifications or a mass
can be seen on mammography but cannot be located
by touch or ultrasound. You will lie face down
on a special table that has a hole that your breast
will be positioned in for the biopsy. The computerized
equipment on the table will map the location of
the area of concern, to be used as a guide for
your surgeon to biopsy the area. Your breast will
be compressed during part of the procedure and
special mammogram films will be taken to verify
the exact area for placement of the needle. Your
surgeon will numb the area with lidocaine and
make a tiny incision to guide the needle through.
Two commonly used needles are devices
such as the Mammotome needle (a vacuum assisted
core biopsy) or Neothermia needle, which takes
one larger sample of tissue. The sample will be
taken to send to pathology for analysis. Once
completed, your surgeon will close the wound with
a steri-strip. Most women find they have mild
pain or swelling after this procedure which is
easily relieved with ice, Tylenol and wearing
a support bra.
Surgical Biopsy: A surgical biopsy
involves removing all or part of the area or lump
for examination. This biopsy may be done in the
outpatient office or outpatient surgical unit.
There are two types of surgical biopsies:
• Incisional Biopsy - removes part of a
• Excisional Biopsy – removes all
of the lump
If the lump or area is too small
to be felt, the surgeon may use ultrasound or
mammography to place a small wire into your breast
to localize the area or guide the surgeon to the
area of concern. These procedures use both local
anesthesia to numb the breast and, if done in
the hospital, medication to make you sleepy. The
biopsy results will take approximately 48 hours.
Your surgeon will call you with the results.
What are the risks of a
All surgery involves some risk.
Your surgeon will discuss any specific risks with
you prior to you signing the consent for your
surgery. General risks and complications associated
with breast surgery include:
• Wound infection - not common, but when
they occur, they are treated with antibiotics.
• Poor wound healing – although not
common, blood or clear fluid can collect in the
breast/wound area, requiring drainage.
• Bleeding: Bleeding during or after the
surgery can occur. We try to minimize this by
asking that you do not take blood thinning products
(like aspirin) for 7 days prior to your biopsy
• Reaction to the anesthesia - this is a
low risk but some people can have a reaction to
If you have any questions or
concerns, please call our office at 847-797-9000.