• What is a breast biopsy?
• What kind of physician does a breast biopsy?
• Who should have a breast biopsy?
• In what setting is the breast biopsy done?
• What is the chance that a biopsy will show cancer?
• What may a benign result indicate?
• How is a suspicious breast growth discovered?
• What should the patient tell the physician about the growth?
• How does a physician confirm the presence of a breast growth?
• Is anesthesia needed for a biopsy?
• What about pain and complications?
• What are the advantages and disadvantages of non-surgical procedures versus surgical breast biopsies?
• What are the different types of breast biopsy procedures and what do they involve?
• How is a fine needle aspiration biopsy (FNAB) done?
• How is a core needle biopsy (CNB) done?
• How is an excision biopsy of the breast done?
• What is the purpose of a breast biopsy?
• Breast Biopsy At A Glance

What is a breast biopsy?

A breast biopsy is a procedure in which part or all of a suspicious breast growth is removed and examined, usually for the presence of cancer . The growth sample is suctioned out through a needle or cut out using a surgical procedure. The sample is then examined and evaluated under a microscope to identify non-cancerous (benign) or cancerous (malignant) tissue.

Words used to refer to the growth before and after diagnosis may include lump, mass, lesion, and tumor.

What kind of physician does a breast biopsy?

Many physicians and healthcare practitioners can be involved in evaluating a woman for a breast biopsy. For example, breast abnormalities during a physical examination might be noticed by a family physician, internist, gynecologist or nurse practitioner. Women themselves are frequently the first to detect abnormalities in their breasts. Radiologists are specialists in interpreting x-rays such as mammograms, as well as other images. Radiologists or surgeons often perform the procedure to obtain the breast tissue sample. Anesthesiologists (specialists in administering anesthesia and monitoring a patient's vital signs) are sometimes necessary during surgical procedures. Pathologists are the specialists who examine and identify under a microscope the type of cells in the samples.

Who should have a breast biopsy?

Anyone, female or male, with a suspicious breast growth or other symptoms of breast cancer should undergo a biopsy. Although 99% of all breast cancers occur in females, males can and do get breast cancer. Therefore, men should regularly examine their breasts as females do for lumps or other cancer symptoms. (Males with the genetic disorder Klinefelter syndrome , which causes breast development, have approximately the same risk of developing breast cancer as females.)

In what setting is the breast biopsy done?

Breast biopsies are performed in the doctor's office, an outpatient facility, or a hospital operating room. The setting depends on the size and location of the growth, the patient's general health, and the type of biopsy performed. Because physicians can perform biopsies in a short time with minimal risk of serious complications, the patient usually does not need to remain hospitalized overnight unless an underlying health problem requires close monitoring.

What is the chance that a biopsy will show cancer?

About 80% of all biopsies done in the U.S. produce benign (not cancerous) results, according to the American Cancer Society.

What may a benign result indicate?

Among the most common benign growths in the breast are cysts (sacs filled with fluid or semisolid material), intraductal papillomas (small wart-like growths that project above a tissue surface), and lumps formed by fat necrosis (the death of tissue often as a result of trauma to the breast).

How is a suspicious breast growth discovered?

A suspicious breast growth may be found by a patient's self- examination, a physician's clinical examination, or a screening x-ray ( mammogram ).

Patients who discover a lump in a breast should see a physician for testing. They should also see a physician if they find a lump in an armpit or above a collarbone (either of which could indicate the presence of spreading cancer). Finally, a physician should be consulted if they have red or irritated breast skin, scaly skin, dimpling skin, swelling skin, nipple discharge other than milk, nipple retraction or inversion, nipple itching, a change in the size or shape of a breast, or breast pain. It is important to remember that these signs and symptoms do not necessarily indicate the presence of cancer.

What should the patient tell the physician about the growth?

The patient should tell the doctor when the growth appeared, what its size was at the time of discovery compared to its present size, and where it is located. The patient should also outline any family history of breast cancer, as well as any personal history of breast problems of any kind.

How does a physician confirm the presence of a breast growth?

A physician confirms the presence of a growth by taking a medical history (and asking numerous questions), performing a clinical examination that includes palpating (feeling) the breast, and interpreting the results of a diagnostic mammogram.

The physician may also analyze nipple discharge (other than milk) and conduct an ultrasound (sonography) exam. Ultrasound sends sound waves into the breast which "bounce" back to a computer screen to form an image of interior structures. This technique can help distinguish between a cyst and a solid growth. After confirming the presence of a suspicious growth, the physician orders a biopsy.

Is anesthesia needed for a biopsy?

For non-surgical biopsies, the patient may need no anesthesia at all or just a local anesthesia (one that numbs the suspicious area only). Sometimes, a patient receives a sedative (calming drug) with the local anesthesia.

For surgical biopsies, the patient may receive a local anesthesia (with or without a sedative) or general anesthesia (one that induces sleep). Patients requiring general anesthesia may have to fast 8 to 12 hours before undergoing a biopsy.

What about pain and complications?

Except for a minor sting from the injected anesthesia, patients usually feel no pain before or during a procedure. After a procedure, some patients may experience some soreness and pain. Usually, an over- the-counter drug is sufficient to alleviate the discomfort.

The risk of complications, such as infection and bleeding, is small for non-surgical procedures and slightly higher for surgical procedures.

What are the advantages and disadvantages of non-surgical procedures versus surgical breast biopsies?

Generally, non-surgical biopsies are less stressful, do not disfigure the skin, leave no internal scar to interfere with the accuracy of future mammograms, and minimize the risk of complications.

However, non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis. For this reason, some patients who undergo a non-surgical biopsy must also undergo a follow-up surgical biopsy.

What are the different types of breast biopsy procedures and what do they involve?

Breast biopsy procedures include fine needle aspiration biopsy (FNAB), core needle biopsy (CNB), and excision biopsy (surgery).

How is a fine needle aspiration biopsy (FNAB) done?

A fine needle aspiration biopsy (FNAB) can be done in several different ways:

• FNAB for Palpable Growths: A palpable growth is one that can be felt. The patient usually sits up while the doctor inserts a small hollow needle with a syringe to withdraw (aspirate) fluid and cells from the growth for testing. To guide the needle to the site, the doctor simply feels (palpates) the suspicious area. When the needle reaches the mass, the doctor suctions out a sample with the syringe. The doctor repeats this procedure several times. If the mass is a cyst, the withdrawn samples will consist mainly of fluid and the cyst may collapse, relieving any pain the patient feels. If the mass is solid, the samples will consist primarily of tissue cells.

  By analyzing the samples immediately after their withdrawal, a doctor may be able to determine that they came from a cyst and simply discard them, diagnosing the growth as benign. In all other cases, fluid and tissue samples are placed on slides and then analyzed in a laboratory by a pathologist.
  
  

• Stereotactic FNAB for Non-Palpable Growths: When a growth is too small or deep to palpate (feel), the doctor must locate it with a special imaging technique. First, the patient lies face down on a table with the breasts suspended through an opening. Next, mammograms of the suspicious breast site are taken from different angles to form a virtual three-dimensional (stereotactic) image that precisely pinpoints the location of the suspicious area. The computer then uses a motor to guide a small hollow needle to the site to remove the samples. The withdrawn samples are then analyzed for the presence of cancer.
  
  
• Ultrasound FNAB for Non-Palpable Growths: The patient lies face up while the doctor observes an ultrasound image of the suspicious area. After guiding a small hollow needle to the site, the physician withdraws samples for laboratory analysis.

How is a core needle biopsy (CNB) done?

A core needle biopsy (CNB) can also be done in several different ways:

• CNB for Palpable Growths: This procedure is similar to FNAB for palpable growths except that that the needle used has a wider diameter and is equipped with a cutter that removes cores of tissue up to a half-inch long. A key advantage of this procedure is that the samples are larger than in FNAB and thus enhance the possibility of making an accurate laboratory analysis.
  
  
• Stereotactic CNB for Non-Palpable Growths: This procedure also uses a wide needle with a cutter that removes cores of tissue large enough to enhance the accuracy of laboratory analysis. However, because the growth is deep in the breast or otherwise not palpable, stereotactic imaging is used to locate it, just as in stereotactic FNAB.
  
  
• Ultrasound CNB: The patient lies face up on an examination table. The doctor observes an ultrasound image of the suspicious area while guiding the cutter-equipped needle to the site. The samples are then withdrawn and examined.

How is an excision biopsy of the breast done?

An excision (surgical) biopsy can also be done in different ways:

• Surgical Biopsy of Palpable Growths (Lumpectomy): This procedure removes part or all of a breast growth, or lump. The doctor makes an incision one or two inches (about 2.5 to 5 cm) across and removes the sample. If the lump is small and measures an inch (2.5 cm) or less across, the doctor usually removes the entire lump for testing. If the lump is large, the doctor usually removes only a portion of it for testing. If cancer is found, the rest of the lump can be removed at the time of the biopsy or at a later time.

  The doctor closes the opening with sutures or clips which remain in place for about a week. Patients who receive general anesthesia rather than a local will require about an hour to recover from drowsiness after the surgery.
  
  

• Surgical Biopsy for Non-Palpable Lumps: This procedure is similar to lumpectomy except that the growth is first located by mammography or ultrasound and then "marked." The doctor inserts a needle that conveys a wire with a hook on the end into the breast, all the while using the mammogram or ultrasound image as a guide. After anchoring the hooked wire to the lump, the doctor withdraws the needle and performs the surgery. Another option is to inject a dye to mark the spot rather than using a hooked wire.

What is the purpose of a breast biopsy?

The basic aim of a breast biopsy is to determine whether a worrisome lump is cancer and, if so, what type it is. Another way to view the procedure is to assure that a lump is benign, or harmless. Fortunately, 4 out of every 5 breast biopsies bring good news and are benign.

Breast Biopsy At A Glance

• A breast biopsy procedure is usually done to determine whether a growth in the breast is cancerous or benign.
• A lump or other sign of breast cancer in a man or woman may warrant a breast biopsy.
• A breast biopsy can be done with a needle or by a surgical procedure.
• Non-surgical biopsies tend to be less stressful and minimize the risk of complications.
• Non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis.
• The biopsy may be done with stereotactic or ultrasound guidance.
• The result of the large majority (80%) of breast biopsies is benign.

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