Biopsy

Types of breast biopsy

There are several different types of biopsies. The type you have depends on a number of factors, including the size of the abnormal area, what your doctor can see on your mammogram, ultrasound or other imaging test, and your personal preferences.

Minimally invasive biopsy

In this type of biopsy, a provider uses a needle to take one or more tissue samples from your breast.

Sometimes this procedure can be done in your doctor’s office. A minimally invasive biopsy doesn’t require surgery or general anesthesia. Local anesthesia may be used to numb the affected breast.

During a minimally invasive biopsy, you’ll lie down and the doctor will find the abnormal area by feeling for a lump. If a lump cannot be felt, your doctor may use imaging machines like an ultrasound, mammogram or MRI to find the area. Many times the doctor will take multiple biopsies from the same area.

Fine-needle aspiration

The least invasive kind of needle biopsy is called a fine-needle aspiration, or FNA. It involves a narrow needle that is inserted into the area where the abnormal finding was seen. Your doctors may be very likely to recommend this option if they suspect the change in your breast is not a tumor but a liquid-filled cyst. Fine-needle aspiration usually causes cysts to collapse once the liquid is removed.

Doctors also may use an FNA to study enlarged lymph nodes.

Core needle biopsy

Core needle biopsy or CNB, often called vacuum-assisted biopsy, is similar to fine-needle aspiration. CNB uses a larger needle and may involve taking more or larger tissue samples.

CNB can be done on a lump that can be felt, with guidance from an ultrasound, mammography machine or MRI machine. When the biopsy is performed using a mammography machine, it is called a stereotactic core biopsy. With a stereotactic core biopsy, you usually lie face down with your breast hanging into a hole in a special table. A small mammography machine under the table takes images that help guide the doctor to the area to be biopsied.

After a CNB, the doctor will often place a tiny clip into your breast to mark the site where the tissue samples were taken. This helps the doctor find the area in case further biopsies or surgery is needed. Most women do not get a scar from these types of procedures.

Surgical biopsy

Doctors often recommend a minimally invasive biopsy as a first option. Your doctor may recommend a surgical biopsy if:

• You already had a needle biopsy but more information is needed
• They believe a needle biopsy won’t give enough information

A surgical biopsy may be called either an incisional biopsy or excisional biopsy.

• During an incisional biopsy, a surgeon removes part of the abnormal area to make a diagnosis.
• In an excisional biopsy, a surgeon tries to remove the entire abnormal area. An excisional biopsy if often used when the doctor suspects there may not be cancer. When cancer is found, it is likely you will need another procedure. In cases where the area is benign, often no more surgery is needed.

Surgical biopsies are done in an operating room. Most people are put to sleep for the procedure. Sometimes this involves “twilight” anesthesia and sometimes general anesthesia. There are small differences in both, so speak with your surgeon about your options.

Because the surgeon uses a scalpel to cut into your breast to remove the abnormal tissue, you will need stitches. These procedures cause a scar, and you may need a couple of weeks to heal.

Lymph node biopsy

You may hear people talk about having biopsies of their lymph nodes, tissues that are part of the immune system. The lymph nodes are often the first place breast cancer travels. Some people will undergo a fine needle aspiration of an abnormal lymph node, but most will have a surgical biopsy. This is called a sentinel lymph node biopsy or an axillary lymph node dissection.