A breast biopsy is the removal of a breast tissue sample from the suspicious part of the breast. It is done after breast screening tests have shown some abnormality.
This biopsied tissue is then prepared and examined under the microscope by a trained pathologist. He or she looks for any cancer cells in the prepared slide of the tissue. This is a true confirmation of breast cancer. Cancer cells look different from normal cells and the pathologist can identify them from their appearance.
Having to go for a breast biopsy does cause a great deal of apprehension to the patient, but the best way to deal with this situation is to get over it as quickly as possible.
In all probability, the result will bring relief as more than 80% of the results of these biopsies turn out to be benign (non-malignant). You can read the full statistics here.
You will be fully awake during your biopsy and you will experience little discomfort. Most women do feel little pain.
Indications for breast biopsy | Why it is done?
A breast biopsy is recommended in the following conditions:
- A lump is detected on a breast exam
- A mammogram shows an abnormal finding
- MRI shows an abnormality in the breast
- The nipple changes in appearance. There may be scaling, crusting, dimpling, or a bloody discharge from the nipple.
Types of breast biopsy procedures
There are several methods by which a breast biopsy is performed. It can either be a needle biopsy or a surgical biopsy.
Fine needle aspiration biopsy of the breast (FNAB)
FNAB is done with the patient usually sitting up. This is done by using a thin needle in which case results of ultrasound or an x-ray are used to identify the area where the needle is to be inserted. Cells or fluid are then aspirated from the suspected tissue.
If the fluid is present as in a cyst, the cyst will collapse after aspiration, but if a solid mass is present, another type of biopsy will be needed to be performed to take a tumor tissue for testing.
Sometimes, the growth may be too deep and non-palpable and the doctor may need imaging procedures such as an ultrasound to help him guide the needle accurately into the breast tumor. In such cases, the patient lies down on the stomach with breasts hanging down through openings in the table.
Core needle breast biopsy (CNB)
In the CNB biopsy, the doctor uses a broad needle with a special tip to remove sample tissue from the breast mass. The advantage is that the sample tissue is larger and this enhances the chances of greater accuracy of the report.
This type of breast biopsy procedure may be used to evaluate a breast lump that has been detected on a mammogram or ultrasound or a clinical breast exam.
The surgeon removes tissue samples from the breast mass usually under ultrasound guidance. Several samples, each about the size of a grain of rice, are removed and sent for analysis.
Stereotactic breast biopsy
This type of breast biopsy involves a core needle biopsy under the guidance of a mammogram. This is especially useful in small lumps that cannot be felt during a breast exam but have been detected in mammograms and MRI.
A small incision is taken on the skin of the breast through which the core needle is inserted and the sample of the lump tissue is taken. The mammogram helps the surgeon to insert the needle correctly into the lump in the breast.
In this procedure, you generally lie facedown on the biopsy table with one of your breasts positioned through a hole in the table. This type of biopsy may also be done in a sitting position. This procedure may take 30 minutes to 1 hour.
The mammogram is taken after the table is raised to make the patient comfortable. The breast is compressed between the two plates to take the mammogram and help locate the exact site of the area to be biopsied.
The surgeon makes a small incision into the breast, inserts either a needle or a vacuum-powered probe, and removes several samples of tissue. This procedure may take 30 minutes to one hour
MRI-guided core needle biopsy.
As the name suggests, this type of core needle biopsy is done under MRI guidance. MRI is an imaging technique that takes multiple cross-sectional images of the breast, which are then generated into 3D images with the help of a computer. This helps to locate a breast lump or any abnormality in the breast tissue.
During this procedure, you lie face down on a specially modified padded table. Your breasts hang freely into a hollow depression in the table.
The MRI machine takes images that help determine the exact location for the biopsy. The surgeon makes a small incision to insert the core needle into the lesion. He then takes several samples of the abnormal tissue.
Surgical Breast Biopsy
A surgical breast biopsy can be of two types:
- An incisional breast biopsy in which the surgeon makes an incision on the breast and takes part of the lump for examination
An excisional breast biopsy in which the surgeon removes the entire lump for pathological examination purposes
If there are any skin changes over the breast, a biopsied sample of the abnormal skin tissue may be taken for examination.
Breast biopsy results
Biopsy results will be available after a few days. Besides diagnosing the tumor to be malignant or not, breast biopsy also tells you of
- the type of cancer cells
- the aggressiveness of cancer
- the grade of the breast cancer and
- whether any hormone receptors are present in the cancer cells.
These findings will enable the oncologist to determine the line of treatment.
Side effects of a breast biopsy
Although a breast biopsy procedure is quite straightforward, certain risks may be involved. Some possible side effects include:
- There may be a change in the breast appearance, which depends on the amount of tissue removed
- There may be bruising
- The biopsy can cause swelling of the breast
- There may be soreness at the biopsy site
- Infection at the site of the biopsy may develop
These side effects are temporary. However, if they persist, your doctor will treat them with antibiotics and anti-inflammatory drugs.
These side effects are rare and not serious and they should never be a contraindication for the biopsy because the benefits far outweigh the risks. The sooner breast cancer is diagnosed, the quicker the treatment can be started, which greatly enhances the chances of a complete cure.
Breast biopsy aftercare
After the breast biopsy, the patient can go home with only a bandage and ice pack over the biopsy site. A surgical biopsy may require sutures.
There will be some pain and bruising and some painkillers may be prescribed. You will be advised to rest for one day. You can resume your normal activities after one day.
It will usually take just a few days for the breast biopsy samples to be examined. You should take proper care of the biopsy wound by keeping it clean and frequently changing the bandages.
If you develop any of the following signs, which indicate infection, you should contact your doctor:
- a fever of over 100°F (38°C)
- redness at the biopsy wound
- discharge from the biopsy wound
The breast biopsy is a minor surgical procedure and recovery is quick in uncomplicated cases.
- Tenderness of the breast should go away in about a week
- The biopsy wound will fade away within two weeks.
- Swelling may last for 6 to 8 weeks.
- Your biopsy incision may have been closed with strips of tape. Keep the tape on for a week or until it falls off.