Definition & Overview
A breast biopsy is a diagnostic procedure that determines whether a suspicious lesion in the breast is cancerous or not. It involves removing sample breast tissue and testing it for cancer cells. Once the test sample has been removed, a localisation device, also called a marker, is inserted in the same area.
The marker, which is either a clip or a small metal pellet, can be seen in an X-ray. It helps doctors easily locate and observe the tumour.
Either a surgeon or a radiologist can perform a breast biopsy, depending on the type of procedure that the patient requires. It can be performed on an outpatient basis. However, if it involves surgery, the patient may need to stay in the hospital for at least a night before being allowed to go home.
Breast biopsies can be done in a doctor’s clinic or a hospital setting. Minimally invasive procedures are usually performed in clinics, but surgical procedures will need to be performed in a hospital's operating room.
Who Should Undergo & Expected Results
Breast cancer is a major health concern for women. For this reason, they are advised to regularly check their breasts for suspicious lumps. If caught early, breast cancer is highly treatable.
Most breast biopsies are performed as outpatient procedures, especially those that are minimally invasive. After the biopsy, patients are allowed to go home and continue with their regular activities after a day’s rest.
The obtained tissue sample is sent to a lab. It can take a while to complete the test, but it should show if the sample is positive or negative for cancer. The test may also be inconclusive, which means that the procedure will have to be repeated.
The pathologist will then forward the results of the biopsy to the attending doctor or oncologist. The doctor will complete the diagnosis and explain it to the patient. If the results are positive, the doctor will recommend a treatment plan.
If the treatment plan involves surgery to remove the tumour, the marker left inside the breast will guide the surgeon to the precise location. If the tumour is benign, the marker is left in place.
Because markers are small, they should not affect the patient in any way. In fact, patients should not even feel the marker when they physically check their breasts.
Unfortunately, negative results do not necessarily indicate that the patient will not develop cancer in the future. Most patients are advised to undergo periodic breast cancer screening so that any additional suspicious growths can be tested with another biopsy.
How Does the Procedure Work?
A breast biopsy can be performed using any of the following methods:
- Fine needle aspiration (FNA) – The tissue sample from the breast is obtained by inserting a fine needle into the lump. If the lump cannot be felt, the radiologist or surgeon will use an ultrasound to guide the needle into the lump.
- Core needle biopsy – The procedure is similar to an FNA. The only difference is the size of the needle used. In a core needle biopsy, the needle is larger. This procedure is done if the surgeon requires a larger sample. Patients can expect the procedure to be repeated at least three times to get a sufficient amount of tissue.
- Vacuum-assisted biopsy or minimally invasive breast biopsy (MIBB) – Instead of using a needle, the surgeon will insert a small probe into the breast. The tissue sample is then obtained using a vacuum. Should there be multiple growths, the probe can be guided to the next suspicious area to obtain samples as well.
- Incisional biopsy – Although considered as a surgical procedure, an incisional biopsy is less invasive. It involves inserting a hollow needle with a wire into the breast. The surgeon will then use the wire as a probe to find the exact area to obtain the tissue sample.
- Excisional biopsy – This procedure is the most invasive as it involves creating a cut into the breast and removing the suspicious growth. It is one of the best ways to determine if the growth is cancerous.
Regardless of the method used in the biopsy, the procedure is usually painless, as it will be done using anaesthetics. However, once the effects of the anaesthetic have subsided, the patient may feel discomfort or a certain degree of pain, depending on the type of procedure performed. Patients are usually given painkillers to manage any pain after the procedure.
Possible Risk and Complications
Every method used in a breast biopsy has associated risks and possibilities for complications. These risks include:
- Bleeding or bruising of the breast
- An altered appearance of the breast if a large tissue sample is obtained
- Inconclusive results, which means that the procedure has to be repeated
- Movement of the marker
Other than physical risks and complications, patients may also suffer from mental stress while waiting for the results. It is important for a patient to remain calm after the procedure and continue with regular activities to reduce the possibility of stress.
Should any complications arise, such as bleeding or infection, patients are advised to contact their doctors right away.
E Burnside MD MPH, R Sohlich MD, E Sickles MD, March 2001 “Movement of a Biopsy-site Marker Clip after Completion of Stereotactic Directional Vacuum-assisted Breast Biopsy: Case Report: http://pubs.rsna.org/doi/full/10.1148/radiol.2212010565
Vic Velanovich, MD, Frank R. Lewis, Jr., MD, S. David Nathanson, MD, Vernon F. Strand, MD,Gary B. Talpos, MD, Srinivas Bhandarkar, MD, Robert Elkus, MD, Wanda Szymanski, RN, BSN, and John J. Ferrara, MD, “Comparison of Mammographically Guided Breast Biopsy Techniques”; Annals of Surgery