Breast Biopsy 101

It is not uncommon for a woman to go for her routine mammogram and end up with a recommendation to biopsy a part of the breast that is abnormal on the mammogram. The purpose of the biopsy is to obtain of a sample of the breast tissue so that it can examined under a microscope and a definitive diagnosis can be made. Keep in mind that the objective of the breast biopsy is not to remove the entire abnormal area. If the biopsy results are benign (e.g. not showing cancer), no further treatment is needed other than a follow up in a few months to check the area. If the biopsy is cancerous or pre-cancerous, then further treatment is often needed with surgery.

Breast Biopsy is generally divided into two categories:  minimally-invasive (sometimes called “percutaneous”) or open-surgical (sometimes called “excisional”). Minimally-invasive biopsies are done in an outpatient office, result in less tissue loss, take very little time, require no incision or stitches, have quick recovery time, and use only local anesthetic. Open-surgical biopsies are done in the operating room, result in more tissue loss, require an incision and stitches, have a longer recovery time, and often require general anesthesia. Both biopsy methods have risks (e.g. bleeding, infection, scarring), however, the risk of complication is higher with the open-surgical method, especially if undergoing general anesthesia. Both methods are equally effective, so there are few reasons why open-surgical biopsy should be the primary method of breast biopsy.

All minimally-invasive biopsies are done in the same manner, and almost-all are guided by some type of imaging device (e.g mammogram, ultrasound, MRI).  When the biopsy is done using the mammogram as guidance, it is called a stereotactic biopsy; if done with ultrasound, then ultrasound-guided biopsy, and if with MRI, then MRI-guided breast biopsy. Occasionally, minimally-invasive biopsies are performed only by touch (e.g. by feeling the abnormal area, the doctor guides the biopsy device into the abnormal area). When you arrive for your appointment, the abnormal area in the breast will be re-identified, then the skin will be cleaned with betadine or alcohol, local anesthetic will be given to make the breast numb, a small nick will be made in the skin, the biopsy device will be guided into the aprropriate target, and samples of the area will be taken.

After enough samples are taken, usually a biopsy marker is placed into the area biopsied so that in future visits the area can be readily identified. Then a bandaid and dressing are placed over the biopsy site. Recovery is very minimal; typically the only restriction is not getting the area wet and not lifting anything heavier than a gallon of milk for a day. All minimally-invasive biopsies use needles, so some also call them needle biopsies. The biopsy can be a core-biopsy (e.g. the biopsy device removes a piece of tissue that looks like a small spaghetti noodle) or a FNA (fine needle aspiration) in which the biopsy device takes very minute fragments or fluid from the tissue. If the biopsy is vacuum-assisted, that simply means the biopsy device has a vacuum attached to it which can help suck or pull the breast tissue into the biopsy device.

If you have an open-surgical biopsy, the surgeon often likes a marker placed into the area that needs removed. This typically involves placing a small wire into the area prior to surgery, hence the name “needle localization.”

 

Thomas Bakondy, MD
Breast Radiologist

 

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