Breast Biopsy

A breast biopsy is a procedure to remove a small sample of breast tissue for laboratory testing. Breast biopsy enables the doctor to evaluate a suspicious area to determine whether or not it is breast cancer. The samples of tissue are used to identify and diagnose abnormalities, which may appear in the cells that make up breast lumps, or in other unusual breast changes that are suspicious or concerning. There are several types of breast biopsy procedures. After the biopsy, the lab report will assist with determining if additional surgery or treatment is warranted.

Your doctor or Windsong may recommend a breast biopsy if:

• A lump or thickening is felt in your breast and your doctor suspects breast cancer
• A suspicious finding was identified on your mammogram, ultrasound and/or Breast MRI
• You have unusual nipple changes which could include crusting, scaling, dimpling skin and/or bloody discharge

The  risks associated with having a biopsy include:

• Bruising and swelling of the breast
• Infection or bleeding at the biopsy site
• Altered breast appearance, depending on how much tissue is removed and how your breast heals
• Additional surgery or other treatment, dependent on the biopsy results

Tell your doctor if you:

• Have any allergies
• Have taken aspirin or anti-inflammatory medications within the last five days
• Are taking blood thinning medications (anticoagulants)
• Are unable to lie on your stomach for an extended period of time
• Are having an MRI biopsy and have a cardiac pacemaker or other electronic device implanted in your body or if you’re pregnant or think you may be pregnant

Your doctor or one of our radiologists may recommend a particular biopsy procedure based on the size, location and other characteristics of the area of concern. Please don’t hesitate to ask for clarification about the type of biopsy that you are having.

There are two main types of breast biopsy procedures:

• Fine-needle aspiration/biopsy. The simplest type of breast biopsy may be used to evaluate a lump that can be felt during a clinical breast exam. You will lie on a table, and the doctor will direct a very thin needle attached to a syringe that collects a sample of cells or fluid from the lump. This type of aspiration can quickly distinguish between a fluid-filled cyst and a solid mass and, possibly avoid a more invasive biopsy procedure. If a solid mass is detected, very small samples will be obtained. Slides are prepared with the small samples and sent to a lab for analysis. This sampling is much smaller than tissue sampling with a core needle biopsy. This is usually done with ultrasound guidance if performed by a radiologist.
• Core needle biopsy. This type of biopsy is used to assess a breast abnormality visible on a mammogram, ultrasound or MRI. During this biopsy your radiologist uses a thin, hollow needle with image guidance to remove tissue samples from the area of concern which is sent to a laboratory for testing. Several small samples, about the size of a grain of rice, are collected and analyzed for the presence of disease. The different types of Core needle biopsies are:
  • Stereotactic core needle biopsy: This type of core needle biopsy uses mammograms to pinpoint the suspicious area within the breast. For this procedure, you generally lie face down on a padded biopsy table with one of your breasts positioned in a hole in the table, or you may have the procedure in a seated position. You may need to remain in this position for up to 30 minutes.
    • If you are lying down, the table will be raised several feet, and the equipment used by the radiologist is positioned beneath the table. Your breast is compressed between two plates while mammograms are taken to show the radiologist the exact location of the area for biopsy.
    • After providing local anesthesia, the radiologist then makes a small incision of less than 1/4-inch long (about 5 millimeters) into your breast. He or she then inserts either a needle or a vacuum-powered probe and removes several samples of tissue. Sampling takes only one to 2 minutes. The samples are then sent to a lab for analysis.
    • Click HERE to view Stereotactic video
  • Ultrasound-guided core needle biopsy:This type of core needle biopsy is done with ultrasound guidance — an imaging method that uses high-frequency sound waves to produce precise images of structures within your breast. During this procedure, you lie on your back or side on an ultrasound table.
    • Holding the ultrasound device (transducer) against your breast, the radiologist locates the area of concern within your breast, provides local anesthesia, makes a small incision to insert the needle and takes several core samples of tissue to be sent to a lab for analysis. Sampling takes several minutes.
    • Click HERE to view Ultrasound-guided core needle biopsy video
  • MRI-guided core needle biopsy: This type of core needle biopsy is done with MRI guidance — an imaging technique that captures multiple cross-sectional images of your breast. During this procedure, you lie face down on a padded scanning table. Your breasts fit into a hollow depression in the table. Your breast will be mildly compressed. This test does require intravenous contrast administration (contrast material given through your vein).
    • The MRI machine provides images that help determine the exact location for the biopsy. Following the administration of local anesthesia, a small incision less than 1/4-inch long (about 5 millimeters) is made to allow the core needle to be inserted. Several samples of tissue are taken and sent to a lab for analysis. Sampling takes a few minutes. The overall exam table time ranges from 25-45 minutes.
    • At the time of the breast biopsy procedures noted above, a small titanium marker or clip may be placed in your breast at the biopsy site. This is done so that if your biopsy shows cancer cells or precancerous cells, your doctor or surgeon can locate the biopsied area and remove more of the surrounding breast tissue surgically (known as the surgical or excisional biopsy). If the core needle biopsy shows no concerning findings, this marker/clip allows the radiologist to closely monitor the area on future imaging studies.
    • If the biopsied area cannot be felt and a surgical biopsy is to be performed, your surgeon may request a needle wire-localization procedure immediately prior to your surgery. The radiologist uses a technique called wire localization to map the route to the area of concern for the surgeon. During a wire localization, the tip of a thin wire is positioned directly in the area of concern. The wires are placed with guidance provided by mammogram, ultrasound or MRI.
    • Click HERE to view MRI-guided core needle biopsy video

After your biopsy, please do not hesitate to contact your doctor if:

• You develop a fever
• The biopsy site becomes red and warm
• You have unusual drainage from the biopsy site

Any of the above symptoms can be signs of an infection that may require prompt treatment. Please contact your Primary Care doctor or your OBGYN doctor immediately if there is any sign of infection.

Having a bra on after the biopsy is helpful as you are able to place a cold pack against the biopsy site and support the breast that was biopsied. We will send you home with bandages and an ice pack over the biopsy site. You will be able to resume normal activities within a day. Bruising is quite common after core needle biopsies. In order to ease your pain and discomfort after a breast biopsy, you may take a non-aspirin pain reliever containing acetaminophen (Tylenol) and apply a cold pack as needed to reduce swelling.

After your biopsy procedure:

• Your breast tissue is sent to a lab, where a doctor (pathologist) examines the samples using a microscope and special procedures.
• It may be several days before the results of a core needle biopsy are available.
• The pathologist will prepare a pathology report that is sent to your doctor and you will be informed of the results, including details about the size, location, and whether cancer, noncancerous (benign) changes or precancerous cells were found.

• Normal results or benign breast changes – Your radiologist may find that your imaging results suggest a more-suspicious lesion such as breast cancer or precancerous lesion, but your pathology report may reveal normal breast tissue. If this is the case, more tissue to further evaluate the area may be needed and you may be recommended to consult a breast surgeon. If your radiologist feels that the biopsy pathology results are consistent with the imaging findings, you will be advised to have follow up imaging in 6 months to closely monitor the area.
• If breast cancer is present – information about the cancer including the type of breast cancer you have and whether it is hormone receptor positive or negative will be available.
  • If you are diagnosed with breast cancer, Windsong Breast Care is here to help guide you through your breast cancer diagnosis. As the first Nationally Accredited Breast Program of Excellence in WNY with board certified breast surgeons and certified breast patient navigators, Windsong Breast Care is held to the highest standards of care for patients with diseases of the breast – working together to provide the most efficient and contemporary breast care using scientific evidence about what works best for patients. Please call our team at 716.626.6300 and we will help you navigate the necessary next steps. You are not alone in your battle against breast cancer. Visit windsongbreastcare.com to learn more about our breast surgical care.