Your Breast Cancer Biopsy Options

If your mammogram results are abnormal, your physician may recommend additional testing, called a biopsy. A sample of breast tissue is removed and tested to determine if cancer is present. The type of biopsy your physician will recommend depends on several factors, including where the lump or lumps are, size and location and what kind of cancer is suspected. Your doctor will discuss your options with you and answer any questions you have. 

Type of breast biopsies

    An imaging technique such as an ultrasound or MRI is used in combination with a biopsy to provide the most accurate reading possible. Imagining helps guide the doctor to the area of the breast where cancer is suspected. These techniques are helpful when the possible cancer is in a difficult-to-reach area or in areas that can only be seen through an imaging technique.

    What to Expect

    Patients are often given a local anesthetic to numb the breast before the procedure. Many biopsies can be performed in an outpatient setting. All biopsies can cause bleeding and swelling. This can make it seem like the breast lump is bigger after the biopsy. This is usually nothing to worry about and the bleeding and bruising go away quickly in most cases.

    Needle biopsy is a procedure to remove breast tissue or fluid with a needle for examination under a microscope. These procedures are commonly used to diagnose breast cancer. 

    The two main types of needle biopsies are fine needle aspiration biopsy and core biopsy. 

    Fine Needle Aspiration Biopsy

    In fine needle aspiration biopsy, the doctor uses a very thin needle attached to a syringe to withdraw a small amount of tissue from the suspicious area. If the area to be biopsied can be felt, your doctor will locate the lump or suspicious area and guides the needle there. If the lump can’t be felt, your doctor might use ultrasound to watch the needle on a screen as it moves into the mass. 

    Once the needle is in place, fluid or tissue is drawn out. If clear fluid is withdrawn, the lump is more likely a benign cyst (not cancer). Bloody or cloudy fluid can mean either a benign cyst or, less often, cancer. If the lump is solid, small pieces of tissue are drawn out and a pathologist will look at the biopsy tissue or fluid under a microscope to find out if it’s cancer.

    Core Needle Biopsy

    A core needle biopsy is much like a fine needle aspiration biopsy. A slightly larger, hollow needle is used to withdraw small cylinders, or cores, of tissue from the abnormal area in the breast. The needle is put in three to six times to get the samples. Core needle biopsy takes longer than a fine needle aspiration biopsy, but it’s more likely to give a clear result because more tissue is taken to be checked. 

    Your doctor will place the needle in the abnormal area using image guidance  to be sure it’s in the right place. 

    What to Expect

    During a fine needle aspiration biopsy, your doctor may use a local anesthetic, but the needle used for the biopsy is so thin that getting the medicine may hurt more than the biopsy itself. 

    A core needle biopsy can usually be done in the doctor’s office with local anesthesia, where you’re awake but your breast is numbed. The procedure can cause some bruising, but usually does not leave scars inside or outside the breast. 

    An open biopsy is a surgical procedure where an incision is in the skin to expose the tumor so it can be removed.   

    There are two types of open (surgical) biopsy: 

    • An incisional biopsy removes only part of the suspicious area, enough to make a diagnosis. 

    • An excisional biopsy removes the entire mass or abnormal area, and may also remove an edge of normal breast tissue.

    What to Expect

    Open biopsies are usually done as an outpatient procedure in the hospital under local anesthesia (you are awake, but your breast is numb). A surgical biopsy is more involved than a fine needle aspiration or a core needle biopsy. Stitches are often needed and it will leave a scar. The more tissue removed, the more likely it is that you will notice a change in the shape of your breast. Your doctor will tell you how to care for the biopsy site and what you can and can’t do while it heals. 

    A sentinel node biopsy, also called a lymph node biopsy, is used to determine how far breast cancer has advanced. Woman’s recommends all patients with invasive breast cancer undergo sentinel node biopsy to determine if the cancer has spread. A sentinel node biopsy is also recommended for women with non-invasive breast cancer if they are high-risk patients.  

    A substance is injected near the tumor that allows the doctor to see which lymph node the substance flows to first. This is the sentinel lymph node, and it is the first lymph node to which cancer is likely to spread. The sentinel lymph node is removed and examined under a microscope. If cancer is not found, the other lymph nodes may be left in place. If cancer is found, more lymph nodes may be removed. 

    Many women elect to have sentinel node biopsy, which lessens the risk of lymphedema because fewer lymph nodes may need to be removed than with axillary lymph node dissection.

    What to Expect 

    Patients having a sentinel node biopsy may have green/blue urine or stool due to the dye used in the procedure. The low level of radioactivity in your body is not dangerous and will go away completely in a few days. Wash your hands carefully after using the toilet for the first two days. 

    • Wwalking out the door to get a mammogram.

      Proactive Health

      Through a breast self-awareness routine, women can learn about their bodies and detect any suspicious changes to their breasts that may require medical attention.

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