A definitive diagnosis of breast cancer can be made only by a biopsy. Expert Patient PJ Hamel explains what to expect with breast biopsy procedures.
Q. I've had a "questionable" mammogram, and I know the next step might be a biopsy. What exactly is a biopsy?
A. A biopsy is acknowledged to be the single most important tool available for diagnosing cancer. It's simply removal of some of the lump you've felt in your breast, or some of the tissue identified as "questionable" in your mammogram. This tissue is then examined by a pathologist, who can determine whether or not it includes cancer cells.
Q. Are there different types of biopsy, or is it one size fits all?
A. There are different types. Some are done with very fine needles under local anesthetic, leaving no scar; some are full-scale lumpectomies, i.e., a portion of your breast is removed surgically, with a resultant scar or "divot" left behind. And there are other types of biopsy between those two extremes.
Q. So, what kind of biopsy will I be getting?
A. It depends on what your mammogram looks like, what your breast feels like to the doctor who examines you, what type your doctor or hospital prefers... there are a host of factors that determine what kind of biopsy you'll have. If you do need a biopsy, ask the doctor to tell you what kind, and explain why he or she thinks it's right for you. Many hospitals are moving away from surgical biopsies towards the less invasive needle biopsies; they're an easier procedure to perform, shorter in duration, less painful, and requiring less medication; they leave your breast less scarred; and they're less expensive. But they're more precise, and therefore demand more skill by the doctor or radiologist performing them, and perhaps more sophisticated equipment. If your doctor recommends a surgical biopsy, ask the reason why; a needle biopsy, if at all possible, will be easier on you.
Q. OK, assuming I can have a needle biopsy, what's it like?
A. Needle biopsies come in two types, basically: a fine needle biopsy, or a core biopsy. They both involve sticking a needle into your breast, but don't worry! A local anesthetic takes care of any pain.
A fine needle biopsy is used when there's a palpable lump in your breast, and it's a straightforward procedure for the doctor to stick a needle into the lump, withdraw some cells, and send them to pathology to be squirted onto a slide and examined.
A core biopsy involves a larger needle, and x-rays or ultrasound to guide the needle to the area in question. It's used when the "suspicious" area isn't so straightforward. Perhaps no one can feel a lump, but your mammogram indicates that your breast has changed since the year before. Maybe there are multiple areas that need examining. Whatever the case, anything less obvious than a lump you can feel probably calls for a core biopsy.
You'll lie on a table, either facedown with your breast hanging down through an opening (if the doctor's using x-rays for guidance; this is called a stereotactic biopsy), or on your back (if the doc's using a hand-held ultrasound device for guidance).
After local anesthetic is injected, the needle will be inserted into the area in question, and a small core of breast tissue cut out and suctioned through the needle to be delivered to the pathologist. For me, this wasn't painful. It just felt "funny;" I had an image of Roto-Rooter, the needle humming as tiny blades inside cut into tissue. When the needle is withdrawn, you'll need nothing more than a small bandage. The whole procedure lasts about 45 minutes, and you should feel fine (if a bit shaken, emotionally) afterwards. You'll probably feel sore in that breast for a few days-just as you'd feel sore after getting a shot-but all in all it's pretty easy.
Q. And that's it?
A. That's it. It's all over but the waiting. Which, of course, is more distressing than the biopsy itself. But take heart; 80% of breast biopsies show no cancer, and hopefully you'll be able to forget about the whole thing and go on your merry way.