What exactly is a biopsy?
A biopsy is the single most important tool available for diagnosing cancer. It’s simply removal of some of the lump a woman might find in her breast, or some of the tissue identified as "questionable" on a mammogram. This tissue is then examined by a pathologist, who can determine whether or not it includes cancer cells.
There are three main types of biopsies, including the following:
Fine needle aspiration biopsy (FNAB)
An FNAB is used when there’s a palpable lump in your breast. It’s a quick and easy procedure, done right in the doctor’s office: the doctor numbs your skin, then sticks a very fine needle into the lump, withdraws some cells, and sends them to pathology to be examined.
FNAB is often utilized when your doctor can feel a lump, and wants to quickly determine if it’s a liquid-filled cyst, vs. something solid. It’s an easy procedure - but also not as good at ruling out cancer as larger-scale biopsies, since it can easily miss an area of cancer.
Core needle biopsy
Core needle biopsy involves a larger needle than an FNAB, and x-rays, MRI, or ultrasound to guide the needle to the area in question. Since it’s more invasive than an FNAB, it’s usually performed at a hospital or imaging center.
Depending on how the area in question is being identified, you’ll lie on your back (ultrasound-assisted biopsy) or stomach (stereotactic mammography or MRI). If you’re on your stomach, your breasts will hang through openings in the table.
The doctor will use local anesthetic to numb your skin and breast. Then, using his or her chosen imaging device, s/he’ll insert a hollow needle into the area in question. Tiny knives will cut samples and draw them into the needle; usually three to six samples are harvested. The samples are passed along to a pathologist to check for cancer cells.
During a core needle biopsy, the doctor will usually leave a tiny titanium clip in the area where the biopsy was taken. If you have cancer and undergo breast conservation surgery (lumpectomy), this clip will be used to guide the surgeon to the exact area of the tumor.
A surgical biopsy is performed in a hospital setting, using local anesthesia; your surgeon may also give you drugs to relax you and make you sleepy. This type of biopsy involves an incision through which the surgeon removes either the entire lump or suspicious area (excisional biopsy) or just part of the lump (incisional biopsy). The tissue removed is then sent to pathology for analysis.
Many hospitals are moving away from surgical biopsies towards the less invasive needle biopsies. Needle biopsies are easier procedure to perform, shorter in duration, less painful, and require less medication. They also leave your breast less scarred; and they’re less expensive. If your doctor recommends a surgical biopsy, ask the reason why; a needle biopsy, if at all possible, will be easier on you.
The biopsy aftermath
The less invasive the procedure, the easier your recovery. FNAB and core needle biopsies don’t require stitches, and thus there’s little if any scarring. You may experience some bruising and soreness, but it should fade quickly.
Surgical biopsy results in stitches and some scarring. You’ll experience bruising and pain, just as you would with any invasive surgery.
The hardest part of any biopsy is waiting for results. Ask your doctor when you can expect to be notified; if you aren’t contacted by that date, call and find out why. There’s nothing more distressing than waiting to find out if you have cancer, so be proactive about getting your biopsy results.
Thankfully, about 80% of breast biopsies are negative: no cancer. So chances are good that in the end, you’ll be getting good news.
“Learn More About Breast Biopsies at Susan G. Komen ®.” October 20, 2015. Accessed December 28, 2015. https://ww5.komen.org/BreastCancer/Biopsies.html.
“Types of Biopsy Procedures.” July 21, 2014. Accessed December 28, 2015. https://www.cancer.org/treatment/understandingyourdiagnosis/examsandtestdescriptions/forwomenfacingabreastbiopsy/breast-biopsy-biopsy-types.
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Breast cancer survivor and award-winning author PJ Hamel, a long-time contributor to the HealthCentral community, counsels women with breast cancer through the volunteer program at her local hospital. She founded and manages a large and active online survivor support network.
PJ Hamel is senior digital content editor and food writer at King Arthur Flour, and a James Beard award-winning author. A 16-year breast cancer survivor, her passion is helping women through this devastating disease. She manages a large and active online survivor support network based at her local hospital and shares her wisdom and experience with the greater community via HealthCentral.com.