A biopsy is surgery to remove a sample of tissue. A pathologist examines the biopsied tissue under a microscope to see if any cancer is present.
The diagnosis of breast cancer depends upon examination of tissue or cells removed by biopsy. A biopsy is the only way to know for sure if a breast change is benign or malignant.
There are a number of methods, depending upon the size and location of the lump or suspicious area, and the general health of the patient. These include:
Aspiration: The use of a needle and syringe to try to drain the lump
Fine-needle aspiration: The use of a thin needle and syringe to collect cell clumps or single cells from the lump. Used for cysts and sometimes to sample cells from masses with or without calcifications.
Aspiration is the fastest and easiest method to perform biopsies, with rapid results and no stitches or scarring. However, the small sample size can lead to incomplete assessment or misdiagnosis.
Core needle biopsy: The removal of a small piece of breast tissue using a needle that has a special cutting edge. It takes sample tissue from solid mass or calcium deposits. There are several needle insertions, but no stitches or internal scar. The larger sample can lead to more accurate diagnosis, although it is still limited enough to possibly underestimate more serious diagnosis.
Vacuum assisted biopsy: The removal of multiple samples of breast tissue via a fairly new technique. Excellent for calcium deposits; can remove several large samples with one needle insertion; no stitches and minimal scarring. It may be less accurate than surgical biopsy to remove the entire lesion, and is not ideal for hard-to-reach area (i.e., near chest wall).
Excisional biopsy: The removal of the entire lump. Used most often, it is the current “standard” procedure for small (less than about an inch in diameter) lumps. Also called a lumpectomy.
Incisional biopsy: The removal of part of the lump. This method may be used if the breast lump is large.
Both excisional and incisional biopsies are called open surgical biopsies. They are used for masses, hard-to-reach lesions, multiple lesions and masses with micro-calcifications. They give the largest tissue sample, which gives the near 100% diagnosis. These require stitches and a longer recovery, and permanent scarring may make future mammograms difficult to read.
Mammographic localization with biopsy: Used when a possible breast tissue abnormality can be seen on a mammogram but cannot be felt. The mammogram is used as a guide for placing small needles at the site of the breast abnormality. Sometimes, dye is used instead of needles to mark the site. The suspicious tissue can then be removed surgically for examination. Another mammogram of the specimen is obtained to document that the lesion was excised.
Computerized Stereotactic Modifications have been added to mammographic units in order to localize abnormalities and perform needle biopsy without surgery. Under mammographic guidance, a biopsy needle can be inserted into the lesion in the mammographer’s suite, and a core of tissue or cells can be examined.
What type of biopsy do you recommend?
What is the procedure of the biopsy?
Are there any risks or complications associated with the biopsy?
How many of each of these types of biopsies do you perform each year?
Will the biopsy leave a scar?
What can be expected after the biopsy?
Will the biopsy remove part or all of the lump?
Will the biopsy be done under a local or general anesthesia?
What anesthesia will be used and what are the side effects?
How long will it take to get the results from the pathologist?
What type of tests will the pathologist do on the breast tissue? What is the accuracy of the different tests?
Is there any alternative to the biopsy?