A physician may advise a breast biopsy if there are changes in the nipple, such as any dimpling, thickening, scaling, or crusting of the skin.
What happens in a breast biopsy?
There are several ways of doing a breast biopsy.
Fine needle aspiration biopsy (FNAB)
If there is a palpable lump, a biopsy may be recommended.
In a fine needle aspiration biopsy, the surgeon, pathologist, or radiologist uses a very fine needle and a syringe to withdraw, or aspirate, a few cells from a palpable lump. They may otherwise take a small amount of fluid from a fluid-filled cavity like a cyst.
FNA is a percutaneous procedure, which means the needle is passed through the skin to get to the area to be sampled.
If the lump or suspicious area can be felt, the doctor can guide the needle to its target by touch. If it cannot be felt, ultrasound may be used to help guide the needle to the right location by watching it on a screen. This is known as an ultrasound-guided biopsy.
In stereotactic needle biopsy, the exact location of the mass is mapped using mammograms taken from two angles. This is also known as image-guided stereotactic breast biopsy.
The needle used in FNAB is usually smaller than the type of needle used for taking blood tests. A local anesthetic is usually not needed.
The fluid or cells will then be examined under the microscope to determine if cancer cells are present. If clear fluid is withdrawn, there is a good chance that it came from a benign cyst and there will be no cancerous cells. Cloudy or bloody fluid may come from either a benign cyst or cancer.
As the needle is thin, it might miss nearby cancerous cells. If the diagnosis is not clear, the doctor may recommend a different biopsy procedure.
Core needle biopsyWith core needle biopsy (CNB), the doctor removes small, solid samples of tissue. A hollow "core" needle is used, similar to the one in FNAB, but slightly larger in diameter.
The procedure is usually guided by ultrasound or X-ray. If a lump is palpable, which means it can be felt with the hand, the needle may be guided by palpating the mass.
The hollow needle withdraws cores, or small cylinders, of tissue from the mass. The needle may enter up to six times to remove several cores of tissue.
CNB takes longer than FNAB, but it is less likely to miss cancer cells, so the result is more reliable. A local anesthetic is often used to numb the area prior to a core biopsy.
After CNB the patient may experience some bruising, but there will not be any stitches or significant scarring.
The doctor makes a small cut, less than one quarter of an inch long. A hollow probe is inserted through the incision and guided to the abnormal mass using MRI, ultrasound, or x-rays. The probe has a hole in its side, into which tissue is "sucked" using a vacuum technique.
The probe can be rotated to collect several samples through one single incision.
No stitches are required and scarring is usually minimal.
In an excisional, or surgical, biopsy, a cut or incision is made in the breast and the whole or part of the lump is taken out and examined under a microscope. The incision is 1 to 2 inches long.
This is normally done in the hospital's outpatient department, with either a local or general anesthetic, so that the patient feels no pain.
Wire localization is used if the surgeon cannot find the lump by touch. A thin, hollow needle is inserted into the breast, while x-rays guide it to the mass. Then a very thin wire with a hook at the end is threaded into the hollow of the needle, and this attaches itself to the lump. The needle is removed, but the wire stays, to guide the surgeon to the target area.
In a surgical biopsy, the patient will need sutures and there will be a scar. If much tissue is removed, the patient may notice a difference in the shape of the breast afterward.
It is common after a biopsy for the area to swell and bleed, making the mass seem bigger afterward. This is normal, and usually the bruising and bleeding will go away within a few days to a week.
What are biopsy markers?
This is a clip or marker to mark the biopsy site. After the tissue samples have been removed, a tiny clip or marker may be placed which is made of surgical grade material that is visible on a mammogram.
The clip marks the exact site of the cancerous area so that it can be located easily at the time of the surgery. This is especially important if a patient has chemotherapy or other systemic treatments that change the size and shape of the cancerous mass. In some cased it can even disappear after treatment.
At the time of surgery, the clip and surrounding tissue will be removed, even if the mass is no longer visible.
Preparing for a biopsy
Patients are advised not to use deodorant, powder, lotion, cream, or perfume on their arms or breasts on the day of the biopsy.
A biopsy can reveal if a lump is cancerous.
Before the procedure, the patient should let the doctor know if they:
- Are allergic to anything
- Have taken aspirin during the previous week
- Are taking anticoagulants (blood-thinning drugs), such as heparin or warfarin
- Have a history of bleeding disorders
- Are taking any prescription drugs, over-the-counter medications, herbs, or supplements
- Have a cardiac pacemaker or any electronic device implanted within their body, in case the doctor plans to use MRI during the procedure
- Are or may be pregnant.
The Mayo Clinic recommend wearing a bra, so that a cold pack can be placed in it after the procedure.
Before leaving, the patient should find out how and when they will get the results.
Patients who are going to have general anesthesia may be required to fast, meaning no food or drink, for up to 12 hours before the procedure.
After the biopsy
Patients who have general anesthesia will go to the recovery room for observation after the procedure, and when their blood pressure, heart rate, and breathing are stable, and they are mentally alert, they will be discharged. They may still be a little drowsy and should arrange for someone else to drive them home.
Patients who have local anesthesia will be discharged as soon as they have completed the recovery period.
After a biopsy, the area around any stitches must be kept clean and dry. If there are no stitches, the medical team will give instructions about removing the dressing or bandage.
The biopsy area will probably be sore and tender for some days, and painkillers may be required, especially for an excisional biopsy. Patients should avoid aspirin, as it thins the blood and increases the risk of bleeding. It may help to wear a supportive bra.
The doctor may recommend avoiding strenuous physical activity for a while.
It is not common but there is a risk of infection with all types of biopsies. If there are any signs of infection, such as fever or chills, redness, bleeding, swelling, or pain around the biopsy site, the patient should inform the doctor.