Breast Biopsy Overview
A breast biopsy test is done by removing tissues or at times fluid from a suspicious area. The extracted cells are examined under a microscope. The same is further tested to diagnose the presence of breast cancer. After a lump is found during an examination on a mammogram, ultrasound or Magnetic Resonance Imaging (MRI), a biopsy is done to determine whether the dubious area is malignant or not.
A breast biopsy procedure can be done in diverse ways:
Why It Is Done
You probably would require a biopsy when some other examination reports show that you might have breast cancer. Most women hold this misconception that biopsy means one already has cancer. But the fact is fundamentally that breast biopsy is just another procedure which is done to detect whether a tumor or a cell is malignant (cancerous) or benign (non-cancerous).
This is the only definitive way to find out whether cancer cells are present or not.
In many cases your doctor may feel that you do not require a biopsy, but if you still feel there might be something wrong, follow your instincts. Get a second opinion if needed. You should not be afraid; a biopsy is the only way to diagnose breast cancer.
How To Prepare
A breast biopsy doesn’t happen just like that. Irrespective of the fact that it is a minor procedure, there are certain crucial steps that you need to follow before undergoing a biopsy. Remember, it is vital for you to know the necessary information relating to the biopsy. Discuss and talk about your doubts before taking the test.
Your consultant would want to know the following from you:
a) Any medication or supplement that you are taking, vitamins or herbal remedies if any.
b) If you are allergic to certain medicines including anesthetics and also latex.
c) Whether you have bleeding troubles or take blood thinner. If you do, then you probably need to stop taking it a week before the biopsy.
d) If you are pregnant or might be pregnant.
In case of doubts and questions, you should talk to your doctor about all your concerns regarding the test. Discuss and know how it will be done, the risk factors involved, and what the results would mean. This will help you understand the importance of the biopsy helping you feel confident and tension free. You might also have to fill up a medical test information form.
After finishing these, you will be given to sign a consent form whereby you understand the risk and agree to undergo the procedure.
Provided the biopsy is done under local anesthesia, you need not do anything for preparation. If it is done under general anesthesia, then you require following the exact instructions suggested by your consultant. Your doctor will tell you when to stop eating and drinking to avoid the procedure being cancelled for not following instructions. If your doctor has recommended medicine on the day of the surgery, do so taking in just by a sip of water.
About an hour before the procedure, an IV channel will be inserted in your arms and a sedative medicine will be given. Make sure to arrange for someone to take you back home post your test.
Other related blood tests might be done prior to your breast biopsy.
How It Is Done
Fine-needle aspiration biopsy
Fine-needle aspiration biopsies are generally outpatient procedures. This test involves the following steps:
a) You would first need to take off your clothes from above your waist. Your shoulder will be then covered with a sterile drape or towels.
b) The affected area will be numbed by injecting a medication under your skin.
c) The procedure may be guided by an ultrasound to help locate the right area.
d) Above the abnormal area a thin needle, attached to a syringe would be inserted through the skin.
e) A vacuum inside the syringe causes fluid or tissue to be aspirated (suctioned) into the needle. If the lump is a cyst, the needle will take out fluid and in case the lump is solid the needle will take a sample of tissue.
It takes a very short time, ranging between 5 to 15 minutes while you lie down on an examination table at a clinic, keeping your hands at your sides or above your head. This will still depend on which position it is easiest to find the lump.
The sample may be examined under the microscope immediately. This will help the doctor in:
i) Verifying whether a suitable sample was obtained.
ii) Making a rapid diagnosis.
The sample might also be sent to laboratory for further testing.
On completion the needle is removed and pressure is put on the area to stop bleeding, if any. A bandage will be also put on that site.
Core needle biopsy
A core needle biopsy uses a hollow needle to remove the sample of tissues from breast. Once you have been given the sedation and you feel the numbness, needle with a special tip is inserted into the breast tissue by making a small cut in your skin.
This type can be used to biopsy:
a) Lump that can be felt (palpable mass)
b) Suspicious area that can only be seen on a mammogram or other imaging test (non-palpable mass)
For a palpable mass before the procedure begins you will be given local anesthesia around the suspicious area. The tissue is then removed by a needle in small amount.
As for non-palpable mass this type is bit more involved. It is generally done by using images from a breast ultrasound, MRI or a Stereotactic mammography (a special kind of mammography) to guide the needle to the suspicious area. However, the most preferred method for this is a breast ultrasound guided biopsy.
Often in core needle biopsy a clip is placed inside your breast which you cannot feel. This is done to mark the location of a tumor. It is simpler to know whether a surgery is required.
Stereotactic biopsy is generally performed by a radiologist. This examination uses mammographic x-rays to target the area of concern and guide the needle to a precise location.
The below steps are followed during this biopsy:
a) First you would need to undress from waist up.
b) You will then be told to lie face down on a padded table. The table will have a hole in it. The same will be raised several feet in the air so that your radiologist can reach your breast through the hole in the table.
c) Two plates will be used then to strongly compress your breast. This helps the person to get the picture and discover the unusualness in the breast tissue. You have to be prepared because this can take time consider anything between half an hour to one hour.
d) When the pictures are clearly taken, you will be given local anesthesia. Your radiologist will then make a tiny nick on your breast from which the sample of tissue will be extracted using a needle. The tissue sample will be removed and sent for testing in the laboratory.
e) After the test is completed the radiologist will apply surgical tape to prevent the tested area from infection. A metal clip might be left in the location where the biopsy was done so that it can be easily be located later provided you have a breast surgery.
Vacuum assisted biopsy
Special instrument and imaging guidance is used in this tissue sampling technique. A single, small skin incision is done on the patient to remove samples. It is a much less invasive procedure than open biopsies. Stereotactic mammography, MRI, and ultrasound – all three of these tests have been successful in identifying the abnormal areas in the breast for further testing, here vacuum assisted biopsy.
After the probe has been positioned for biopsy, there is a vacuum that pulls the breast tissue through an opening. The tissue is pulled into the sampling chamber of the device and sent for testing. Vacuum assisted breast biopsy is becoming popular and commonly used biopsy type.
Open or surgical biopsy
A surgical breast biopsy is needed when results from the needle biopsy are not clear. Sometimes the lump is very hard for needle a biopsy to obtain an appropriate sample. Sometimes, for this reason an open biopsy is required. Surgical biopsy also helps in removing large tissue samples. Open biopsy is done in a hospital under either local or general anesthetic.
When your breast area is numb or you are asleep, the doctor will make an incision over the mass and locate it with wire localization. When there is a handful of tissues taken for diagnosis, your cut will be closed with stitches and dressing. The whole process takes about an hour. You will be allowed to return home the same day with someone assisting you.
How It Feels
All types of breast biopsies except the surgical one allow you to go back home on the same day of the procedure. However, you should relax and take it easy for the rest of the day by avoiding lifting weights or any kind of strenuous activity that puts pressure on your chest. You will be able to restart your normal chores the next day of examination.
During the biopsy you will feel a rapid sting from the needle provided you have been given local anesthesia for the biopsy. You may also feel a slight pressure when the needle is inserted. In case of core needle biopsy, fine-needle aspiration biopsy or a stereotactic biopsy, the area might remain sensitive for the next two to three days.
You may expect bruising, swelling, or minute bleeding as well. If these show up, you may use ice pack or take mild medicine (not aspirin) to relieve yourself from swelling and pain.
If you have a surgical or open breast biopsy you might be under general anesthesia. This means you will not be conscious while the procedure is on. When you are back to your senses you will still feel the numbness in the breast area. Your breast may feel tender, firm, swollen, and bruised. As mentioned earlier, an ice pack and mild pain medicine can help. But remember, the swelling may last up to 6 to 8 weeks. However, tenderness goes away within a week’s time.
You will also feel sleepy and dizzy for several hours. The tiredness may persist for the next one or two days. You will likely have stitches so your doctor will tell you how to deal with it. You may also suffer a sore throat if a tube was used for your stable breathing in the OT. You can try a warm salt water gargle at home to overcome this discomfort.
Breast biopsy may sound simple and hassle free; however there are some possible risk factors which may include:
a) Infection, bleeding, or puss forming in the biopsy area
b) Change in the appearance of your breast
c) Feeling of dizziness which can lead to collapsing or fainting
d) Fever with redness of the biopsy site
e) Surgical biopsy leaving a scar depending on the size of the excision
Give your doctor a call right away provided you find any of the above is seen.
Negative results may be caused by:
a) The biopsy sample failing to correct tissue area.
b) An unsuitable method of biopsy that was taken considering the Lesions present. For e.g, if FNA was performed, it might have revealed a benign cell, despite the presence of a palpable (felt) lump.
c) Technical failure of the equipment used to perform the biopsy.
A breast biopsy removes a sample of breast tissue that is looked at under a microscope for breast cancer.
No cancer cell present
Change in the breast seen – Benign (non-cancerous)
Cancer cells are present.
What Affects the Test
A needle biopsy takes tissue from a small area, so there is a chance that cancer may be missed.
What To Think About
Here are some facts that you should know:
a) Not all breast lumps are malignant or cancerous. But, post menopause chances of having breast cancer increases. It is rare that women have breast cancer before reaching menopause.
b) Sometimes you may feel lumpiness in your breast. That is normal especially before your menstruation.
c) This lumpiness also known as fibrocystic change is very common in women. Doctors now think that this change is normal.
d) After your menopause these changes are likely to go away, but they may also be found in women who regularly take hormone medication following menopause.
Other Works Consulted
Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.