Biopsy for Breasts

If cancer is suspected, a biopsy will be performed. A biopsy involves removing tissue and examining it under a microscope for cancerous cells. Listed below are the different types of biopsies:

 

Image-Guided Biopsies

Doctors can use minimally invasive procedures like fine needle and core needle biopsy to diagnose breast lumps even if you can't feel them. Using breast-imaging methods such as ultrasound and stereotactic mammography, the doctor can find the lesion for biopsy.

During an ultrasound examination, the physician can view the needle on a screen as it moves toward and into the mass.

Stereotactic needle biopsy is a method that is useful when the lump is visible on a mammogram but not felt. Based on mammograms taken from two angles, a computer maps the precise location of the lump. A small electric motor controlled by the computer guides the placement of the needle for core needle or, less often, fine needle biopsy.

Wire localization is a procedure used to guide a surgical (excisional) breast biopsy when the lump or abnormality is difficult to feel. After numbing the area with local anesthetic, a hollow needle, thinner than that used for drawing blood, is placed into the breast using x-rays to guide the needle to the suspicious area. When the tip is in the correct position, a small amount of blue dye will be injected through it. The needle will be removed or replaced with a wire and you will be taken to surgery for your biopsy. The surgeon uses the wire or the dye as a guide to locate the abnormal area to be removed.

 

Fine Needle Biopsy

In a fine needle biopsy fluid and cells are taken from the suspicious lump through a fine needle. If primarily fluid is removed, it means the lump is most likely a cyst and the removal of the fluid will make the lump disappear. If cells are extracted, a pathologist will look at them to see if they are benign or cancerous.

A local anesthetic is applied to the breast to numb the area before the needle is inserted. For this type of biopsy, there is no need to make a cut in the breast.

If the lump cannot be felt, stereotactic images may be used help the doctor pinpoint the abnormality. Digital images of the breast are taken from several angles and a computer calculates the exact location of the lump.

If the abnormality is a fluid-filled cyst, it is usually benign, but it can be drained and a sample analyzed for definitive diagnosis.

 

Core Needle Biopsy

In a core needle biopsy, a hollow needle is inserted into the lump and a portion of the tissue is taken out for evaluation. A local anesthetic is applied to the breast to numb the area before the needle is inserted. Only a very tiny cut is needed to insert the core needle.

If the lump cannot be felt, stereotactic images may be used to help the doctor pinpoint the abnormality. Digital images are taken from several angles and a computer calculates the exact location of the lump.

The advantages of this procedure are many. It is less traumatic than an open surgical biopsy and you will have no surgical scar. For those with negative results (non-cancerous tumors), a surgical biopsy will not be necessary.

 

Incisional Biopsy

In incisional biopsy, the surgeon cuts out a sample of a lump or suspicious area. The biopsy is done to check if the lump is benign or cancerous. This type of biopsy is done only when the lump is so large that the breast would need to be removed entirely (mastectomy), or complete removal is not necessary or would result in cosmetic deformity. A disadvantage of this type of biopsy is that the entire lump has not been removed. If it is cancerous, it will usually require additional treatment or surgery.

 

Excisional Biopsy

The surgeon removes all of the lump or suspicious area. A pathologist then examines the tissue under a microscope to check for cancer cells. This procedure may also function as a lumpectomy with, in some cases, no further surgery needed.

Wire localization is a procedure used to guide a surgical (excisional) breast biopsy when the lump or abnormality is difficult to feel. After numbing the area with local anesthetic, a hollow needle, thinner than that used for drawing blood, is placed into the breast using x-rays to guide the needle to the suspicious area. When the tip is in the correct position, a small amount of blue dye will be injected through it. The needle will be removed or replaced with a wire and you will be taken to surgery for your biopsy. The surgeon uses the wire or the dye as a guide to locate the abnormal area to be removed.

 

Sentinel Node Biopsy

This procedure is used to determine if the cancer has spread beyond the original tumor. The sentinel lymph node(s) are the first nodes to which cancer is likely to spread from the primary tumor. Many surgeons find that the use of both nuclear medicine and dye agents increases their incidence of correctly identifying the sentinel lymph node.

 

Axillary Node Dissection

Axillary lymph node dissection helps determine the stage of the breast cancer, which in turn helps determine treatment choices. It is performed either after a lumpectomy or at the same time as a lumpectomy or modified radical mastectomy. Some of the lymph nodes under the arm are removed and analyzed.