Breast biopsy facts

• A breast biopsy procedure is usually done to determine whether a growth in the breast is cancerous or benign.
• A lump or other sign of breast cancer in a man or woman may warrant a breast biopsy.
• A breast biopsy can be done with a needle or by a surgical procedure.
• Non-surgical biopsies tend to be less stressful and minimize the risk of complications.
• Non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis.
• The biopsy may be done with imaging guidance.

What is a breast biopsy?

A breast biopsy is a procedure in which part or all of a suspicious area in the breast is removed and examined, usually for the presence of cancer. The growth sample is suctioned out through a needle or cut out using a surgical procedure. A pathologist then examines and evaluates it under a microscope to identify non-cancerous (benign) or cancerous (malignant) tissue.

Words used to refer to the abnormal area or growth before and after diagnosis may include lump, mass, lesion, calcification, and tumor.

What is the purpose of a breast biopsy?

The breast biopsy is used to determine whether or not a worrisome abnormality or area of calcification is cancer and, if it is cancer, what type it is and how to develop a treatment plan. When no cancer is detected, the diagnosis of a benign or harmless lump is reassuring.

What specialties of physicians and other health-care professionals perform breast biopsies?

Many physicians and health-care professionals can be involved in evaluating a woman for a breast biopsy.

• For example, breast abnormalities during a physical examination might be noticed by a family physician, internist, gynecologist, or nurse practitioner. Women themselves are frequently the first to detect abnormalities in their breasts.
• Radiologists are specialists in interpreting x-rays such as mammograms, as well as other imaging studies. Radiologists or surgeons often perform the procedure to obtain these breast tissue samples.
• Anesthesiologists (specialists in administering anesthesia and monitoring a patient's vital signs) are sometimes necessary during some surgical procedures.
• Pathologists are physician specialists who examine and identify under a microscope the type of cells in the samples and determine whether or not cancer is present.

Who should have a breast biopsy?

Anyone, female or male, with a suspicious breast growth, abnormality detected on imaging study, or other symptoms of breast cancer should undergo a biopsy. Ninety-nine percent of all breast cancers occur in females, however, males can and do get breast cancer. Therefore, men should regularly examine their breasts as females do for lumps or other cancer symptoms. (Males with the genetic disorder Klinefelter syndrome, which is associated with increased breast development, have approximately the same risk of developing breast cancer as females.)

In what setting is the breast biopsy done?

Breast biopsies are performed in the doctor's office, an outpatient facility, or a hospital operating room. The setting depends on the size and location of the growth, the patient's general health, and the type of biopsy performed. Because physicians can perform biopsies in a short time with minimal risk of serious complications, the patient usually does not need to remain hospitalized overnight unless an underlying health problem requires close monitoring.

What may a benign result indicate?

Among the most common benign growths in the breast are cysts (sacs filled with fluid or semisolid material), intraductal papillomas (small wart-like growths that project above a tissue surface), and lumps formed by fat necrosis (the death of tissue often as a result of trauma to the breast). A fibroadenoma is the most common type of benign (non-cancerous) breast tumor and is found in young women.

How is a suspicious breast growth discovered?

A suspicious breast growth may be found by a patient's self-examination, a physician's clinical examination, or a screening procedure such as a mammogram.

What breast symptoms should I be concerned about?

Females and males (regardless of age) who discover a lump in a breast should see a doctor for testing. They also should see a doctor if they find a lump in an armpit or above a collarbone (either of which could indicate the presence of spreading cancer).

A doctor or health-care professional should be consulted if they a person has:

• red or irritated breast skin,
• scaly skin on the breast,
• dimpling skin on the breast,
• swelling breast skin,
• nipple discharge other than milk,
• nipple retraction or inversion,
• nipple itching,
• a change in the size or shape of a breast, or
• breast pain.

It is important to remember that these signs and symptoms do not necessarily indicate the presence of cancer.

What should the patient tell the doctor about the growth?

The patient should tell the doctor when the growth appeared, what its size was at the time of discovery compared to its present size, and where it is located. The patient should also outline any family history of breast cancer, as well as any personal history of breast problems of any kind.

How does a physician confirm the presence of a breast growth?

A physician confirms the presence of a growth by taking a medical history (and asking numerous questions), performing a clinical examination that includes palpating (feeling) the breast, and interpreting the results of a diagnostic mammogram and sometimes other imaging studies such as ultrasound or MRI.

Ultrasound sends sound waves into the breast that "bounce" back to receiver that can record an image on a computer screen to visualize interior structures. This technique can help distinguish between a cyst and a solid growth. The physician may also order the laboratory analysis of any nipple discharge (other than milk) for the presence of cancerous cells. After confirming the presence of a suspicious growth, the physician orders a biopsy.

Is anesthesia needed for a biopsy?

For non-surgical biopsies, the patient may need no anesthesia at all or just a local anesthesia (one that numbs the suspicious area only). Sometimes, a patient receives a sedative (calming drug) with the local anesthesia.

For surgical biopsies, the patient may receive a local anesthesia (with or without a sedative) or general anesthesia (one that induces sleep). Patients requiring general anesthesia may have to fast 8 to 12 hours before undergoing a biopsy.

What about pain and complications?

Except for a minor sting from the injected anesthesia, patients usually feel no pain before or during a procedure. After a procedure, some patients may experience some soreness and pain. Usually, an over-the-counter drug is sufficient to alleviate the discomfort.

The risk of complications, such as infection and bleeding, is small for non-surgical procedures and slightly higher for surgical procedures.

What are the advantages and disadvantages of non-surgical procedures versus surgical breast biopsies?

Generally, non-surgical biopsies are less stressful, do not disfigure the skin, leave no internal scar to interfere with the accuracy of future mammograms, and minimize the risk of complications.

However, non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis. For this reason, some patients who undergo a non-surgical biopsy must also undergo a follow-up surgical biopsy.

What are the different types of breast biopsy procedures and what do they involve?

Breast biopsy procedures include:

• fine needle aspiration biopsy (FNAB),
• core needle biopsy (CNB),
• vacuum-assisted breast biopsy, and
• excision biopsy (surgery).

How is a fine needle aspiration biopsy (FNAB) done?

A fine needle aspiration biopsy (FNAB) can be done in several different ways:

• Fine needle aspiration biopsy (FNAB) for palpable growths: A palpable growth is one that can be felt. The patient usually sits up while the doctor inserts a small hollow needle with a syringe to withdraw (aspirate) fluid and cells from the growth for testing. The doctor simply feels (palpates) the suspicious area to the needle to the site When the needle reaches the mass, the doctor suctions out a sample with the syringe. The doctor repeats this procedure several times. If the mass is a cyst, the withdrawn samples will consist mainly of fluid and the cyst may collapse, relieving any pain the patient feels. If the mass is solid, the samples will consist primarily of tissue cells.

By analyzing the samples immediately after their withdrawal, a doctor may be able to determine that they came from a cyst and simply discard them, diagnosing the growth as benign. In all other cases, fluid and tissue samples are placed on slides and then analyzed by a pathologist in a laboratory. Atypical cells found in a fine needle aspiration biopsy may signal that cancer is present or that repeat biopsies are necessary.

• Guided FNAB for Non-Palpable Growths: When a growth is too small or deep to palpate (feel), the doctor must locate it with one of several imaging techniques. First, the patient lies face down on a table with the breasts suspended through an opening. With stereotactic mammography, mammograms of the suspicious breast site are taken from different angles to form a virtual three-dimensional (stereotactic) image that precisely pinpoints the location of the suspicious area. The computer then uses a motor to guide a small hollow needle to the site to remove the samples. The withdrawn samples are then analyzed for the presence of cancer. Ultrasound and MRI are other imaging techniques that may be used to guide breast biopsies.

How is a core needle biopsy (CNB) done?

A core needle biopsy (CNB) can also be done in several different ways:

• Core needle biopsy (CNB) for palpable growths: This procedure is similar to FNAB for palpable growths except that that the needle used has a wider diameter and is equipped with a cutter that removes cores of tissue up to a half-inch long. A key advantage of this procedure is that the samples are larger than in FNAB and thus enhance the possibility of making an accurate laboratory analysis.
• Guided CNB for Non-Palpable Growths: This procedure also uses a wide needle with a cutter that removes cores of tissue large enough to enhance the accuracy of laboratory analysis. However, because the growth is deep in the breast or otherwise not palpable, stereotactic imaging, ultrasound, or MRI is used to locate the growth.

Who should have a breast biopsy?

Anyone, female or male, with a suspicious breast growth, abnormality detected on imaging study, or other symptoms of breast cancer should undergo a biopsy. Ninety-nine percent of all breast cancers occur in females, however, males can and do get breast cancer. Therefore, men should regularly examine their breasts as females do for lumps or other cancer symptoms. (Males with the genetic disorder Klinefelter syndrome, which is associated with increased breast development, have approximately the same risk of developing breast cancer as females.)

In what setting is the breast biopsy done?

Breast biopsies are performed in the doctor's office, an outpatient facility, or a hospital operating room. The setting depends on the size and location of the growth, the patient's general health, and the type of biopsy performed. Because physicians can perform biopsies in a short time with minimal risk of serious complications, the patient usually does not need to remain hospitalized overnight unless an underlying health problem requires close monitoring.

What may a benign result indicate?

Among the most common benign growths in the breast are cysts (sacs filled with fluid or semisolid material), intraductal papillomas (small wart-like growths that project above a tissue surface), and lumps formed by fat necrosis (the death of tissue often as a result of trauma to the breast). A fibroadenoma is the most common type of benign (non-cancerous) breast tumor and is found in young women.

How is a suspicious breast growth discovered?

A suspicious breast growth may be found by a patient's self-examination, a physician's clinical examination, or a screening procedure such as a mammogram.

What breast symptoms should I be concerned about?

Females and males (regardless of age) who discover a lump in a breast should see a doctor for testing. They also should see a doctor if they find a lump in an armpit or above a collarbone (either of which could indicate the presence of spreading cancer).

A doctor or health-care professional should be consulted if they a person has:

• red or irritated breast skin,
• scaly skin on the breast,
• dimpling skin on the breast,
• swelling breast skin,
• nipple discharge other than milk,
• nipple retraction or inversion,
• nipple itching,
• a change in the size or shape of a breast, or
• breast pain.

It is important to remember that these signs and symptoms do not necessarily indicate the presence of cancer.

What should the patient tell the doctor about the growth?

The patient should tell the doctor when the growth appeared, what its size was at the time of discovery compared to its present size, and where it is located. The patient should also outline any family history of breast cancer, as well as any personal history of breast problems of any kind.

How does a physician confirm the presence of a breast growth?

A physician confirms the presence of a growth by taking a medical history (and asking numerous questions), performing a clinical examination that includes palpating (feeling) the breast, and interpreting the results of a diagnostic mammogram and sometimes other imaging studies such as ultrasound or MRI.

Ultrasound sends sound waves into the breast that "bounce" back to receiver that can record an image on a computer screen to visualize interior structures. This technique can help distinguish between a cyst and a solid growth. The physician may also order the laboratory analysis of any nipple discharge (other than milk) for the presence of cancerous cells. After confirming the presence of a suspicious growth, the physician orders a biopsy.

Is anesthesia needed for a biopsy?

For non-surgical biopsies, the patient may need no anesthesia at all or just a local anesthesia (one that numbs the suspicious area only). Sometimes, a patient receives a sedative (calming drug) with the local anesthesia.

For surgical biopsies, the patient may receive a local anesthesia (with or without a sedative) or general anesthesia (one that induces sleep). Patients requiring general anesthesia may have to fast 8 to 12 hours before undergoing a biopsy.

What about pain and complications?

Except for a minor sting from the injected anesthesia, patients usually feel no pain before or during a procedure. After a procedure, some patients may experience some soreness and pain. Usually, an over-the-counter drug is sufficient to alleviate the discomfort.

The risk of complications, such as infection and bleeding, is small for non-surgical procedures and slightly higher for surgical procedures.

What are the advantages and disadvantages of non-surgical procedures versus surgical breast biopsies?

Generally, non-surgical biopsies are less stressful, do not disfigure the skin, leave no internal scar to interfere with the accuracy of future mammograms, and minimize the risk of complications.

However, non-surgical biopsies are not always as reliable as surgical biopsies in producing a conclusive diagnosis. For this reason, some patients who undergo a non-surgical biopsy must also undergo a follow-up surgical biopsy.

What are the different types of breast biopsy procedures and what do they involve?

Breast biopsy procedures include:

• fine needle aspiration biopsy (FNAB),
• core needle biopsy (CNB),
• vacuum-assisted breast biopsy, and
• excision biopsy (surgery).

How is a fine needle aspiration biopsy (FNAB) done?

A fine needle aspiration biopsy (FNAB) can be done in several different ways:

• Fine needle aspiration biopsy (FNAB) for palpable growths: A palpable growth is one that can be felt. The patient usually sits up while the doctor inserts a small hollow needle with a syringe to withdraw (aspirate) fluid and cells from the growth for testing. The doctor simply feels (palpates) the suspicious area to the needle to the site When the needle reaches the mass, the doctor suctions out a sample with the syringe. The doctor repeats this procedure several times. If the mass is a cyst, the withdrawn samples will consist mainly of fluid and the cyst may collapse, relieving any pain the patient feels. If the mass is solid, the samples will consist primarily of tissue cells.

By analyzing the samples immediately after their withdrawal, a doctor may be able to determine that they came from a cyst and simply discard them, diagnosing the growth as benign. In all other cases, fluid and tissue samples are placed on slides and then analyzed by a pathologist in a laboratory. Atypical cells found in a fine needle aspiration biopsy may signal that cancer is present or that repeat biopsies are necessary.

• Guided FNAB for Non-Palpable Growths: When a growth is too small or deep to palpate (feel), the doctor must locate it with one of several imaging techniques. First, the patient lies face down on a table with the breasts suspended through an opening. With stereotactic mammography, mammograms of the suspicious breast site are taken from different angles to form a virtual three-dimensional (stereotactic) image that precisely pinpoints the location of the suspicious area. The computer then uses a motor to guide a small hollow needle to the site to remove the samples. The withdrawn samples are then analyzed for the presence of cancer. Ultrasound and MRI are other imaging techniques that may be used to guide breast biopsies.

How is a core needle biopsy (CNB) done?

A core needle biopsy (CNB) can also be done in several different ways:

• Core needle biopsy (CNB) for palpable growths: This procedure is similar to FNAB for palpable growths except that that the needle used has a wider diameter and is equipped with a cutter that removes cores of tissue up to a half-inch long. A key advantage of this procedure is that the samples are larger than in FNAB and thus enhance the possibility of making an accurate laboratory analysis.
• Guided CNB for Non-Palpable Growths: This procedure also uses a wide needle with a cutter that removes cores of tissue large enough to enhance the accuracy of laboratory analysis. However, because the growth is deep in the breast or otherwise not palpable, stereotactic imaging, ultrasound, or MRI is used to locate the growth.

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