Understanding Breast Biopsy Options in the Diagnosis of Breast Cancer

What is a breast biopsy ?

A breast biopsy involves the removal of a sample of cells or tissue from the breast. This sample is then examined under a microscope to look for signs of cancer.

When and why are breast biopsies recommended?

Your doctor may recommend a breast biopsy if you develop a lump in your breast or experience other breast changes. Biopsy results can indicate whether or not the suspicious areas are the result of breast cancer or a benign (non-cancerous) condition.

Will a breast biopsy hurt?

You can receive a local anesthetic before you undergo a biopsy, so the procedure is unlikely to be painful.

Are there different kinds of biopsies?

The two main types of biopsies are needle biopsies and surgical biopsies. You and your doctor will choose which procedure is most appropriate based on the location and size of the suspicious area, your general health, and your preference. There are risks and benefits with both kinds of biopsy.

How is each type of biopsy performed?

Needle biopsies are simple, fast procedures that are usually performed in the outpatient setting with local anesthesia. A needle is used to remove cells or a small amount of tissue from the suspicious area. If the abnormal area cannot be felt but only seen on a mammogram or MRI, your doctor can use additional equipment (such as ultrasound imaging or MRI) to guide the needle.

There are three types of needle biopsies:

  • Core needle biopsy—In this procedure a doctor uses a thin, hollow needle to remove a small tissue sample.
  • Fine needle aspiration—An even thinner needle than the needle used for a core needle biopsy is used in this procedure. The needle removes a few cells from the suspicious area.
  • Vacuum-assisted biopsy—This procedure can remove cores of tissue by using a thicker, hollow needle and a vacuum-assisted probe. If your doctor cannot feel the abnormal area, ultrasound imaging as well as stereotactic mammography can be used to guide the needle.

The most common type of surgical biopsy is an excisional biopsy. This involves the removal of the entire breast lump as well as some surrounding normal tissue. Though more invasive than needle biopsy, excisional biopsy is the most accurate way to diagnose breast cancer. As well, because the entire tumor is removed, this procedure may be the only surgery needed to both diagnose and treat breast cancer. Surgical biopsies can be done in the hospital or in the outpatient setting, and anesthesia is used.

What are the advantages and disadvantages of both needle and surgical biopsies?

Needle biopsies are less invasive, faster, and less expensive than surgical biopsies but have some limitations. For example, if a needle biopsy result is inconclusive or the needle misses the tumor, a surgical procedure may still be necessary. As well, because the lump is not removed, additional surgery may be required if cancer is found.

A surgical biopsy is more accurate than a needle biopsy, provides more information needed for treatment planning, and because the entire lump is removed, may be the only surgery required. However, because this is an open surgical procedure, there is a higher risk of infection, scarring, and changes to the breast in appearance and feel.

What should I talk to my doctor about before I undergo a biopsy?

In addition to details about the biopsy itself (such as the choice of procedure and amount of lump removed), be sure to ask your doctor how the procedure will affect you. Important details include: How long will the biopsy take? Can I go home on the same day? How much scarring can I expect? Are there any possible side effects? As well, find out when you’ll receive the results of the biopsy—the waiting period can be stressful, so it’s helpful to know when to expect results.

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