Breast biopsy is performed to collect samples of tissue or cells from a suspicious lump or area in the breast. Image-guided biopsy is recommended for almost all cases of suspected breast cancer and is used to confirm the results of previous tests or when imaging techniques fail to yield decisive results. It is the only way to be sure whether an abnormality in the breast is cancerous or not. Statistically, 70%-80% of women who have a biopsy do not have cancer. In women found to have cancer, the information obtained from a biopsy can help physicians plan surgery and/or treatment. 

There are four types of image-guided biopsy procedures used to collect breast tissue samples. The first three methods described below are minimally-invasive and performed under local anesthesia.

• Fine-needle aspiration biopsy: This simplest and most prescribed method of breast biopsy uses a syringe with a very fine needle to extract tissue, fluid or cell samples from a lump that a doctor can feel. This method helps the doctor immediately distinguish between a benign, fluid-filled cyst and a solid mass. The latter may require further diagnostic tests or surgical removal.

• Core needle biopsy: Core needle biopsy uses a thin, hollow needle (although not as thin as the one used for fine needle aspiration) to remove tissue samples about the size of a grain of rice. Samples are then sent to a pathology lab for analysis to determine a diagnosis.

• Vacuum-assisted biopsy: Basically the same as core needle biopsy, vacuum-assisted biopsy involves a modified, rotating needle and vacuum technique to draw multiple and varied tissue samples from a single, small incision in the breast.

• Surgical biopsy: Typically performed in an operating room under sedation and a local anesthetic, a surgical biopsy removes the entire lump or a significant portion of it for laboratory analysis. In cases where the surgeon is unable to locate the breast mass by touch, a technique called wire localization - performed by a radiologist just prior to the surgery - may be used to guide the surgeon to the mass. 

Florida Hospital uses three imaging technologies during biopsy to guide the needle or surgeon to the precise location of the potentially cancerous tumor, cell cluster or tissue mass:

• Ultrasound biopsy
• Stereotactic biopsy
• MRI biopsy

Each of these imaging technologies has its advantages and limitations. Choosing the right one for any patient depends on the surgical procedure and location of the abnormality, the unique characteristics of the individual's breasts, her personal and family medical history, whether or not she's pregnant, known allergies and other considerations.

Safety

Breast biopsy, though generally minimally-invasive, carries risks associated with any procedure that penetrates the skin. They include:

• Risk of bleeding or hematoma (a collection of blood) at the biopsy site
• Residual pain or discomfort, easily controlled by non-prescription pain medication
• Risk of infection, requiring antibiotic treatment
• A biopsy of tissue located deep within the breast carries an extremely low risk that the needle will pass through the chest wall and cause the lung to collapse.

What to Expect

Preparation for and a patient's experience during a biopsy depend on the type of biopsy performed and the imaging technique used to guide the procedure. The aftercare and cautions following breast biopsy generally apply regardless of the biopsy or imaging method used.

After the Procedure

Avoid strenuous activity for at least 24 hours following the biopsy. Temporary bruising at the biopsy site is normal. If you experience swelling and bruising, you may be instructed to apply a cold pack to the site and take over-the-counter pain medication. Contact your doctor if you experience excessive swelling, bleeding or redness in the breast.

The Results

The lump or tissue samples removed during biopsy are sent to a pathology laboratory for analysis. A pathologist, a physician specially trained in diagnosing disease from tissue and cell samples, will examine your samples and create a report of his/her findings that will be sent to your doctor. Your doctor will present the results and discuss them with you.