Comparing breast biopsy choices

Biopsy generally follows abnormal mammogram findings, but the majority of biopsies find nothing of concern. However, there are a number of biopsy methods that your doctor might recommend depending on the type and extent of abnormality on the mammogram or other imaging findings.

What type of biopsy you experience will depend on the discussions you have with your doctor.

What is a breast biopsy?

Breast biopsy is the removal of breast tissue, which is required to determine the cause of abnormalities seen on mammogram. A biopsy may be done under other conditions, such as finding a lump upon physical examination. Removing the tissue allows pathologists to look at the structure of the cell layers and structures within the breast to determine if cancer is present.

There are two primary categories of breast biopsy: needle and surgical (often called ‘open breast biopsy’). They both attempt to remove tissue from within the breast where the abnormal mammogram signature was seen. Each biopsy technique has particular benefits and is chosen based on the particular woman’s situation, including the type of abnormality seen on mammogram.

Surgical biopsy

Open breast biopsy requires a cut be made in the breast. The amount of tissue that it displaces depends on the woman’s particular diagnostic findings on mammogram and other examinations. 

Incisional biopsy removes a portion of the area of interest, whereas excisional biopsy removes the entire area. Excisional biopsy is called a lumpectomy when a lump is removed. Imaging methods may be used to ensure the surgeon can visualize the appropriate tissue, sometimes using guide wires placed prior to the operation. 

 

Local or general anesthesia is used depending on the extent of tissue removal. This also affects recovery and healing. There will be sutures and a bandage, and the area will be sore and tender for several days, so your surgeon will recommend no heavy lifting or shower for 24 hours afterwards.

The potential risks are the same as other surgical procedures - infection at the surgical site, bleeding, bruising, and scarring (extent depends on amount of tissue removed), as well as the side effects of general anesthesia if it is used.

Needle biopsy

Unlike surgical biopsy, needle biopsy does not require stitches and does not lead to scarring, though some techniques require a small cut be made in the breast. If the lump or area of interest cannot be felt, the doctor may use imaging to locate it during insertion – called stereotactic needle biopsy. There are few ways to obtain a needle biopsy.

Fine needle aspiration: This technique is beneficial for determining whether a lump is actually a fluid-filled cavity called a cyst. Any cells contained in the aspirate can be viewed to determine whether the breast requires further biopsy. In this technique, a very thin needle pierces the breast to draw out a very small amount of the tissue in the area of interest. The procedure generally takes 5 to 15 minutes as an outpatient procedure. Anesthesia may not be needed, though local may be used to avoid discomfort. Like getting a vaccine, there will be pressure applied to stop any bleeding and a band-aid. The potential risks of the procedure are that it may miss the lump and require second biopsy for certainty.

Core needle biopsy: This technique is fine needle aspiration with a larger needle. A hollow needle draws out approximately 3 to 6 cores of tissue from the area of interest. It takes longer than fine needle aspiration but is a more certain procedure. There are various kinds of core needle biopsies. Local anesthesia is used but aftercare is similar to fine needle aspiration. Research has shown that the procedure increases the risk of infection in subsequent breast surgery, but the risk can be reduced by using a vacuum procedure.

Combination techniques

A type of needle biopsy that has similarities to surgery is large core biopsy. The various techniques that are used to obtain these breast tissue samples benefit from vacuum assistance and/or rotator blades. They are done with local anesthetic like needle biopsy, but they may cause scarring. The rotator blade technique removes a large cylinder of tissue and may also require a few stitches. The advantage of vacuum-assisted core needle biopsy is that the probe does not have to be removed between tissue samples. These techniques can be beneficial for avoiding surgery to remove a small lump. 

 

Each patient and their doctor should discuss the advantages and risks of the type of biopsy they may need to determine what is best for obtaining a diagnosis.