Breast Biopsy

Test Overview

A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer. A breast biopsy is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram or ultrasound. See an illustration of the female breast.

There are several ways to do a breast biopsy. The sample of breast tissue will be looked at under a microscope to check for cancer cells.

• A fine-needle aspiration biopsy puts a thin needle through the skin, into the lump, and removes cells to look at. Needle aspiration may be done to see if the lump is solid or fluid-filled (cyst). If the lump is a cyst, it will go away after the fluid is removed. If there is no fluid, another type of biopsy will be done.
• A core needle biopsy uses a large needle fitted with a special tip. The needle goes through the skin to the lump or area to take out a sample of tissue about the size of a pencil lead. A core needle biopsy can also be done using a suction unit that gently removes a larger sample of tissue.
• A stereotactic biopsy uses a special type of X-ray during a core needle biopsy to find the area of the breast where the biopsy sample will be taken. This technique can check a lump that cannot be felt on breast examination but is seen on mammogram or ultrasound. A small incision is then made in the skin of the breast, and the core needle is guided by the X-ray to the biopsy site to take a tissue sample. Stereotactic biopsy may not be appropriate for all types of breast lumps.
• An open biopsy makes a cut in the skin and removes a sample of the lump or the entire lump. If your doctor cannot feel a lump, a needle (or wire) can be put in the suspicious area during a mammogram done just before surgery. The needle (or wire) then guides your doctor to the suspicious area to take a biopsy sample.

More tests or biopsies may be needed if problems are found during the first biopsy or if your doctor is concerned about a certain area of your breast.

Why It Is Done

A breast biopsy checks to see if a breast lump is cancerous (malignant) or noncancerous (benign).

How To Prepare

Tell your doctor if you:

• Are taking any medicines.
• Are allergic to any medicines, including anesthetics.
• Are allergic to latex.
• Have any bleeding problems or take blood thinners, such as aspirin, heparin, warfarin (Coumadin), enoxaparin sodium (Lovenox), or clopidogrel bisulfate (Plavix).
• Are or might be pregnant.

You will be asked to sign a consent form. Talk to your doctor about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will indicate. To help you understand the importance of the biopsy,

If you take a blood thinner, you will probably need to stop taking it for a week before the biopsy.

If a breast biopsy is to be done under local anesthesia, you do not need to do anything else to prepare for the biopsy.

If the biopsy is to be done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. An intravenous line (IV) is put in your arm, and a sedative medication is given about an hour before the biopsy. Arrange for someone to drive you home if you have general anesthesia or are given a sedative.

Other tests, such as blood tests, may be done before your breast biopsy.

How It Is Done

Fine-needle aspiration biopsy

A fine-needle aspiration biopsy may be done by an internist, family medicine doctor, radiologist, or a general surgeon. The biopsy may be done in your doctor's office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a needle is put through your skin into your breast tissue. Ultrasound may be used to guide the placement of the needle during the biopsy. If the lump is a cyst, the needle will take out fluid and tissue samples. If the lump is solid, a sample of tissue is taken. The biopsy sample is sent to a lab to be looked at under a microscope. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

See an illustration of a fine-needle breast biopsy.

Core needle biopsy

A core needle biopsy may be done by an internist, family medicine doctor, radiologist, or general surgeon. The biopsy may be done in your doctor's office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a small cut is made in your skin. A needle with a special tip is put into the breast tissue. Ultrasound may be used to guide the placement of the needle during the biopsy. You must lie still while the biopsy is done.

The needle is removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. This may be repeated several times to make sure enough tissue samples were collected.

A core needle biopsy takes about 15 minutes.

See an illustration of a core needle breast biopsy.

Stereotactic biopsy

A stereotactic biopsy is done by a radiologist. The biopsy is done in a radiology department.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. You will lie on your stomach on a special table that has a hole for your breast to hang through. A mammogram is used to find the exact site for the biopsy.

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a small cut is made in the skin. With a special X-ray to guide the needle, it is put into the suspicious area. Usually, more than one sample is taken through the same cut. You must lie still while the biopsy is done.

The small cut made for the needle does not usually need stitches. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A small metal marker (clip) is usually placed in the area where the biopsy sample was taken. This is done to locate the exact spot where the tissue sample was taken.

This type of breast biopsy takes about 60 minutes. However, most of this time is needed for the mammogram and finding the area for the biopsy.

See an illustration of a stereotactic breast biopsy.

Open biopsy

An open biopsy is done by a general surgeon, gynecologist, or family medicine doctor. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes above the waist. You will be given a gown to use during the biopsy. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

An open biopsy can be done using local or general anesthesia. If local anesthesia is used, you may also be given a sedative.

If you have general anesthesia, an intravenous (IV) line will be put in your arm to give you medications. You will not be awake during the biopsy.

After the breast is numb (or you are unconscious), your doctor makes a cut through the skin and into the breast tissue to the lump. If a probe was placed using mammogram to mark the biopsy site, your doctor will take a biopsy from the area at the tip of the probe.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. You can usually return to your normal activities the next day.

An open biopsy takes about 60 minutes.

See an illustration of an open breast biopsy.

How It Feels

You will feel only a quick sting from the needle if you have a local anesthetic to numb the skin. You may feel some pressure when the biopsy needle is put in. After a fine-needle aspirationstereotactic biopsy, the site may be tender for 2 to 3 days. You also may have a bruise around the site. biopsy, core needle biopsy, or

During a stereotactic biopsy, it may be hard to lie still during the biopsy. For 24 hours after the biopsy, do not do any heavy lifting or other activities that stretch or pull the muscles of your chest.

If you have general anesthesia for an open breast biopsy, you will not be awake during the biopsy. After you wake up, the area may be numb from a local anesthetic that was put in the biopsy site. You will also feel sleepy for several hours.

For 1 to 2 days after an open biopsy, you may feel tired. You may also have a mild sore throat from the tube that was used to help you breathe during the biopsy. Using throat lozenges and gargling with warm salt water may help with the sore throat.

After an open biopsy, your breast may feel tender, firm, swollen, and bruised. The tenderness should go away in about a week, and the bruising fades within 2 weeks. However, the firmness and swelling may last for 6 to 8 weeks. You should wear a bra or sports bra for support for 2 to 3 days after the biopsy. Do not do any heavy lifting or other activities that stretch or pull the muscles of your chest.

Risks

The possible risks from a breast biopsy include:

• An infection at the biopsy site. An infection can be treated with antibiotics.
• Bleeding from the biopsy site.

Call your doctor immediately if:

• Your pain lasts longer than a week.
• You have redness, a lot of swelling, bleeding, or pus from the biopsy site.
• You have a fever.

Core needle and stereotactic breast biopsies may leave a small round scar; open biopsies leave a small straight line scar. The scar fades over time. A fine-needle biopsy usually does not leave a scar.

Results

A breast biopsy removes of a sample of breast tissue that is looked at under a microscope for breast cancer.

Breast biopsy

Normal:	No abnormal or cancer cells are present.
Abnormal:	Noncancerous (benign) problems include fluid-filled cysts, fibrocystic lumps, and firm tumors (fibroadenomas). Fibroadenomas may be either taken out or left in but checked closely. They do not go away, but they are not likely to become cancer.
	Other noncancerous problems include growths of fat tissue (lipoma); scar tissue with calcium (calcification); an abscess; too much growth of cells (called atypical ductal hyperplasia, or ADH); or changes in the breast tissue cells called columnar alteration with prominent snouts and secretions (CAPSS). If ADH is present, an open biopsy is needed to make sure there is no cancer.
	Cancer cells are present.

What Affects the Test

If your breast is very thick, it may be hard to find the exact spot to biopsy.

A needle biopsy takes tissue from a small area, so there is a chance that a cancer may be missed.

What To Think About

• Ultrasound is used to guide the placement of the needle during a fine-needle aspiration biopsy or core needle biopsy if the lump shows up on an ultrasound scan. For more information, see the medical test Breast Ultrasound.
• Some lumpiness of breast tissue is normal. The fibrous tissue in the breast often feels lumpy or bumpy, especially before your menstrual period. This lumpiness (fibrocystic changes) is so common in women that doctors now think it is a normal change. These changes usually go away after menopause, but they also may be found in women who are taking hormone replacement following menopause.
• Most breast lumps are not cancer. The chance of a breast lump being cancerous depends on whether you have gone through menopause. The risk of cancer is greater after menopause than before menopause.
• If you cannot feel the lump, the most accurate type of biopsy is an open biopsy done after a needle has been placed in the suspicious area of the breast using mammography.
• A mammogram and clinical breast examination may be needed after needle or stereotactic biopsy shows the biopsy sample is not cancer (benign). This is done to make sure that the biopsy sample was taken from the correct area. If more tissue needs to be taken, an open biopsy may be done.
• The biopsy sample may be looked at immediately. This method is called a frozen section because the sample is frozen and then sliced into very thin sections to be looked at under a microscope. Your doctor may give you the results right away. A frozen section is more likely to be done after an open biopsy. A more careful look of the biopsy is done with a permanent section to check the results of the frozen section. The results of a permanent section are available in about 3 to 5 days.
• When a breast biopsy shows that cancer is present, hormone receptor tests may be done. These tests check to see if the hormones estrogen and progesterone affect the way the cancer grows. They also may give information about the chances of the cancer returning. The results help your doctor decide whether to use hormone therapy, such as tamoxifen (Nolvadex), as part of your treatment.
• Additional tests will be done if breast cancer is found. These tests may include:
  • Flow cytometry, which checks the types of cells in the biopsy sample. This helps find cells that are growing quickly. Fast-growing cells are more likely to be cancer.
  • Tumor marker testing, which checks for the protein HER-2/neu on the cells taken during the biopsy. This marker may help your doctor choose the best medication to treat breast cancer.
• If breast cancer is found, surgery called axillary lymph node dissection may be done next to see if the cancer has spread to the lymph nodes. Axillary lymph node dissection is done by taking some or all of the lymph nodes in the armpit. Removal of the axillary lymph nodes may cause significant, long-term swelling (lymphedema) in some women.
• Sentinel node biopsy may be done instead of an axillary lymph node dissection. Sentinel node biopsy takes out less tissue, and it does not cause as many problems with lymphedema.
  • Before a sentinel node biopsy, a special test is done to find the first lymph node to which the cancer would spread. A radioactive tracer is put into the breast where the cancer is found, and a special camera takes pictures of the lymph nodes. A blue dye may also be used during a sentinel node biopsy. The first lymph node to show the tracer is called the sentinel node. A biopsy sample is then taken from this sentinel node. The dye may cause your skin to look blue or green for several days after the biopsy. It also makes your urine green for 24 hours.
  • The tissue with the sentinel nodes is taken out and looked at under a microscope for cancer. If the sentinel nodes have cancer cells, an axillary lymph node dissection also is usually done to find out how far the cancer has spread.

References

Other Works Consulted

• Chernecky CC, Berger BJ, eds. (2004). Laboratory Tests and Diagnostic Procedures, 4th ed. Philadelphia: Saunders.

• Wood WC, et al. (2005). Malignant tumors of the breast. In VT DeVita Jr et al., eds., Cancer: Principles and Practice of Oncology, 7th ed., vol. 1, pp. 1415–1477. Philadelphia: Lippincott Williams and Wilkins.

Credits

Author	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Tracy Landauer
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Brent Shoji, MD - General Surgery
Last Updated	May 1, 2007