A Guide to Breast Biopsy

To be sure that a lump in your breast is not cancerous, you need to have some or all of the tissue removed (a biopsy). A pathologist can tell if the tissue is normal or cancerous.

• When your lump can be felt
• When your lump can be seen, but not felt
• Anesthesia
• Biopsy Results
• Questions to ask your doctor or nurse

When your lump can be felt

If your lump can be felt, you will most likely have one of the following types of biopsies:

• Fine Needle Aspiration (FNA) - This type of biopsy can be performed in a doctor's office and leaves no scar. A thin needle is placed into the lump. Local anesthesia may be used to make you more comfortable.
  
  A Fine Needle Apsiration can immediately confirm if a lump is a cyst or not (if fluid comes out and the lump disappears, it's a cyst and usually not cancerous). If the lump remains, any tissue samples obtained will be sent for testing.



• Core Biopsy - Under local anesthesia, a slighly larger needle is used to remove a small piece of tissue from the lump. This procedure leaves a barely noticable scar.
  
  If cancer is found, you will need surgery to remove the part of the lump that is still in your breast. In some rare cases, even when the tissue removed shows no signs of cancer, your physician may recommend a further surgical biopsy to confirm the absence of cancer.



• Surgical Biopsy - There are two types of surgical biopsies, incisional and excisional. They will leave a scar. They are generally done under conscious sedation or general anesthesia, but may be done under local anesthesia.
  • Incisional - Removes more tissue that is removed with a core biopsy, but does not remove the entire lump.
  • Excisional - Removes the entire lump, as well as a small margin of normal tissue around the lump. With certain cancers, the excisional biopsy may be all the surgery you need even if the lump is malignant.
    The physician may still need to go back and remove additional tissue, depending upon the findings

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When your lump can be seen, but not felt

Sometimes you have an area of concern that cannot be felt in the breast but shows up on mammography or ultrasound. In these situations, you may have one of the following types of biopsy

• Needle Localization Biopsy in Conjunction with Surgery - Using mammography or ultrasound as a guide, a physician places a needle and then a fine wire as a guide to the surgeon to the suspicious area. The patient is then taken to surgery where the biopsy is performed.



• Stereotactic Needle Biopsy - This procedure pinpoints the area of concern using x-ray (mammography) images from more than one direction.
  
  The patient lies on her stomach on a special table throughout the biopsy procedure. There may be some occasional discomfort and the procedure can be done under local anesthesia.
  
  A computer plots the exact area and guides the insertion of a core needle so the physician can take a biopsy. This procedure leaves a barely noticeable scar.



• Ultrasound Guided Core Biopsy - This procedure uses sound waves that outline the tissues, creating images to help the physician guide a core needle to the site. This procedure is performed with local anesthesia and leaves a barely noticeable scar.
  
  Only solid masses can be biopsied with this technique; clusters of calcification cannot be biopsied. Not all masses are visable by ultrasound.

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Anesthesia

The type of anesthesia you will have will depend on the type of procedure you have as well as your general physical condition and location of procedure.

• Local anesthesia - With local anesthesia, the medication is targeted to the area of the procedure. You remain awake, but should feel no pain. This method is used if the lump is small and near the surface of the skin.



• General anesthesia - With general anesthesia, you will be given medication to put you in a deep sleep. You will not feel pain during the surgery. This method is used if the tumor is large, located deep in the breast, when the patient is extremely anxious about the procedure or if the patient has a physical disability.



• Conscious sedation - This is a type of general anesthesia and you will feel relaxed and drowsy. You will feel no pain with the procedure.

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Biopsy Results

Negative
If your biopsy result is negative (benign), no cancer was found. It is still important to have regular breast exams and follow-up mammograms.

Positive
If your biopsy result is positive (malignant), cancer was found. You will need to make decisions about your treatment options. Information about these options can be obtained from your physician.
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Questions to ask your doctor or nurse

• Do you think I need to have a biopsy? If not, why?
• What type of biopsy do you recommend? Why?
• How soon will I know the results?
• What will the scar look like after the incision from the biopsy heals?
• Do you suggest a local anesthesia, conscious sedation or general anesthesia? What are the advantages of each one?
• What do I need to do to prepare for the recommended biopsy?
• If I have further questions, who should I call and what are the phone numbers?

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