When the doctor says you need a biopsy

 

[October 16, 2020]   When other tests show that you might have breast cancer, you will probably need to have a biopsy. Needing a breast biopsy doesn’t necessarily mean you have cancer. Most biopsy results are not cancer, but a biopsy is the only way to find out for sure. During a biopsy, a doctor will remove small pieces from the suspicious area so they can be looked at in the lab to see if they contain cancer cells.

Types of breast biopsies

There are different kinds of breast biopsies. Some are done using a hollow needle, and some use an incision (cut in the skin). Each has pros and cons. The type you have depends on a number of things, like:

• How suspicious the breast change looks

• How big it is

• Where it is in the breast

• If there is more than one

• Any other medical problems you might have

• Your personal preferences

For most suspicious areas in the breast, a needle biopsy (rather than a surgical biopsy) can be done. Ask the doctor which type of biopsy you will have and what you can expect during and after the procedure.

Fine Needle Aspiration (FNA) Biopsy of the Breast

If other tests show you might have breast cancer, your doctor may refer you for a fine needle aspiration (FNA) biopsy. During this procedure, a small amount of breast tissue or fluid is taken from the suspicious area and is checked for cancer cells.

What is an FNA breast biopsy?

In an FNA biopsy, the doctor uses a very thin, hollow needle attached to a syringe to withdraw (aspirate) a small amount of tissue or fluid from a suspicious area. The biopsy sample is then checked to see if there are cancer cells in it.

If the area to be biopsied can be felt, the needle can be guided into it while the doctor is feeling it.

If the lump can't be felt easily, the doctor might watch the needle on an ultrasound screen as it moves toward and into the area. This is called an ultrasound-guided biopsy.

What should you expect if you have an FNA?

During an FNA

An FNA is an outpatient procedure most often done in the doctor’s office. Your doctor might use a numbing medicine (called a local anesthetic), but it's not needed in all cases. This is because the needle used for the biopsy is so thin that getting an anesthetic might hurt more than the biopsy itself.

You’ll lie on your back for the FNA, and you will have to be still while it’s being done.

If ultrasound is used, you may feel some pressure from the ultrasound wand and as the needle is put in. Once the needle is in the right place, the doctor will use the syringe to pull out a small amount of tissue and/or fluid. This might be repeated a few times. Once the biopsy is done, the area is covered with a sterile dressing or bandage.

Getting each biopsy sample usually takes about 15 seconds. The entire procedure from start to finish generally takes around 20 to 30 minutes if ultrasound is used.

After an FNA

Your doctor or nurse will tell you how to care for the biopsy site and what you can and can’t do while it heals. Biopsies can sometimes cause bleeding, bruising, or swelling. This can make it seem like the breast lump is larger after the biopsy. Most often, this is nothing to worry about, and the bleeding, bruising, and swelling go away over time.

What does an FNA show?

A doctor called a pathologist will look at the biopsy tissue or fluid to find out if there are cancer cells in it.

If the fluid is brown, green, or tan, the lump is most likely a cyst, and not cancer.
Bloody or clear fluid can mean either a cyst that’s not cancer or, very rarely, cancer.

If the lump is solid, the doctor will look at small groups of cells from the biopsy to determine what it is.

The main advantages of FNA are that it is fairly quick, and the skin doesn’t have to be cut, so no stitches are needed and there is usually no scar. Also, in some cases it’s possible to make the diagnosis the same day.

An FNA biopsy is the easiest type of biopsy to have, but it can sometimes miss a cancer if the needle does not go into the cancer cells, or if it doesn't remove enough cells. Even if an FNA does find cancer, there might not be enough cancer cells to do some of the other lab tests that are needed.

If the results of the FNA biopsy do not give a clear diagnosis, or your doctor still has concerns, you might need to have a second biopsy or a different type of biopsy.

Core Needle Biopsy of the Breast

This is often the preferred type of biopsy if breast cancer is suspected, because it removes more breast tissue than a fine needle aspiration (FNA), and it doesn't require surgery.

During this procedure, the doctor uses a hollow needle to take out pieces of breast tissue from the area of concern. This can be done with the doctor feeling the area, or while using an imaging test to guide the needle.

What is a core needle biopsy?

For a CNB, the doctor uses a hollow needle to take out pieces of breast tissue from a suspicious area the doctor has felt or has pinpointed on an imaging test. The needle may be attached to a spring-loaded tool that moves the needle in and out of the tissue quickly, or it may be attached to a suction device that helps pull breast tissue into the needle.

A small cylinder (core) of tissue is taken out in the needle. Several cores are often removed.

The doctor doing the CNB may put the needle in place by feeling the lump. But usually the needle is put into the abnormal area using some type of imaging test to guide the needle into the right place. Some of the imaging tests a doctor may use include:

• Ultrasound

• MRI

• Mammogram (or breast tomosynthesis)

What should you expect if you have a CNB?

During the CNB

A CNB is an outpatient procedure most often done in the doctor’s office with local anesthesia (you’re awake but part of your breast is numbed). The procedure itself is usually quick, though it may take more time if imaging tests are needed or if one of the special types of CNB described below is used.

You may be sitting up, lying flat or on your side, or lying face down on a special table with openings for your breasts to fit into. You will have to be still while the biopsy is done.

For any type of CNB, a thin needle will be used to put in medicine to numb your skin. Then a small cut (about ¼ inch) will be made in the breast. The biopsy needle is put into the breast tissue through this cut to remove the tissue sample. You might feel pressure as the needle goes in. Again, imaging tests may be used to guide the needle to the right spot.

Typically, a tiny tissue marker (also called a clip) is put into the area where the biopsy is done. This marker shows up on mammograms or other imaging tests so the exact area can be located for further treatment (if needed) or follow up. You can’t feel or see the marker. It can stay in place during MRIs, and it will not set off metal detectors.

Once the tissue is removed, the needle is taken out. No stitches are needed. The area is covered with a sterile dressing. Pressure may be applied for a short time to help limit bleeding.

After the CNB

You might be told to limit strenuous activity for a day or so, but you should be able to go back to your usual activities after that. Your doctor or nurse will give you instructions on this.

A CNB can cause some bleeding, bruising, or swelling. This can make it seem like the breast lump is larger after the biopsy. Most often, this is nothing to worry about, and any bleeding, bruising, or swelling will go away over time. Your doctor or nurse will tell you how to care for the biopsy site and when you might need to contact them if you’re having any issues. A CNB usually doesn’t leave a scar.

Special types of core needle biopsies

Stereotactic core needle biopsy

For this procedure, a doctor uses mammogram pictures taken from different angles to pinpoint the biopsy site. A computer analyzes the x-rays of the breast and shows exactly where the needle tip needs to go in the abnormal area. This type of CNB is often used to biopsy suspicious microcalcifications (tiny calcium deposits) or small masses or other abnormal areas that can’t be seen clearly on an ultrasound.

Vacuum-assisted core biopsy

For a vacuum-assisted biopsy (VAB), a hollow probe is put through a small cut into the abnormal area of breast tissue. The doctor guides the probe into place using an imaging test. A cylinder (core) of tissue is then suctioned into the probe, and a rotating knife inside the probe cuts the tissue sample from the rest of the breast. Several samples can be taken from the same cut. This method usually removes more tissue than a standard core needle biopsy.

What does a CNB show?

A doctor called a pathologist will look at the biopsy tissue and/or fluid to find out if there are cancer cells in it. A CNB is likely to clearly show if cancer is present, but it can still miss some cancers.

Ask your doctor when you can expect to get the results of your biopsy. If the results of the CNB do not give a clear diagnosis, or your doctor still has concerns, you might need to have a second biopsy or a different type of biopsy.

Surgical Breast Biopsy

If other tests show you might have breast cancer, your doctor may refer you for a breast biopsy. Most often this will be a core needle biopsy (CNB) or a fine needle aspiration (FNA) biopsy. But in some situations, such as if the results of a needle biopsy aren’t clear, you might need a surgical (open) biopsy. During this procedure, a doctor cuts out all or part of the lump so it can be checked for cancer cells.

What is a surgical biopsy?

For this type of biopsy, surgery is used to remove all or part of a lump so it can be checked to see if there are cancer cells in it.

There are 2 types of surgical biopsies:

• An incisional biopsy removes only part of the abnormal area.

• An excisional biopsy removes the entire tumor or abnormal area. An edge (margin) of normal breast tissue around the tumor may be taken, too, depending on the reason for the biopsy.

Preoperative localization to guide surgical biopsy

If the change in your breast can’t be felt and/or is hard to find, a mammogram, ultrasound, or MRI may be used to place a wire or other localizing device (such as a radioactive or magnetic seed, or a radiofrequency reflector) into the suspicious area to guide the surgeon the right spot. This is called preoperative localization (or stereotactic wire localization if a wire is used).

For wire localization, your breast is numbed, and an imaging test is used to guide a thin, hollow needle into the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place, while the other end of the wire remains outside of the breast. The needle is then taken out. You then go to the operating room with the wire in your breast. The surgeon uses the wire as a guide to the area to be removed. When this method is used, it is done the same day as your surgery.

In newer methods of localization, a localizing device is put into the suspicious area before the day of your surgery, so you don’t have to have it done the morning of your operation. Radioactive or magnetic seeds (tiny pellets that give off a very small amounts of radiation or that create small magnetic fields) or radiofrequency reflectors (small devices that give off a signal that can be picked by a device held over the breast) can be placed completely inside the breast (unlike the wire used for wire localization). Your surgeon can then find the suspicious area by using a handheld detector in the operating room.

What should you expect if you have a surgical biopsy?

During a surgical biopsy

Rarely, a surgical biopsy might be done in the doctor's office. But most often it's done in a hospital’s outpatient department. You are typically given local anesthesia with intravenous (IV) sedation. (This means you’re awake, but your breast is numbed, and you’re given medicine to make you drowsy.) Another option is to have the biopsy done under general anesthesia (where you’re given medicine to put you in a deep sleep and not feel pain).

The skin of the breast is cut, and the doctor removes the suspicious area. You often need stitches after a surgical biopsy, and pressure may be applied for a short time to help limit bleeding. The area is then covered with a sterile dressing.

After a surgical biopsy

The biopsy can cause bleeding, bruising, or swelling. This can make it seem like the breast is larger after the biopsy. Most often, this is nothing to worry about, and the bleeding, bruising, and swelling go away over time. Your doctor or nurse will tell you how to care for the biopsy site and when you might need to contact them if you’re having any issues.

A surgical biopsy may leave a scar. You might also notice a change in the shape of your breast, depending on how much tissue is removed.

What does a surgical biopsy show?

A doctor called a pathologist will look at the biopsy tissue under a microscope to find out if there are cancer cells in it.

Ask your doctor when you can expect to get the results of your biopsy. The next steps will depend on the biopsy results.

If no cancer cells are found in the biopsy, your doctor will talk to you about when you need to have your next mammogram and any other follow-up visits.

If cancer is found, the doctor will talk to you about the kinds of tests needed to learn more about the cancer and how to best treat it. You might need to see other doctors, too.

Questions to Ask Before a Breast Biopsy

There are different types of breast biopsies. It's important to understand the type of biopsy you’ll have and what you can expect during and after the biopsy.

Here are some questions you might want to ask before having a breast biopsy:

• What type of biopsy do you think I need? Why?

• Will the size of my breast affect the way the biopsy is done?

• Where will you do the biopsy?

• What exactly will you do?

• How much breast tissue will you remove?

• How long will it take?

• Will I be awake or asleep during the biopsy?

• Will the biopsy area be numbed?

• Will I need someone to help me get home afterward?

• If you can’t feel the abnormal area in my breast, how will you find it?

• If you are using a guide wire to help find the abnormal area, how will you make sure it’s in the right place (with ultrasound or a mammogram)?

• Will I have a hole there? Will it show afterward?

• Will my breast have a different shape or look different afterward?

• Will you put a clip or marker in my breast? If so, what will happen to it?

• Will I have a scar? Where will it be? What will it look like?

• Will I have bruising or changes in the color of my skin? If so, how long will it last?

• Will I be sore? If so, how long will it last?

• Might I have any other types of problems after the biopsy? Are there any I'd need to call your office about?

• When can I take off the bandage?

• When can I take a shower or bath?

• Will I have stitches? Will they dissolve or will I need to come back to the office and have them removed?

• When can I go back to work? How will I feel when I do?

• Will my activities be limited? Can I lift things? Care for my children?
  How soon will I know the biopsy results?

• Should I call you or will you call me with the results?

• Will you or someone else explain the biopsy results to me?

Regardless of which type of biopsy you have, the biopsy samples will be sent to a lab where a specialized doctor called a pathologist will look at them. It typically will take at least a few days for you to find out the results.

If the doctor doesn't think you need a biopsy, but you still feel there’s something wrong with your breast, follow your instincts. Don’t be afraid to talk to the doctor about this or go to another doctor for a second opinion. A biopsy is the only sure way to diagnose breast cancer.

[The American Cancer Society medical and editorial content team]