If images taken of your breast show suspicious or questionable areas, a breast biopsy is performed to gain more specific information. Your physician takes a sample of suspicious breast tissue and analyzes it in a laboratory for signs of breast cancer.
Your physician will order the biopsy that is most appropriate for you. It is important for you to ask questions or voice concerns—the more information that you have before, the more comfortable you will feel.
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It is a more invasive procedure than a core needle biopsy or vacuum-assisted biopsy, but as it removes a larger sample, the results are usually more accurate. The recovery period for this type is longer. You will need stitches and it will probably take a full day to recover. There will likely be a small scar.
Two types are performed
- Excisional biopsy: An incision is made in the breast and the entire mass is removed.
- Incisional biopsy: Only part of the mass is removed.
If the lump cannot be felt, a localization procedure is performed prior to the biopsy.
As cancer cells spread, they can metastasize through the lymphatic system (the nodes, tissues, and organs that produce and store infection-fighting white blood cells). The first lymph nodes the cancer cells come in contact with as they move from their tumor of origin are called sentinel lymph nodes.
This type of procedure is a surgery to identify, remove, and microscopically examine the lymph nodes directly in the pathway of spreading cancer cells to assess whether breast cancer has spread to lymph nodes under your arm, which are the most likely lymph nodes to contain breast cancer.
In this procedure, only those lymph nodes that may be affected by abnormal cells are removed, increasing the potential to save lives while eliminating, in most cases, the need for a more complicated surgery.
Two methods are used to identify a sentinel lymph node; most commonly, both are used:
- Radioisotope: With this method, you receive an injection in the nuclear medicine department, before you go to the operating room. Based on where the radioisotope travels, your doctor determines whether the lymph fluid in your breast cancer is draining to the lymph nodes in your armpit.
- Blue dye: During the operation, your surgeon injects blue dye into your breast. Based on where the dye travels, your doctor determines whether the lymph fluid in your breast cancer is draining to the lymph nodes in your armpit.
Breast surgeons at MedStar Health recommend minimally invasive breast biopsies whenever possible so the most effective and least uncomfortable approach is used.
Minimally invasive biopsies offer:
- Reduced risk of infection
- Less recovery time
- Less scarring
This is an outpatient procedure. Some of the minimally invasive biopsies performed at MedStar include:
- Core Needle Biopsy: Uses a hollow core needle to remove a small sample of breast tissue. A tissue marker is left in place to designate the area that has been sampled. This kind of biopsy requires little recovery time, and there is no significant scarring to the breast.
Sometimes the abnormality cannot be felt because it is too small or is in a difficult-to-reach place. In those situations, the doctor will use image-guidance, such as an ultrasound, to help guide the needle to the appropriate area.
- MRI-Guided Biopsy: MRI (magnetic resonance imaging) guides a radiologist to the site of abnormalities to remove samples for examination and diagnosis. This procedure is often used to take samples of the abnormal areas your doctor cannot easily detect on a digital mammogram or ultrasound. A tissue marker is left in place to designate the area that has been sampled. This kind of procedure requires little recovery time, and there is no significant scarring to the breast.
- Stereotactic Biopsy: The procedure uses a special computer to guide a needle to a suspicious area seen on a mammogram. It is a non-invasive procedure and accurately obtains the tissue sample required for diagnosis. This requires little recovery time, and there is no significant scarring to the breast. A tissue marker is left in place to designate the area that has been sampled.
This is performed by a MedStar board-certified radiologist who specializes in these kinds of breast biopsies. The radiologist is assisted by a radiological technologist who also specializes in breast imaging.
- Ultrasound-Guided Biopsy: This is a highly accurate procedure to evaluate suspicious masses within the breast that are visible on ultrasound even if they were not felt on breast self-examination or clinical examination. This kind of biopsy requires little recovery time, and there is no significant scarring to the breast. A tissue marker is left in place to designate the area that has been sampled. An ultrasound does not involve the radiation exposure that comes from using X-rays to locate suspicious tissue.
After placing an ultrasound probe over the site of the breast lump and using local anesthesia, the radiologist guides a biopsy needle directly into the mass. Tissue specimens are then taken using either an automatic spring-loaded or vacuum-assisted device.
This procedure uses either stereotactic mammography, ultrasound, or MRI imaging to pinpoint the location of the breast mass. Your doctor inserts a needle, and a vacuum withdraws breast tissue, capturing it in the sampling chamber of the device.
The procedure is similar to a core needle biopsy, but your doctor may have to insert a needle several times to remove sufficient tissue samples. A vacuum-assisted biopsy uses a specialized instrument, which allows the doctor to remove several samples through a single incision.
This is a surgical biopsy. A wire localization procedure is performed when a breast abnormality is small or difficult to find by touch.
MedStar Health doctors use a wire as a guide to find the tissue that needs to be removed.
Wire Localization Procedure
Your radiologist inserts a thin, hollow needle into your breast. The tip of the needle rests on the abnormality, and a fine wire is threaded through to rest on the abnormal tissue. The wire has a tiny hook at the end so it can grab onto the breast tissue. The radiologist then removes the needle, leaving the wire in place.
You will get a second mammogram to ensure that the wire is resting in the proper position. Once the radiologist confirms that it is in place, the wire will be securely taped. During the following biopsy or lumpectomy, the surgeon removes the wire.