Different Breast Biopsy Procedures

What Type of Breast Biopsy Procedure is Right For You?

woman having a fine needle breast biopsy
What are the different types of breast biopsy procedures?. Linda Bartlett (photographer)/Wikimedia Commons/PD/National Institutes of Health images

If you've had a mammogram or a breast exam that has caused concern, or if you've felt a lump in your breast, you should talk to your doctor or nurse practitioner. If your doctor recommends it, you may need to have a breast biopsy done, to determine whether the affected tissue is actually worrisome, is only a cyst, or is just a normal change. There are several kinds of breast biopsy techniques, and each one has advantages and disadvantages.

Breast Biopsy

A biopsy is a procedure that takes a sample of tissue so that it can be sent for testing to a lab. It's important to get accurate results from a biopsy because if there is any disease, the biopsy result will help to determine what your next course of action should be. That said, there are several different ways in which a sample of tissue can be obtained. These include:

  • Fine-needle aspiration
  • Core needle biopsy
  • Stereotactic biopsy
  • Open (surgical biopsy)

Let's take a look at each of these procedures separately.

Fine-Needle Aspiration Breast Biopsy

During a fine-needle aspiration breast biopsy, a surgeon will thread a thin needle through the skin over your breast and into the lump. Cells will be drawn into the needle, and given to a pathologist to look at under a microscope. Needle aspiration might also be done to determine if the lump is solid or liquid (a cyst). If the lump is a cyst, after the fluid has been removed, the cyst will deflate and disappear.

If there is no fluid, and the tissue in the lump is too hard to draw into the needle, then you may need a different type of biopsy, in order to get the best results.

Core Needle Breast Biopsy

For a core needle breast biopsy, a surgeon will use a large, hollow-core needle, which has a special tip. The surgeon puts this needle through the skin and into the lump.

(This is often done with ultrasound guidance during a breast ultrasound.) A very small tissue sample will be taken into the core needle. Sometimes the surgeon will also use suction, in order to remove a slightly larger sample of tissue. The sample is then sent for lab tests. If the surgeon has difficulty targeting the lump, and the tissue sample does not give a clear result, you may need to have this procedure repeated, or your doctor may suggest a different type of procedure.

One concern with core needle biopsy is that of spreading the tumor (neoplastic seeding) along the line of the needle as the sample is withdrawn. For the most part, this does not seem to be very problematic, however, for those who have high-grade triple- negative breast cancer and/or multiple needle insertions, a core biopsy may be a risk factor for tumor seeding.

Stereotactic Breast Biopsy

A stereotactic breast biopsy is used to get a tissue sample from a lump that cannot be felt during a breast exam but can be seen on a mammogram or an ultrasound. The lump may be too deep inside the breast to be palpable (felt by your fingers.) The surgeon will use a special type of X-ray imaging, to find the lump that the needle must target, in order to get an accurate tissue sample.

The needle will follow the X-ray to the area of concern and take a tissue sample. Recently, some surgeons have begun to implant a small bit of metal at the biopsy site, after taking a tissue sample, so that in future mammograms or ultrasounds, they can see where a biopsy was done. This kind of biopsy will create some scar tissue, where the biopsy occurred, but the metal tag will help your doctors distinguish between scar tissue and a benign area in your breast.

Open (Surgical) Breast Biopsy

An open surgical breast biopsy requires a cut in the skin, in order to remove a sample of the lump, or sometimes, the entire lump.

An open surgical biopsy will be done in a hospital or surgical center. If your surgeon cannot feel the lump and does not know where to take a tissue sample, then you will be asked to have a mammogram done just before the surgery. The mammogram will show the target area, and a needle will be placed in the suspicious area, to guide the surgeon right to the site. A tissue sample will be surgically removed and sent for testing immediately. If the surgeon missed the target area, they may have to take another sample, during the same procedure. This helps you get the most accurate results from the lab tests, which the lab does on the tissue sample. This can be a minimally invasive procedure, which may leave a small scar on your skin, and will create some scar tissue at the biopsy site.

Fine Needle Biopsy vs Core Needle Biopsy

In general, when there is a choice between a fine needle biopsy and a core needle biopsy, a fine needle biopsy is thought to be the preferable test (but is not always possible.) The sensitivity (chance a test will detect a cancer which is present) is greater for a core needle biopsy than a fine needle biopsy. The specificity ( the chance that a positive diagnosis is truly positive,) however, is similar between the two tests.​

Further Tests After Your Breast Biopsy

You may need further tests or biopsies, if problems are found during the first biopsy, or if the results of the tests are unclear, or if your doctor is concerned about a particular area of your breast.

Bottom Line on the Different Types of Breast Biopsy

It may be confusing to consider all of the different types of breast biopsy, but usually, the nature of the lump or abnormality on mammogram or ultrasound will guide you and your doctor as to the best procedure. Fortunately, getting a sample of tissue from a biopsy can often clear up questions about whether an abnormality is breast cancer or due to some benign process in your breast. It's important to note that, as with all tests, breast biopsies are not foolproof, and if you have any persistent problems or concerns after your biopsy it's important to talk to your doctor and consider other testing options.

Sources:

Santiago, L., Adrada, B., Huang, M., Wei, W., and R. Candelaria. Breast Cancer Research and Treatment. 2017 July 20. (Epub ahead of print).

Tani, E., Fuentes-Martinez, N., and L. Skoog. A Review of the Use of Fine-Needle Aspiration Biopsy of Mammary Tumors for Diagnosis and Research. Acta Cytologica. 2017. 61(4-5): 305-315.

Wang, M., He, X., Chang, Y., Sun, G., and L. Thabane. A Sensitivity and Specificity Comparison of Fine Needle Aspiration Cytology and Core Needle Biopsy in Evaluation of Suspicious Breast Lesions: A Systematic Review and Meta-Analysis. Breast. 2017. 31:157-166.

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