Different Breast Biopsy Procedures

Four Types of Procedures

Breast Needle Biopsy
Breast Needle Biopsy. Photo © ADAM

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 about it. If the 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.

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.

  • Fine-needle aspiration During a fine-needle aspiration, the surgeon will put a thin needle through the skin 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 biopsy For a core needle biopsy, the 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. 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 done again, or your doctor may suggest a different type of procedure.
  • Stereotactic biopsy This kind of 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 biopsy, or surgical biopsy This surgical technique 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.

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.

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