A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders.

Breast tissue samples may be obtained by a needle biopsy or open biopsy. The sample may consist of connective tissue, fat lobules, or milk ducts.

If the area of interest cannot be felt or is difficult to find, x-ray or ultrasound imaging may be used to help locate it. For an imaging-guided needle biopsy, imaging is used at the same time as the biopsy. For an open biopsy that requires imaging, the area of interest is marked with a needle or wire prior to surgery.

NEEDLE BIOPSY

The injection site is cleaned, then injected with a local anesthetic. Fluid or cells may be removed with a needle attached to a syringe (fine needle aspiration), but removal of a piece of tissue requires a special needle apparatus. Several samples may be taken from the same area. When imaging is used, a small metal clip may be placed into the breast in the area of the biopsy to mark it for future mammograms.

Once the tissue sample has been taken, the needle is removed, and pressure is applied to the site to stop any bleeding. A bandage will be applied to absorb any fluid.

OPEN BIOPSY

An open biopsy may remove part (incisional biopsy) or all (excisional biopsy) of the area of interest. If the entire lump or area of interest is removed, this method may also be called a lumpectomy.

Usually, you lie on your back for the procedure. Depending on the patient and the size of the lump, choices of anesthesia include local anesthesia, local anesthesia with sedation, or general anesthesia. An incision is made and breast tissue removed. Sometimes, testing is done for a preliminary diagnosis at the time of the procedure, but obtaining a final diagnosis requires more time.

After the tissue sample is taken, the incision is sutured, and a dressing and bandage are applied.

If general anesthesia is administered, vital signs (temperature, pulse, rate of breathing, blood pressure) will be monitored for at least an hour after completion of the procedure. Pain medication may be prescribed.

• Your medical history will be taken, and a manual breast exam performed.
• An informed consent form must be signed. If you are going to have general anesthesia, you may be asked to fast for 8 to 12 hours before the test.
• If you take medications (including aspirin or herbals), ask your doctor whether to discontinue these before the biopsy.

There may be a sharp, stinging sensation when the local anesthetic is administered. During the procedure, you may feel slight discomfort or light pressure.

After the test, the breast may be sore and tender to the touch for several days. If an incision is made, pain medication will probably be prescribed. For needle biopsy, over-the-counter pain medication should be adequate.

A biopsy is the only way to determine if tissue is benign (non-cancerous) or malignant (cancerous).

A normal result means there is no sign of cancer.

Benign tumors include:

• Adenofibroma
• Fibrocystic breast disease
• Intraductal papilloma
• Mammary fat necrosis
• Mastitis

• Adenocarcinoma
• Colloid carcinoma
• Cystosarcoma
• Infiltrating carcinoma
• Inflammatory carcinoma
• Intraductal carcinoma
• Lobular carcinoma
• Medullary or circumscribed carcinoma
• Sarcoma

Ask your doctor about your specific condition and how it applies to you.

• There is a slight chance of infection at the injection or incision site.
• Excessive bleeding is rare, but may require draining or re-bandaging. Bruising is common.
• There will be a scar. Depending on the amount of tissue removed and how the breast heals, the appearance of the breast may be affected.
• Depending on the results of the biopsy, further surgery or treatment may be needed.

Most breast lumps are detected during a manual breast exam or mammography. A discharge from the nipple may indicate the presence of a cancerous tumor. Even if the biopsy results are benign, discuss ongoing breast screening with your doctor.

Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004.

Whitman GJ. Ultrasound-guided breast biopsies. Ultrasound Clin. Dec 2006; 1(4); 603-615.