BY REBECCA WEATHERSBY
A guide to the several types of breast cancer biopsies for the detection of breast cancer
Every woman dreads
being told by her doctor, “You need a breast biopsy.” A breast biopsy might be
needed to evaluate a lump in your breast, or a suspicious mammogram or
sonogram. It involves the removal of a small sample of tissue that doctors can
use to diagnose and identify any abnormalities in the cells that make up the lump
or that cause the changes in the breast. A radiologist or surgeon may perform
the biopsy. The breast tissue is then sent to a pathologist, a doctor who looks
at the tissue under a microscope to see if there are cancer cells.
There are three ways of doing a breast biopsy: ultrasound
guided core, stereotactic, and excisional. An excisional biopsy may also
require that you have a needle localization to mark the area of concern. You
and your doctor will decide which of these is best for you. These three types
of biopsies will be briefly discussed over the next few weeks. Stay tuned!
Core Needle Biopsy
One of the most common breast biopsies is called an
ultrasound-guided core needle biopsy. In this case, the radiologist uses
ultrasound to guide a needle into the area of concern. The procedure does not
require any stitches and only takes about an hour of your time.
Once in the ultrasound room, the area to be biopsied will
be identified by the technologist and radiologist by using a small hand-held
device called a transducer. The area will then be cleaned, then numbed with
local anesthesia. You will feel a prick and a small amount of burning due to
the numbing medicine. A small slit (about ¼ inch) will be made in the skin
through which a biopsy needle will be inserted. The needle will be used to
remove several small samples of breast tissue.
After the needle is removed, pressure and ice will be
applied to the biopsy site. Steri-strips and a dressing will also be applied to
the biopsy site. You will then be allowed to leave, with very few restrictions.
The stereotactic breast biopsy is a safe and easy
procedure. It does have some risks, though they are rare. These include
bleeding and infection. Bruising is common.
The stereotactic needle biopsy procedure uses a computer
to look at information from mammograms taken at two angles. The computer finds
the right angle and depth needed to place the needle tip into the abnormal
area. It takes approximately two to three hours for the entire procedure,
including the actual biopsy and recovery time.
Before the procedure begins, you will be asked to undress
and change into a robe. The technologist will place you on your stomach on a
special x-ray table. Your breast will be put through an opening in the table.
Once you are in position, your breast will be held in place with compression.
An x-ray will be taken. You may need to be repositioned until your breast is in
the desired position. A computer is used to find the abnormal area.
Next, the radiologist will clean the area. This area will
be numbed with local anesthesia. You will feel a prick and a small amount of
burning due to the numbing medicine. Once the area is numb, a small slit (no
more than ¼ of an inch) will be made in the skin through which a biopsy needle
will be inserted. You may feel some slight pressure at this time. The needle is
then guided to the biopsy area. Several small samples of breast tissue will be
In an excisional biopsy, your surgeon will remove the
whole area of suspected abnormal breast tissue. This is done in the hospital as
an outpatient. You may be put to sleep. If the lump or abnormality cannot be
felt by the surgeon, and is only seen by mammogram and/or ultrasound, a
radiologist will help by first putting a needle into the breast to guide the
surgeon in locating the correct area. This procedure is called a marking
mammogram or needle localization. After the lump is removed, the breast will be
sewn together with stitches. You will probably have a scar, but it usually
fades over time.
A marking mammogram or needle localization is a safe and
easy procedure. Most patients experience only a small amount of discomfort. You
will be awake during this procedure. A radiologist will use ultrasound or x-ray
to locate the area of abnormal tissue. The radiologist numbs the area with a
local anesthetic, such as lidocaine. You may feel a prick and a small amount of
burning due to the numbing medicine. Then, a special type of needle with a fine
wire inside it will be guided to the area of concern. Another ultrasound or
x-ray is taken to show that the needle is in the correct location. The needle
and wire are left in the breast until you are taken to surgery. By using this
method, the surgeon is able to remove the abnormal tissue without removing a
large amount of normal tissue. It also helps assure that the correct area is
Once the needle localization is complete, you will return
to the pre-op area. From there, you will be taken to the operating room. A
general or local anesthetic will be given to you before the surgery. The
surgeon makes an incision and removes the abnormal tissue and the needle/wire.
This tissue is sent to be x-rayed or evaluated by ultrasound. This will confirm
that the abnormal area is removed. You will go to recovery for a short period
of time, then you will be sent home.
The tissue is sent to the pathology department of the
hospital. Pathology results will be sent to your surgeon. You will follow up with
your surgeon, usually about a week after your surgery, to get results and to
check your surgical site. GFM
Courtesy of Cancer
Life Center—The Medical Center of Central Georgia (MCCG). The article was
written by Rebecca Weathersby, RN, MSN, CBCN, CBPN-IC, a breast health
specialist at MCCG.