Biopsy and Diagnosis
After a breast exam, a mammogram, ultrasound, or breast MRI, your doctor may determine that a biopsy is needed to make a diagnosis. A breast biopsy removes a sample of breast tissue that is examined under a microscope to determine whether the lump is cancerous (malignant) or not (benign).
There are several different types of breast biopsy methods, and the one recommended for you will depend on what was detected at imaging or physical exam.
Fine Needle Aspiration
This procedure involves inserting a thin needle into the breast to remove fluid or cells from a lump. This is usually done under ultrasound guidance. Local anesthesia is given. This test is most often done to determine whether a lump is solid or is a fluid-filled cyst. A cyst will collapse and disappear after the fluid is removed. If the lump is not a cyst, the aspirated cells may be examined under a microscope or the doctor may proceed to an ultrasound-guided core biopsy (see below).
Ultrasound-Guided Breast Biopsy
For masses that are visible using ultrasound, an ultrasound-guided core biopsy is a highly accurate, minimally invasive method to guide a biopsy needle into a suspicious area and remove tissue for further examination by a pathologist. Local anesthesia is given. A tiny skin nick is made for the biopsy needle. There is no visible scarring after the procedure.
Stereotactic Core Biopsy
This biopsy is used to evaluate a lump that is seen on a mammogram, but cannot be felt during a breast examination. During the procedure, the patient lies on a specially designed table with an opening for the breast. If a table is used, the table is raised so that the radiologist and technologist can work underneath. A special type of X-ray precisely locates the part of the breast from where the biopsy sample is to be taken. Using local anesthesia, a needle is placed into the breast tissue to extract cells that will be sent to a pathologist to examine for cancer. There is no visible scarring after the procedure.
In a surgical biopsy, the surgeon makes an incision and removes a lump or other suspicious abnormality. This is usually done on an outpatient basis, with local or general anesthesia. The tissue is then examined by a pathologist. If cancer is found, additional surgery may be necessary. Needle localization is generally performed prior to surgical biopsy (see below).
Needle Localization Biopsy
Performed under local anesthesia, this procedure involves placing a fine needle with a very thin wire (or multiple wires) into the breast at the site of an abnormality. This procedure can be done under x-ray or ultrasound guidance prior to surgery. At surgery, the wire guides the surgeon to the precise areas of breast tissue to remove. The tissue is reviewed by a pathologist.
Lymphatic Mapping in Preparation for SLN Bx
Lymphatic Mapping and sentinel lymph node biopsy is a minimally invasive method to determine whether or not a cancer has spread to the lymph nodes. Prior to surgery, a radioactive tracer is injected into the breast and a special gamma-camera image is taken of the lymph nodes. The surgeon will remove the sentinel nodes that took up the radioactive tracer at surgery.