Breast Program

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 and only a tiny skin nick is made for the biopsy needle, usually with no visible scarring after the procedure.

Stereotactic Core Biopsy

This biopsy is used to evaluate a mass or calcifications that are seen on a mammogram, but cannot be detected on ultrasound or physical exam. During the procedure, the patient lies on a specially designed table with an opening for the breast. The table is raised so that the radiologist and technologist can work underneath, maximizing patient comfort. Special mammogram views precisely locate the part of the breast from where the biopsy sample is to be taken. Using local anesthesia, a needle is placed into the breast to extract tissue cores that will be sent to a pathologist to examine for cancer. There is usually no visible scarring after the procedure.

Tomosynthesis or 3D-guided Core Biopsy

This biopsy is used to evaluate an abnormality best detected on 3D mammogram or tomosynthesis. 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. 3D mammogram or tomogram are used to precisely locate the part of the breast from where the biopsy sample is to be taken. Using local anesthesia, a needle is placed into the breast to extract tissue cores that will be sent to a pathologist to examine for cancer. There is usually no visible scarring after the procedure.

MRI-guided Core Biopsy

This biopsy is used to evaluate an abnormality detected only on MRI and not visualized on any other imaging studies. During the procedure, the patient lies on the sliding table of the MRI, with an opening for the breast. A gentle compression grid is applied to help locate the target and immobilize the breast. After intravenous contrast injection is given, the MRI images are used to precisely determine biopsy needle placement. Using local anesthesia, the biopsy needle extracts the tissue cores that will be sent to a pathologist to examine for cancer. There is usually no visible scarring after the procedure.

Surgical/Excisional Biopsy

In a surgical biopsy, also known as an excisional 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/Wire Localization with Surgical 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 is done under x-ray or ultrasound guidance the morning of surgery. At surgery, the wire guides the surgeon to the precise areas of breast tissue to remove. The tissue is reviewed by a pathologist.

Wireless Localization with Surgical Biopsy

This is a newer technology which can be utilized on the majority of cases that used to be performed with needle/wire localization with significant improvements in patient comfort. Performed under local anesthesia, this procedure involves placing a special marker in the breast through a small needle, at the area of tissue to be removed under direct ultrasound or mammographic guidance. This avoids the use of wires and can be placed up to 30 days before the surgery date. In the operating room, while the patient is anesthetized, the surgeon uses a handheld probe which finds a signal to the precise location of the marker indicating the area of breast tissue to be removed. The tissue is then reviewed by a pathologist.

Lymphatic Mapping in Preparation for SLN Biopsy

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 take up the radioactive tracer at surgery, possibly avoiding full axillary node dissection.