Breast Biopsy - Percutaneous (in office)

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A breast biopsy is a procedure done to remove a small amount of tissue from your breast. The breast tissue is then analyzed to determine if it has cells that are cancerous.

Your doctor might recommend a biopsy of the breast if:

• You feel, or your doctor feels, an area in your breast with a small lump or other thickening
• A mammogram or ultrasound shows a lump or other abnormal characteristics in your breast
• An MRI shows something that looks abnormal or suspicious
• There is a bloody discharge or other unusual changes -- including crusting or scaling -- around your nipple

There are several ways a breast biopsy can be performed. Your doctor will recommend the procedure that can obtain a good sample of tissue in the least invasive way — with the smallest incision or least disruption to your breast.

The type of biopsy necessary may depend on several factors, including:

• how large the area of suspicious tissue is
• where the suspicious tissue is located within the breast
• whether there is more than one area of suspicious tissue
• other medical or healthcare issues you might have
• your own preference of procedure

For any biopsy, even the less invasive ones, the medical team will numb the area in your breast where the biopsy is being obtained.

Some of the most common biopsies, from least invasive to more invasive, are:

Fine Needle Aspiration Biopsy

In a fine needle aspiration biopsy, you'll usually be lying down. Your doctor or surgeon inserts a thin, hollow needle -- attached to a syringe -- into your breast and draws out a very small amount of tissue from the suspicious area. The needle is smaller than those usually used to draw blood.

In some cases, fine needle aspiration will help determine if the lump is a fluid-filled cyst instead of a solid lump.

Core Needle Biopsy

In a core needle biopsy, a larger needle is used to draw out tissue. You'll also be lying down for this procedure. The surgeon or doctor will often use the needle to remove several small cylinder-shaped samples of tissue. The samples are usually about the size of a grain of rice.

Your surgeon or doctor may be able to perform the procedure without any other imaging equipment. In those cases, the procedure can be performed in your doctor's office.

In some cases, the doctor may want to use ultrasound equipment or magnetic resonance imaging (MRI) to help locate the area of concern and retrieve a sample of tissue from the right area. In those cases, the procedure will be done in a room with access to that type of equipment, like in an imaging center. During an ultrasound-guided needle biopsy, you'll lie on your side or back on a special table. During an MRI-guided needle biopsy, you'll lie face down on a special table, with your breasts fitting into a depression in the table.

Stereotactic Biopsy

This type of biopsy uses a mammogram machine to specifically locate the suspicious area. You'll typically lie face down on a padded table that has a hole for your breast. The medical provider — often a specialist doctor called a radiologist — may slightly compress or move your breast in the machine so the suspicious area can be easily seen. The radiologist then inserts either a needle or a vacuum-assisted probe into your breast and draws out tissue for testing. This procedure can take 30 minutes to an hour.

Surgical Biopsy, or Open Biopsy

In some cases, your doctor may recommend a surgical biopsy, which removes a larger part -- or sometimes the entire mass -- of the suspicious lump. A surgical biopsy is often done not only with local anesthesia but with sedation, medicine to relax you, that's given in a vein in your arm. In an incisional biopsy, the surgeon cuts through the skin with a scalpel to remove a piece of tissue. In an excisional biopsy, the surgery removes the entire area of tissue that might be cancer. In both cases, the tissue is sent to a lab for examination.

Biopsies are generally scheduled at your own convenience, though most women want them scheduled quickly after a doctor recommends one.

Depending on the type of biopsy, your doctor may recommend that you avoid taking aspirin or any other blood-thinning medications in the days before the procedure. If an MRI might be considered for the biopsy, your doctor will want to know if you have an electronic device implanted in your body -- like a cardiac pacemaker -- or if you might be pregnant. Those situations may mean an MRI isn't appropriate.

A doctor called a pathologist will examine the tissue under a microscope to determine whether the sample contains cancer cells. If the biopsy shows cancer, the pathologist will examine the cells and can provide a better understanding of the specific type of breast cancer and how it might be treated.

Usually within about a week of the biopsy, the pathologist will deliver a report to your doctor, who will then contact you to provide more information.

In the United States, a doctor's recommendation for a breast biopsy does not mean that cancer is likely present. In fact, cancer is not found in about 80 percent of U.S. women who have a breast biopsy.

You'll often go home the same day as the breast biopsy. Your breast may be bandaged and you'll be provided with other bandages and an ice pack to place on the biopsy area to reduce swelling.

You will likely have bruising after some procedures, including a core needle biopsy. You will have stitches if you've had a surgical biopsy. You can take non-aspirin pain relievers like acetaminophen to help with any pain.

Sources:
https://www.breastcancer.org/symptoms/testing/types/biopsy?gclid=EAIaIQobChMIh73R6bfu4QIVsRx9Ch1RiwALEAAYASAAEgI-OvD_BwE
https://www.mayoclinic.org/tests-procedures/breast-biopsy/about/pac-20384812
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/breast-biopsy.html
https://www.nationalbreastcancer.org/breast-cancer-biopsy