In this type of breast biopsy, a needle is used to aspirate (draw out) fluid or tissue from a breast lump or mass. Needle aspiration leaves no scarring, is less invasive and quicker than open excisional biopsy, and usually does not require stitches or a recovery period. The patient can resume regular activities immediately.
Needle Aspiration Techniques
Needle aspiration procedures include the following:
Each procedure differs in how it is performed, the equipment used, the type of lesion it works best on, and the amount of tissue it removes. Unlike surgical biopsy, needle aspiration cannot remove the entire lesion and misdiagnosis can occur.
Fine Needle Aspiration
This procedure is performed under local anesthesia. The surgeon uses a fine hollow needle that is attached to a syringe to extract fluid from a cyst or cells from a solid lesion. The needle used in this procedure is very small (smaller than those used to draw blood). Several insertions are usually required to obtain an adequate sample. The procedure takes a few minutes and is often done in a doctor's office.
If the lump cannot be felt, ultrasound may be utilized to help the physician guide the needle into the breast and to the lesion. Stereotactic mammography may also be used. This mammography utilizes a computer to pinpoint the mass or cyst. Mammograms are taken from two angles and the computer maps the precise location of the lesion.
There is no incision and a very small bandage is put over the site where the needle entered. Fine needle aspiration is the easiest and fastest method of obtaining a breast biopsy, and is very effective for women who have fluid filled cysts. However, the pathological evaluation can be incomplete because the tissue sample is very small. When used alone, about 10 percent of breast cancers may be missed. The effectiveness of this procedure depends on the skill of the surgeon or radiologist who performs it.
Core Needle Biopsy
This procedure is similar to fine needle aspiration, but the needle is larger, enabling a larger sample to be obtained. It is performed under local anesthesia and ultrasound or stereotactic mammography is used if the lump cannot be felt.
Three to six needle insertions are needed to obtain an adequate sample of tissue. A clicking sound may be heard as the samples are being taken and the patient may feel some pressure, but should not feel pain. The procedure takes a few minutes and no stitches are required.
Core needle biopsy may provide a more accurate analysis and diagnosis than fine needle aspiration because tissue is removed, rather than just cells. This procedure is not accurate in patients with very small or hard lumps.
This method utilizes a vacuum-like device to remove breast tissue. Local anesthesia is used and no incision is made. Stereotactic mammography is used to guide a breast probe to the lesion. Computers pinpoint the mass and suction draws out the breast tissue. The needle is inserted once to obtain multiple samples. In some cases, the entire lesion may be removed.
Vacuum-assisted biopsy is safe, reliable, and valuable for patients who are not candidates for other minimally invasive biopsy techniques and those who wish to avoid surgical biopsy. The procedure should be performed by a highly skilled radiologist or surgeon who is experienced and familiar with this method.
Large Core Biopsy
This procedure, also called advanced breast biopsy instrumentation (ABBI), is an alternative for patients who prefer a less invasive procedure than surgery. Large core biopsy is able to remove a sizeable specimen or an entire lesion using a surgical device and stereotactic mammography. It combines wire needle localization and the ability to remove a tissue specimen and allows the sample to be removed in one piece.
After the region is numbed using a local anesthetic, the localizing needle is guided to the lesion. A very small incision is made and a cannula (i.e., a tube and a cutting device) is passed through the incision. Breast tissue is removed through the tube.
The procedure takes 30 minutes to 2 hours, but it generally takes less than an hour. A few stitches may be required to close the opening in the skin.
Needle procedures are performed in doctors' offices, clinics, surgical centers, and hospitals. Where the procedure is performed depends on the technique selected, availability of equipment, the patient's health, and the doctor's preference.
There is little preparation needed for these procedures, other than signing an informed consent form to make sure the procedure has been explained and the patient is aware of potential risks.
Sedation is not required for these procedures. If a patient requests it, this matter can be discussed with the physician prior to the appointment. Once the patient is in the procedure area, local anesthesia is administered. This consists of several injections, using a small needle. The injections hurt, but the pain is brief. Within a few minutes, the area is numb.
Recovery is generally quick and uncomplicated from these procedures. Most patients are able to resume normal activity almost immediately afterwards. Pain is minimal and can usually be managed with an over-the-counter pain reliever.
The large core and vacuum-assist procedures may cause bruising on the breast for about 1 week after the biopsy. The bruising is temporary, and ice or a cold pack helps reduce the symptoms. Swelling may also occur after the vacuum-assisted method.
Stitches used to close an incision made for a large core biopsy are removed in a week to 10 days following the procedure.
Complications are rare, but excessive swelling, redness, and bleeding or other drainage can indicate an infection or abnormal bleeding, and the physician should be notified immediately.