Needle, Open, or Stereotactic Breast Biopsy

A sample of cells or tissue is extracted from the breast for microscopic examination; the specimen is taken from a lump or mass that was detected on an imaging test such as mammography or ultrasound. Several different techniques may be used. Which one is appropriate for you depends on a variety of factors, including the size of the breast mass, its location in the breast, how suspicious it appears, how many abnormalities are present, and your overall health and personal preferences.

Fine needle biopsy uses a thin, hollow needle attached to a syringe to withdraw cells or fluid from a mass. The doctor may feel for the lump to guide the needle or may use ultrasound imaging for guidance.

Open biopsy accesses a breast mass through a surgical incision. Depending on its size, all of the lump may be removed (excisional biopsy) or just part of it (incisional biopsy).

Stereotactic biopsy, a new alternative to open biopsy, uses mammograms taken from two angles to map the precise location of a breast lesion, allowing for a smaller incision. Tissue samples may be removed with a springloaded needle (core needle biopsy); a vacuum-assisted biopsy device; or an automated device called Advanced Breast Biopsy Instrumentation (ABBI) that uses a tube, or cannula, to remove an entire lesion.

Purpose of the Breast Biopsy

  • To distinguish between benign or malignant (cancerous) tumors that were detected on an imaging test, such as mammography, thermography, or ultrasound
  • To evaluate breast lumps or other abnormalities in the breast

Who Performs Breast Biopsy

  • Fine needle biopsy is conducted by a doctor.
  • Open biopsy is performed by a surgeon and a surgical team.
  • Stereotactic biopsy is usually conducted by a radiologist.

Special Concerns about Breast Biopsy

  • Open biopsy may require general anesthesia, but usually is performed using only local anesthesia plus sedation. The fine needle and stereotactic procedures require only local anesthesia.
  • Open biopsies obtain larger samples and are therefore more accurate for identifying cancer than the fine needle technique. Stereotactic procedures can be performed at a reduced cost compared to open biopsy and may be cosmetically more appealing.

Before the Breast Biopsy

All tests:

  • Tell your doctor if you regularly take anticoagulants or nonsteroidal anti-inflammatory drugs (such as aspirin, ibuprofen, or naproxen). You will be instructed to discontinue them for some time before the test.
  • Do not put talcum powder, lotion, or perfume on your breasts or use deodorant on the day of the test.
  • Emptying your bladder before the procedure can improve comfort during breast biopsy.

Fine needle and stereotactic biopsies:

  • You will be asked to disrobe above the waist and put on a hospital gown.

Open biopsy:

  • If the procedure will be performed under general anesthesia, do not eat or drink anything after midnight on the day before the test.
  • You will be asked to disrobe and put on a hospital gown.
  • General anesthesia is administered through an intravenous (IV) line inserted into a vein in your arm before the procedure begins.
  • If a local anesthetic is being used, you may receive an IV sedative to help you relax during the procedure.

What You Experience during Breast Biopsy

Fine needle biopsy:

  • You will sit in a chair or on a table.
  • The skin over the biopsy site is cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area (this injection may cause slight discomfort).
  • The doctor inserts a thin biopsy needle and withdraws a small amount of fluid or tissue. In some cases, ultrasound imaging is used to visualize the mass and guide needle placement.
  • The needle is withdrawn. Pressure is placed on the biopsy site until bleeding has stopped, and a small bandage is applied.
  • The procedure takes less than 15 minutes.

Open biopsy:

  • You will lie on your back on a table.
  • The skin over the biopsy site is cleansed with an antiseptic solution, and (unless general anesthesia is being used) a local anesthetic is injected to numb the area (this injection may cause slight discomfort).
  • The surgeon makes a small incision in the skin over the mass, and removes all or a portion of the lump with surgical instruments.
  • The incision is sutured closed and a bandage is applied.
  • The procedure takes less than 1 hour.

Stereotactic biopsy:

  • The skin over the biopsy site is cleansed with an antiseptic solution, and a local anesthetic is injected to numb the area (this injection may cause slight discomfort).
  • You will lie face down on a special table with a hole through which the breast protrudes. The breast is then slightly compressed to keep it immobile.
  • Two mammography units positioned at different angles are used to create a three-dimensional image of the breast.
  • For core needle biopsy, a biopsy gun is guided to the lesion and fired; the spring-loaded inner needle advances into the lesion and obtains a small core of tissue. The gun is rotated and this process is repeated to obtain multiple samples.
  • The vacuum-assisted biopsy device uses a similar technique, except a larger needle is employed and suction is used to remove progressively larger core samples. On average, 10 to 20 specimens are obtained.
  • For the ABBI technique, a machine inserts a cannula—a tube that is larger than a needle and designed to remove larger amounts of tissue—through a small incision and guides it to the breast lesion. The entire lump is removed.
  • Pressure is placed on the biopsy site until bleeding has stopped, and a small bandage is applied. You may need sutures to close the incision after an ABBI biopsy.
  • Stereotactic biopsy takes 1 hour or less.

Risks and Complications of Breast Biopsy

  • You may experience some pain or bruising after a breast biopsy.
  • A rare complication following an open biopsy is infection.
  • If open biopsy was performed under general anesthesia, it will carry all the associated risks.

After the Breast Biopsy

Fine needle and stereotactic biopsies:

  • You may return to your normal activities.
  • You may experience a small amount of bleeding or bruising around the biopsy site and your breast may be tender for several days. Over-the-counter pain relievers, such as acetaminophen, or ice packs can help to relieve any discomfort.

Open biopsy:

  • You will rest in a recovery room until the effects of anesthesia or sedation have subsided. During this time, your vital signs will be monitored and you will be observed for signs of complications.
  • You may experience tenderness and bruising around the biopsy site for several days. You may be given pain-relieving medication such as acetaminophen and advised to use ice packs to relieve any discomfort.
  • The appearance of the breast may change due to tissue removal or healing.
  • You will be instructed to wear a support bra at all times until the biopsy site has healed. Avoid strenuous activity for 1 to 2 weeks.
  • If you develop a fever or you experience increased bleeding, pain, or swelling around the biopsy site, call your doctor.

Breast Biopsy Results

  • The tissue samples are sent to a pathology laboratory and inspected under a microscope for unusual cells. This examination usually results in a definitive diagnosis. (For more on laboratory testing, see Chapter 1.)
  • If the biopsy reveals cancerous cells, surgical treatment to remove the entire malignant tumor will be instituted (unless the mass was already removed completely, as with excisional or ABBI biopsy). Additional tests, including a chest CT scan, blood tests, and a bone scan, will also be performed to determine if the cancer has spread. If the tissue has been completely removed, radiation therapy or chemotherapy may be initiated.
  • If no cancer is present, your doctor will recommend a schedule of periodic tests, such as mammography, to monitor your breast health.

Source:

The Johns Hopkins Consumer Guide to Medical Tests

Simeon Margolis, M.D., Ph.D., Medical Editor

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at Healthcommunities.com

Published: 13 Jan 2012

Last Modified: 13 Jan 2012