Description of the test

A breast biopsy is the removal and examination of a sample of breast tissue. This test is usually done when a lump is detected during a breast examination, mammogram, or ultrasound. The sample can either be taken using a needle, or it can be cut out.

How often should the test be performed?

Your doctor will decide when and how frequently this test is required.

Why is this test performed?

A breast biopsy is performed to help evaluate abnormalities (such as lumps) that are found in the breast. The abnormality might be felt during a physical exam or seen on a mammogram or ultrasound. Most growths, such as cysts (sacs filled with fluid) or fibroadenomas (noncancerous growths of fibrous tissue), are benign (i.e., harmless). However, breast lumps can also be malignant (i.e., cancerous).

A breast biopsy allows the doctor to obtain a sample of the breast tissue to determine if the lump is cancerous or harmless. If the lump is cancerous, this test can help determine the type of cancer.

Are there any risks and precautions?

Certain risks are common to all surgery and anesthesia. These risks depend on many factors including the type of surgery and your own medical condition. Although some may be rare, the possible risks include side effects of the anesthesia, breathing problems, infection, bleeding, and scarring.

Although a breast biopsy is generally considered safe, it does have some risk of side effects or complications. These include:

  • bleeding
  • infection
  • swelling and bruising of the breast

These side effects should go away with time, however, if they persist or become bothersome, talk to your doctor. An infection can often be treated with antibiotics. More severe infections may be drained surgically. A small scar may remain after your breast heals. You may also notice a change in the appearance of your breast, depending on how much tissue your doctor removed.

There is a slight risk of a false negative result (i.e., the negative test result was in error). The risk of a false negative result decreases with the amount of tissue removed.

If you are concerned about any symptoms following this test, speak to your doctor. Take the time to be sure you understand all the risks of complications and side effects as well as any precautions you or your doctor can take to avoid them. Be sure your doctor understands all your concerns.

What happens during the test?

A breast biopsy is performed in a hospital. There are several different ways to perform a breast biopsy. For all methods, you will be asked to remove all your clothing above the waist and put on a hospital gown.

Fine needle aspirate biopsy: A needle is inserted through the skin into the breast tissue. Your doctor may be able to feel the lump or may use an ultrasound to locate it. The needle will withdraw fluid if the lump is a cyst. If the lump is hard, the needle can suction out cells. After drawing out a sample, your doctor will remove the needle and apply pressure to the site to stop any bleeding. This test usually takes about 5 to 15 minutes.

Core needle biopsy: This test is similar to the fine needle aspirate biopsy except that it uses a larger needle. Local anesthesia will be given to numb the area. Imaging techniques, such as ultrasound or magnetic resonance imaging (MRI), may be used to guide the needle to the biopsy site. The needle, equipped with a special cutting device, collects a piece of tissue roughly the size of a grain of rice. Generally, about 3 to 12 tissue samples will be collected to make sure that the results are accurate. This test usually takes about 15 minutes.

Stereotactic biopsy: This technique is used when the lump is too small or too deep to feel. You will be required to lie on your stomach on a table. This table is specially designed to have a hole and the breast hangs down through the hole. A mammogram is performed to determine the exact location of the lump. Local anesthesia is given to numb the area where the needle will be inserted into the breast. This test usually takes about 60 minutes.

An incision is then made in the skin. A special X-ray machine (known as a stereotactic device) will guide the needle to the biopsy site where a tissue sample is collected. Often, several samples will be taken through the same incision. You will need to remain very still while the sample is being removed. Afterwards, the needle will be withdrawn and pressure applied to the site.

This technique can be used for both a fine needle aspirate biopsy and core needle biopsy.

Vacuum-assisted biopsy: This technique is performed by a radiologist or a surgeon, and can be used for both a core needle biopsy and stereotactic biopsy. An imaging technique, such as a mammogram or ultrasound, is used to locate the area of the breast where the tissue sample will be removed. Then, local anesthesia is given to numb the area and a small incision is made on the skin where the needle will be inserted. The needle contains a hollow probe with a tip that is vacuum-powered. Once the needle is at the biopsy site, several tissue samples are vacuumed into the probe which will be sent to a laboratory for analysis. The needle is then removed and pressure is applied to the site to stop any bleeding. The test usually takes less than an hour.

Open biopsy or surgical biopsy: This biopsy is usually done by a general surgeon. You will receive either local anesthesia to numb the area or general anesthesia. General anesthesia is given through a needle in a vein so you won't be awake for the procedure.

The surgeon will make an incision in the breast until the lump can be seen. If the lump is small, the whole lump may be removed (known as excisional biopsy or lumpectomy). If it is large, a part of the lump is removed (known as incisional biopsy). Once the lump or sample is taken, the incision is stitched closed and bandaged. You will be sent to the recovery room until the anesthesia has worn off. Open or surgical biopsies usually take about 30 to 60 minutes.

How should I prepare for this test?

Before having this procedure, discuss the advantages, disadvantages, long-term risks, and consequences associated with the procedure with your doctor. Be sure you fully understand what will happen and are comfortable with your doctor's answers to your questions.

Wear a two-piece outfit if you are having a needle biopsy since you will be asked to undress from the waist up. Also, wear a bra to the appointment because you may be sent home with an ice pack placed against the biopsy site; the bra can hold it in place and support the breast. No other specific preparation is needed if you are receiving local anesthesia.

If you are receiving general anesthesia, do not eat for 8 hours before the procedure. You may be able to continue to drink clear liquids until 2 hours before the procedure. If your doctor has recommended different times, follow the timing recommended by your doctor.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have. Arrange for someone to drive you home from the hospital.

Ask your doctor or pharmacist whether you need to stop taking any of your medications before the test.

With the exception of a surgical biopsy, you will be sent home with bandages and an ice-pack over the biopsy site following the test. Arrange for someone to drive you home afterwards.

What can I expect after the test?

After the procedure, you may feel soreness or pain. Apply ice if needed. Your physician may recommend a pain medication, usually acetaminophen, to help with any pain or discomfort.

You will likely go home the same day as the test. Before you go home, the doctor or nurse will go over what you need to do at home to complete your recovery. You may resume normal activities within 24 hour of the test.

Following an open biopsy, you may feel tenderness for the next week. Any bruising should go away after 2 weeks. However, firmness or swelling may take 1 to 2 months to go away. Your stitches will be removed after approximately 1 week.

Results

Ask your doctor how soon you can expect your test results. Your doctor can discuss with you what was learned about the cells or fluid found in the breast sample.

A biopsy (a sample of fluid and tissue) is taken with a needle from a lump in the breast for further investigation.
A biopsy (a sample of fluid and tissue) is taken with a needle from a lump in the breast for further investigation.