Hoag Breast Care Center

Breast Biopsy Overview

The process of removing a small sample of tissue from the breast for histopathologic examination (microscopic analysis by a pathologist) is called a breast biopsy. If breast imaging and/or a physical examination reveal an area of concern, a breast biopsy may be necessary. Hoag’s expert team of radiologists and breast surgeons are well versed in performing a full range of leading-edge breast biopsy procedures – all of which are promptly scheduled to reassure patients and minimize anxiety.

Breast biopsies are performed to evaluate an area of concern (lesion) identified on a mammogram, breast ultrasound or on a physical exam. Almost all breast biopsies can be performing using minimally invasive biopsy techniques such as core needle biopsy and vacuum-assisted breast biopsy, also known as rotational cutting biopsy. Open surgical biopsy should be reserved for the one to two lesions out of 100 that cannot be biopsied using minimally invasive techniques.

The way a biopsy is performed is tailored to the lesion and will be determined by the radiologist and surgeon. Most breast biopsy methods rely on image-guidance such as stereotactic mammography, ultrasound or MRI (magnetic resonance imaging). These tools allow the radiologist to precisely locate the abnormality within the breast.

Once a sample of breast tissue is removed, it is fixed and stained with special materials and dyes, and evaluated by a pathologist using a microscope. The pathologist is able to tell from the microscopic appearance, if the tissue contains cancer or not.

It is normal to feel nervous or frightened about having a biopsy. However, it’s important to know that the majority of breast biopsies do not turn out to be breast cancer. In spite of a woman’s reservations to have a breast biopsy, the results can provide peace of mind since breast biopsy is generally a definitive method for determining the nature of the abnormality.

*PLEASE NOTE: The biopsy method most suitable for a particular patient depends on a number of factors, including the size of the lesion and breast, location of the lesion in the breast, appearance and characteristics of the breast lesion. In general, the best biopsy method will be determined by the Breast Care Center Radiologist.

Stereotactic-guided Breast Biopsy

Digital mammography pinpoints the exact location of a breast lesion by using a computer and digital x-ray images taken from two different angles. Using these coordinates, the radiologist inserts a thin hollow biopsy needle through the skin, advances it into the lesion and removes tissue samples. Image-guided, minimally invasive procedures such as stereotactic breast biopsy are most often performed by a specially trained interventional radiologist and are usually done on an outpatient basis.

For more details about stereotactic-guided breast biopsy, click here.

Ultrasound-guided Breast Biopsy

Using ultrasound to visualize the exact location of the breast lesion, the radiologist inserts a thin hollow biopsy needle through the skin, advances it into the lesion and removes tissue samples. With continuous ultrasound imaging, the physician is able to view the biopsy needle as it advances to the location of the lesion in real-time. Image-guided, minimally invasive procedures such as ultrasound-guided breast biopsy are most often performed by a specially trained interventional radiologist and are usually done on an outpatient basis.

For more details about ultrasound-guided breast biopsy, click here.

MRI-guided Breast Biopsy

Unlike conventional x-ray examinations and computed tomography (CT) scans, magnetic resonance imaging (MRI) does not depend on radiation. Instead, radio waves are directed at protons, the nuclei of hydrogen atoms, in a strong magnetic field. Using MRI guidance to calculate the position of the abnormal tissue and to verify the placement of the needle, the radiologist inserts a thin hollow biopsy needle through the skin, advances it into the lesion and removes tissue samples. Image-guided, minimally invasive procedures such as MRI-guided breast biopsy are most often performed by a specially trained interventional radiologist and are usually done on an outpatient basis.

For more details about MRI-guided breast biopsy, click here.

Fine Needle Aspiration/Cyst Aspiration

Fine needle aspiration (FNA) is most often used to confirm that a breast lesion is a cyst. A fine gauge needle is used to aspirate the cyst (remove fluid from it). In some cases, the fluid sample is sent to the laboratory for analysis. Fine needle aspiration is no longer a common breast biopsy technique for a solid mass, and has generally been replaced by needle biopsy. It is more commonly used to biopsy lymph nodes.

Open Surgical Biopsy

Until recently, most breast biopsies were open surgical procedures. Today however, the vast majority of breast biopsies can be performed as minimally invasive needle biopsies. Needle biopsies are equally as accurate, but far less invasive. At Hoag Breast Care Center, about one percent of all biopsies require an open surgical procedure. In cases where surgical biopsy is required, prior to the procedure, the patient receives a combination of intravenous (through the vein) sedation with a local anesthetic administered to the breast. Sometimes, general anesthesia may be required.

There are two methods of open surgical biopsy – excisional and incisional. With excisional surgical biopsy, the surgeon removes the entire breast abnormality. If the lump can be felt by examination, excisional biopsy is generally a brief, straightforward surgery performed at one of Hoag’s outpatient surgery centers, or at the hospital. Incisional surgical biopsy is similar to excisional biopsy except only a portion of the breast abnormality is removed. This type of biopsy is generally performed only on large breast masses. Again, open surgical biopsies are a rarity since virtually all breast abnormalities can be biopsied with a needle.

In either case, if the breast abnormality is not palpable (cannot be felt), image-guidance is required to help locate the area of concern. The area is then marked with a wire to guide the surgeon to the tissue to be removed. This technique is known as “wire localization.” During wire localization, a radiologist will identify the abnormality using mammography, ultrasound or MRI. Then using a thin, hollow needle, the radiologist inserts the thin wire through the center of the needle to indicate the exact area to be removed.

Pathology

After a breast biopsy or breast surgery, a pathologist conducts tests on the cells and/or tissue removed from the breast. The pathologist carefully notes the results of this testing in a pathology report, which is provided to the patient’s physician.

The pathology report helps physicians to determine which treatment options are best for the individual patient. Patients may ask for a copy of the pathology report to review, or for second opinion consultation.

The pathology report varies and generally includes information about the following:

Diagnosis – for example DCIS, early breast cancer, advanced stage breast cancer.
Size and location of the cancer – the size and location of the cancer is an important component in determining what treatment options are best.
Surgical margin – after a surgical biopsy or breast surgery, the surgeon removes the cancer and some healthy surrounding tissue. The healthy breast tissue is called the surgical margin. If there are no cancer cells (or very few cancer cells) in the healthy surrounding tissue, it’s likely that all of the cancer was removed. In this case, the surgical margin is said to be “clear.” If there are several cancer cells in the healthy surrounding tissue, it is likely that not all the cancer was removed. In this case, the patient may will need additional surgery.
Staging of the cancer – the pathologist examines the cancer cells and classifies them according to various stages.
Hormone receptor status – the pathology report may indicate whether or not the cancer cells have hormone receptors. If the cancer is hormone receptor positive, this means the growth of the cancer is affected by hormones. This will help physicians to determine whether hormonal therapy may be beneficial as part of the patient’s treatment protocol.
Lymph node status – the pathology report also indicates whether there are cancer cells in the lymph nodes. This will affect whether systemic treatments such as chemotherapy and hormonal therapy are recommended.

Prep for Breast Biopsy

It is important to avoid the following supplements or medications five to 10 days before your biopsy.

Vitamin E
Omega 3 fatty acids
Flaxseed oil
Fish oil
Aspirin
NSAIDS such as Advil, Nuprin or Ibuprofen

Consult your prescribing physician regarding discontinuing Coumadin, Plavix, Lovenox.

Do not eat or drink after midnight the night before your procedure unless otherwise instructed by your physician. You may have solid food up to eight hours before the procedure and may have dry toast and clear liquids up to six hours before the procedure. You may have clear liquids up to two hours before surgery such as water, coffee or tea without cream and any liquids you can see through.

Wear comfortable, loose clothing to the hospital. If you are staying overnight, bring your robe, slippers and toiletries.

Post Breast Biopsy Care

It is normal to experience some bruising and tenderness after your biopsy, however, following these instructions should help minimize any discomfort. These instructions help prevent complications and should be followed carefully.

If you experience mild bleeding from the biopsy site after you leave the hospital, apply at least five minutes of firm pressure on the bandage.

For the next 24 hours, do not engage in strenuous activities, especially those that involve movement of the chest and arms.

A small icepack applied to the breast 15 minutes to 4 hours may help relieve pain and swelling. You may find it more comfortable to sleep in a bra.

If you need to take pain medicine during the next 48 hours, use acetaminophen products, such as Tylenol. Do not use aspirin or ibuprofen products, such as Advil or Motrin, as it may increase bleeding.

Remove the gauze dressing the next morning after surgery. Do not bathe or shower until the dressing has been removed.

Remove the Steri-strips four to five days after your biopsy. You may shower carefully with them in place. If necessary, use a Band-Aid after the Steri-strips have been removed.

Over the next few days, if you develop any signs of infection, such as redness, drainage, fever, severe pain or swelling, contact the Breast Care Center at 949/ 764-5780.

Obtaining Biopsy Results

Breast biopsy results are usually available within one to two days. A post-biopsy appointment will be made within 48 hours of the biopsy (unless the biopsy is done on Thursday or Friday, in which case it will be made on Monday). The biopsy results will be reviewed at the time the biopsy site is checked. Your referring physician will also be informed of the biopsy results.

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