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A breast biopsy is the surgical removal of a small sample of breast tissue or cells to be tested for breast cancer. The doctor may recommend a biopsy if the patient has an abnormal mammogram or a lump in the breast.
A breast biopsy can be recommended for one of several reasons.
There are several methods for a breast biopsy.
In a FNAB (fine needle aspiration biopsy) the surgeon, pathologist or radiologist uses a very fine needle and a syringe to withdraw (aspirate) a sample of fluid from a breast cyst. It can also be used to remove clusters of cells from a solid lump. FNA is a percutaneous (through the skin) procedure.
If the doctor can feel the lump or suspicious area, the surgeon guides the needle to its target just by touch. If it cannot be felt, ultrasound may be used to see where the needle is going on the screen - this is known as an ultrasound-guided biopsy.
Stereotactic needle biopsy - the exact location of the mass is mapped using mammograms taken from two angles. That data is fed into a computer. Also known as "image-guided stereotactic breast biopsy".
The needle used in FNAB is very thin, thinner than one used for taking blood tests. According to the American Cancer Society, sometimes the patient may not even need a local anesthetic.
If clear fluid is aspirated, the mass is probably not malignant (cancerous) and the patient has a benign cyst. Cloudy or bloody fluid usually means it is either cancer or a benign cyst. If small pieces of tissue are withdrawn, the pathologist will look at the tissue and/or fluid under a microscope to determine whether it is cancer.
As the needle is so thin, the procedure might miss nearby cancerous cells. If the diagnosis is not clear, the doctor may recommend a further biopsy or a different procedure.
This video below, from SouthSound Radiology, tells you what to expect from a image-guided stereotactic breast biopsy.
With CNB (core needle biopsy), the surgeon removes solid, small samples of tissue. A hollow "core" needle is used, similar to the one in FNAB, but this one is slightly larger.
The surgeon is usually guided by ultrasound or x-rays. If a lump is palpable - can be felt with one's hand - the needle may be guided while palpating the mass.
The hollow needle withdraws cores (small cylinders) of tissue from the mass. The needle goes in several times, possibly up to six times, to remove several cores of tissue.
Although CNB is a longer procedure than FNAB, it is less likely to miss cancer cells, so the result is more reliable.
After CNB the patient may experience some bruising, but no scars.
BUPA explains the procedure during a core needle breast biopsy.
A small cut, less than ¼ inch long is made and a hollow probe is inserted through the incision and guided to the abnormal mass using MRI, ultrasound or x-rays. The probe has a hole in its side, into which tissue is "sucked" using a vacuum technique.
The surgeon can rotate the probe and collect several samples through one single incision.
No stitches are required and scarring is usually minimal.
The breast is cut and the whole (excisional biopsy) or part (incisional biopsy) of the lump is taken out and examined under a microscope. The incision is between 3 to 5 centimeters (1 to 2 inches) long
This procedure is more commonly done in the hospital's outpatient department than in the doctor's office. The patient may either receive a local or general anesthetic - in either case, the patient feels no pain.
Wire localization - if the surgeon cannot find the lump by touch, a thin, hollow needle is inserted into the breast while x-rays guide it to the mass. Then a very thin wire with a hook at the end is threaded into the hollow of the needle and attaches itself to the lump. The needle is removed, but the wire stays so that the surgeon can be guided to the target area.
With a surgical biopsy, the patient will need sutures and there will be a scar. If much tissue is removed, the patient may notice a difference in the shape of her breast afterwards.
It is common in all biopsies for the area to swell and bleed, making the mass seem bigger afterwards. This is normal - usually the bruising and bleeding will go away rapidly.
This is a clip or marker to mark the biopsy site. After the tissue samples have been removed, the surgeon may place a tiny clip or marker, a surgical grade medical device that is visible on mammograms.
The marker helps the doctor locate the exact site of the suspicious area in future mammograms to determine whether there are any changes.
Researchers from the Technical University of Munich in Germany explained in the Journal of Molecular Diagnostics why multiple tumor zones should be analyzed for proper biopsy diagnosis.
You will be asked to sign a consent form which shows that you have given permission for the procedure to go ahead. Read it carefully and ask questions about anything that concerns you.
The John's Hopkins Hospital tells patients not use deodorant, powder, lotion, cream, or perfume on their arms or breasts on the day of the biopsy.
Before the procedure, it is important to let the doctor know if you..:
The Agency for HealthCare Research & Quality (AHRQ) recommends that you ask the medical team "Who will give me the results?" and "When will I get the results?".
The Mayo Clinic recommends patients wear a bra. After the procedure the medical team may place a cold pack against the biopsy site, which the bra can hold in place.
If you are to have general anesthesia, you may be required to fast (no food or drink) for up to 12 hours before the procedure.
Patients who received general anesthesia are taken to the recovery room for observation after the procedure. As soon as their blood pressure, heart rate and breathing are stable, and they are mentally alert, they will be discharged.
If you are to receive general anesthesia or sedatives, arrange for somebody to drive you home afterwards.
Patients who received local anesthesia will be discharged as soon as they have completed the recovery period.
If there are stitches, keep the area clean and dry. If there are no stitches, remove the dressing or bandage according to the medical team's instructions.
The biopsy area will probably be sore and tender for some days. Your doctor will have recommended which painkillers to take. Avoid aspirin as it thins the blood and increases the risk of bleeding. Many women find that wearing a supportive bra helps.
Avoid any strenuous physical activity, according to your doctor's instructions.
Let your doctor know immediately if you have any signs and symptoms of infection, such as fever/chills, redness, bleeding, swelling, or pain around the biopsy site.
Written by Christian Nordqvist
Copyright: Medical News Today
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