Why A Breast Biopsy Is Performed
A breast biopsy is typically performed to investigate a lump in the breast. Most breast lumps are noncancerous.
Your doctor will usually order a biopsy if they are concerned about the results of a mammogram or breast ultrasound, or if a lump was found during a physical exam.
A biopsy may also be ordered if there are changes in your nipple, including:
- bloody discharge
Although a breast biopsy is relatively simple and its risks are low, every surgical procedure carries a risk. Some possible side effects of a breast biopsy include:
- an altered appearance of your breast, depending on the size of the tissue removed
- bruising of the breast
- soreness at the biopsy site
- an infection of the biopsy site
These side effects are typically temporary. If they persist, they can be treated. Be sure to follow your doctors instructions for care after the biopsy. This will greatly reduce your chance of infection.
Complications from a biopsy are rare. The benefits of having your potentially cancerous lump inspected far outweigh the risks from the procedure.
The sooner breast cancer is detected, the faster that treatment can begin. This will greatly improve your overall outlook.
How Does The Procedure Work
Ultrasound imaging uses the same principles as the sonar that bats, ships, and fishermen use. When a sound wave strikes an object, it bounces back or echoes. By measuring these echo waves, it is possible to determine how far away the object is as well as its size, shape, and consistency. This includes whether the object is solid or filled with fluid.
Doctors use ultrasound to detect changes in the appearance of organs, tissues, and vessels and to detect abnormal masses, such as tumors.
In an ultrasound exam, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it sends small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound’s pitch and direction. A computer instantly measures these signature waves and displays them as real-time pictures on a monitor. The technologist typically captures one or more frames of the moving pictures as still images. They may also save short video loops of the images.
How Many Lymph Nodes Are Removed
Depending on the size and other characteristics of the breast cancer, you may have one to 10 or more lymph nodes removed. Here are a few things to keep in mind:
To make sure that women have the appropriate lymph node surgery, the American Society for Clinical Oncology released guidelines on sentinel lymph node biopsy for people diagnosed with early-stage breast cancer. The guidelines say sentinel lymph node biopsy SHOULD be offered under these circumstances:
- breast cancer in which there is more than one tumor, all of which have formed separately from one another these types of breast cancers are rare
- DCIS treated with mastectomy
- women who have previously had breast cancer surgery or axillary lymph node surgery
- women who have been treated before with chemotherapy or another systemic treatment
Sentinel node biopsy SHOULD NOT be offered under these circumstances:
- the cancer is 5 cm or larger or locally advanced
- the cancer is inflammatory breast cancer
- DCIS treated with lumpectomy
The guidelines also say:
- Women with negative sentinel node biopsies shouldnt have axillary node surgery.
- Women with one or two positive sentinel nodes who plan to have lumpectomy plus radiation also dont need axillary node surgery.
- Women who have one or more positive sentinel nodes and plan to have mastectomy with no radiation should be offered axillary node surgery.
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How Is The Biopsy Performed
Your doctor will ask some questions about the lump:
- Where it is?
- How and when you first became aware of it?
- Have you noticed any changes in it?
Next, the doctor will feel the lump. Before the actual biopsy is performed the doctor will give you an opportunity to ask any questions or express any concerns you might have about the procedure. After all your questions and concerns have been addressed, the actual procedure will begin.
Holding the lump with one hand, the doctor will precisely sample the lump with a thin needle held in a needle holder, which provides greater control. Usually, two to three samples will be required from the lump to provide an accurate diagnosis. During the procedure, the doctor will usually leave the examination room with one of the slides to check that there is enough tissue to prevent the need for a second office visit.
Percutaneous Biopsies: Fine Needle And Core Biopsy
A percutaneous biopsy is simply means that the surgeon takes the sample through the skin with a needle, in opposition to an actual surgical excision.
So, the surgeons will use different sizes and diameters of needles. In a fine needle aspiration surgeons take just a small tissue sample from the lesion. So, with FNA, the surgeon will typically use a 21 or 20 gauge needle.
A core biopsy is simply a special needle of a larger gauge, that is able to get a core of tissue inside the needle, like a core sample of a glacier. Surgeons perform a core biopsy with an 18 16 or 14 gauge needle .
A relatively new procedure, the vacuum assisted biopsy is also uses an 11 gauge needle and a vacuum assisted device or VAD. For example, the Mammotome ® which seems to get a larger tumor sample with less attempts.
An 11 gauge probe together with a vacuum-assisted device typically picks up 94 mg with each core sample. The 14 gauge needle with vacuum assistance typically picks up 37 mg. However, the sample size drops to only 17 mg when surgeons use an automated biopsy gun.
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What Happens At A Biopsy Results Appointment
Youll be told your results, and there are three possibilities: its benign , its cancer or its indeterminate.
Indeterminate means the result is unclear and you may need another biopsy or other tests to get a definite answer.
Whatever the result, its a good opportunity to ask any questions youve had in your mind. For example, if youre told its benign, will you need any other tests or procedures, or will you be discharged?
The results will go to your GP and you can also ask for a copy to be sent to you. That will be another opportunity for you to look at the results.
If theres anything in your results that youre unsure of, you can on 0808 800 6000.
What Can I Do To Cope With The Worry
We all cope differently in times of stress.
Some people cope by keeping busy or distracting themselves. Others use calming breathing exercises or mindfulness and relaxation.
Whats not helpful is to start looking for information online about breast cancer.
Googling breast cancer is often what drives peoples anxiety. Remember that any information you find online at this point will not be specific to your situation.
Its a much better idea to look for information on managing worry or anxiety while youre waiting for your results.
Waiting for biopsy results can be a very worrying time. Our nurses are here for you if you need to talk things through.
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Tests To Determine Specific Types Of Treatment
You’ll also need tests that show whether the cancer will respond to specific types of treatment.
The results of these tests can give your doctors a more complete picture of the type of cancer you have and how to treat it.
In some cases, breast cancer cells can be stimulated to grow by hormones that occur naturally in your body, such as oestrogen and progesterone.
If this is the case, the cancer may be treated by stopping the effects of the hormones or by lowering the level of these hormones in your body. This is known as hormone therapy.
During a hormone receptor test, a sample of cancer cells will be taken from your breast and tested to see if they respond to either oestrogen or progesterone.
If the hormone is able to attach to the cancer cells using a hormone receptor, they’re known as hormone-receptor positive.
While hormones can encourage the growth of some types of breast cancer, other types are stimulated by a protein called human epidermal growth factor receptor 2 .
These types of cancers can be diagnosed using a HER2 test and are treated with medicine that blocks the effects of HER2. This is known as targeted therapy.
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What Can I Expect During And After A Needle Biopsy
During a needle biopsy, you will remain awake, and your breast will be numbed with a local anesthetic. The lump will be located with image guidance, or by touch, and a core needle will be inserted through your skin into the lump to remove the sample tissue. Three to six samples are usually taken to ensure accuracy. Women should expect to feel some pressure but not any significant pain. After the procedure, you may experience slight bruising at the needle sites, but you will be able to carry on with your regular routine. A pathologist will examine the tissue samples, and a written report will be sent to your doctor with the results.
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Minimum Sample Recommendations For Core Biopsies
If the pathologist wishes to examine microcalcifications, then the minimal recommended sample is 10 specimens with the 14 gauge needle.
If a mass is present, then the recommendations are 5 specimens with stereo tactic guidance, or just 4 with ultrasound guidance. Core samples tend to be about 17 to 20 mg each with a 14 gauge needle. With a 14 gauge probe and a VAD, the samples are about 37 to 40 mg each using an 11 gauge. However, VAD samples can be as large as 94 mg each .
What Is A Breast Biopsy
A breast biopsy is a test that removes tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and further tested to check for the presence of breast cancer. A biopsy is the only diagnostic procedure that can definitely determine if the suspicious area is cancerous.
The good news is that 80% of women who have a breast biopsy do not have breast cancer.
There are three types of biopsies:
- Fine-needle aspiration
- Surgical biopsy
The latter two are the most commonly used on the breast.
There are several factors that help a doctor decide which type of biopsy to recommend. These include the appearance, size, and location of the suspicious area on the breast. Before discussing biopsy results, lets first distinguish between the three types of biopsies.
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What Does This Summary Cover
This summary can help you talk with your doctor or nurse about breast biopsy. If you have a breast lump or shadow on your mammogram, a breast biopsy tells if it is cancer or not. This summary will tell you about the different kinds of breast biopsies. It will tell you what to expect if you have a breast biopsy.
This summary covers research about how well different kinds of biopsies work to find breast cancer. It will also tell you about possible side effects. It is based on a government-funded review of research reports about breast biopsy.
What Happens After Your Her2 Test
Once you have your HER2 results, your doctor should talk to you about the next steps. Breast cancers that are HER2-positive often respond very well to targeted therapies medications that identify and attack cells with the HER2 protein. If you have HER2-positive breast cancer, your doctor will probably recommend that you use targeted therapies.
Read more about treatment options for HER2-positive breast cancer.
At some point after you begin receiving breast cancer treatment, your doctor may have you undergo more HER2 testing. Results can help show whether the treatment is working. If you were diagnosed with HER2-positive cancer, and later tests show that your HER2 levels are normal, this may mean your tumor is shrinking. High HER2 levels, on the other hand, may indicate that your cancer has come back.
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How To Prepare For A Breast Biopsy
Before your breast biopsy, tell your doctor about any allergies you may have, especially any history of allergic reactions to anesthesia. Also tell your doctor about any medications you may be taking, including over-the-counter drugs, like aspirin or supplements.
If your doctor recommends an MRI, tell them about any electronic devices implanted in your body, like a pacemaker. Also, tell your doctor if youre pregnant or concerned you may be pregnant.
Consider wearing a bra to your appointment. You may be given a cold pack after the procedure to help with pain and inflammation. Your bra will help keep the cold pack in place.
Before the breast biopsy, your doctor will examine your breast. This could include:
- a physical examination
- a mammogram
- an MRI scan
During one of these tests, your doctor may place a thin needle or wire into the area of the lump so the surgeon can easily find it. Youll be given local anesthesia to numb the area around the lump.
There are several ways a surgeon can take a sample of breast tissue. These include:
How To Prepare For Your Breast Biopsy
While a breast biopsy doesnt require much preparation on your part, there are some things you can do beforehand to minimize the risk of side effects.
- Stop taking certain medications, such as aspirin or blood thinners, a few days ahead of the procedure
- Tell your doctor if you have any drug allergies
- Wear comfortable clothing to the appointment
- Prepare to have someone else drive you homeespecially if sedation or general anesthesia is used
- Give yourself time after the appointment to decompress
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How Long Will It Take To Get The Results
Unfortunately, breast biopsies arent instant. Frimmer explains this is because the radiologist and pathologist want to make sure they take their time and make sure they understand as much as possible about whats happening with your body before giving you any news.
A lot depends on the institution where you got your mammogram and biopsy done. Some places have the facilities and personnel for a quick turnaround like 24 hours, Frimmer says. Other places can take several days or a week to get the results. Frimmer recommends asking your doctor or radiologist how long you should expect to wait for the results to make that difficult time a little easier to manage.
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Pathologists Make Sure Biopsy Tissue Is Used Effectively To Determine An Accurate Diagnosis
Pathologists are the caretakers of tissue samples and must exercise good judgment with them. Samples allow us to make a correct diagnosis. But we can also use the samples to perform additional tests, such as immunostains, which can identify where a tumor started. This is really valuable in treating cancer that has spread from another part of the body, called metastasis.
Your pathologist will also make sure that biopsy samples are used to identify other factors affecting your treatment and recovery. These can include genetic changes that could guide treatment options or predict your chance of recovery. For example, in breast cancer, pathologists use the biopsy sample to identify hormone receptors such as estrogen and progesterone receptors and human epidermal growth factor receptor . As we identify more precise characteristics of cancer from the biopsy sample, we can identify a growing number of patients who may benefit from new, more effective targeted therapies.
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What Are The Risks Of A Breast Biopsy
All procedures have some risk. Some possible complications of a breast biopsy include:
Bruising and mild pain at the biopsy site
Prolonged bleeding from the biopsy site
Infection near the biopsy site
If the biopsy is done using an X-ray, the amount of radiation used is small. The risk for radiation exposure is very low.
You may have other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the biopsy is done.
Diagnosis Of Breast Cancer
Diagnosis is the process of finding out the cause of a health problem. Diagnosing breast cancer usually begins when you find a lump in your breast or a screening mammography suggests a problem with the breast. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for breast cancer or other health problems.
The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as breast cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of breast cancer.
The following tests are usually used to rule out or diagnose breast cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.
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Biopsy For Breast Cancer Diagnosis: Fine Needle Aspiration
Your health care providers may refer you for a fine needle aspiration biopsy if a lump is discovered in your breast. The FNA biopsy is used to assess the lump. In the past, this required a sometimes painful surgical procedure that involved a longer waiting period for the results. With FNA, a sample of the lump is obtained using a small, thin needle. The test often allows doctors to make a diagnosis within two to three days of the test.