Biopsies (USG)

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Many women, at some point of their life, will have a breast lump or an abnormal mammogram diagnosis. This would then be followed up with additional testing to confirm that the lump or abnormal area is not cancerous. In many cases, additional mammograms or other imaging techniques can help rule out the possibility of cancer.

When these tests are inconclusive and cancer cannot be ruled out, a woman will need to undergo a biopsy. A biopsy is a procedure that involves removing cells or tissue from a suspicious area of the breast and then examining them under a microscope. Unfortunately, is still the only definitive way to confirm if an abnormality is cancerous or not.

Depending on the situation, different types of biopsies are performed. These are the two main types of biopsies used to diagnose breast cancer:

  • Needle biopsy
  • Surgical biopsy

Needle biopsies

In needle biopsy, a needle is used to aspirate (draw out) fluid or tissue from a breast lump. Compared to a surgical biopsy, a needle aspiration leaves no scarring, and is less invasive and quicker to perform. However, unlike surgical biopsy, needle biopsies cannot remove the entire lesion and misdiagnosis may occur.

Needle procedures are performed in doctors’ offices, clinics, surgical centers and hospitals. There is little preparation needed for these procedures. Recovery is generally quick and uncomplicated from these procedures. Most patients are able to resume normal activity almost immediately afterwards. Pain is minimal and can usually be managed with an over-the-counter pain reliever.

Needle biopsy procedures include the following:

Fine Needle Aspiration

Fine needle aspiration is only recommended for suspicious areas that can be felt (palpable masses). It is also done as a quick method to obtain sample of a breast lump felt during a clinical breast exam.

Performed under local anesthesia, the surgeon uses a fine hollow needle that is attached to a syringe to extract fluid from a cyst or cells from an abnormal area of the breast. The needle used in this procedure is very small (smaller than those used to draw blood). Several insertions are usually required to obtain an adequate sample. The procedure takes a few minutes and is often done in a doctor’s office. There is no incision and a very small bandage is put over the site where the needle entered.

Advantages

  1. Fine needle aspiration is the easiest and fastest method of obtaining a breast biopsy, and is very effective for women who have fluid filled cysts.
  2. Does not involve any incision and is relatively painless, inexpensive and quick to perform.
  3. Minimal chance for complications such as infection or bruising.
  4. Can be accurate when performed by an experienced doctor.
  5. For women whose abnormal area was considered unlikely to be cancer at initial evaluations, a benign test result means they will likely avoid a surgical biopsy.

Disadvantages

  • The evaluation can be incomplete or inaccurate because the tissue sample is very small. Fine needle aspiration can miss a cancerous tumor and take a sample of normal cells instead. When used alone, up to about 10% of breast cancers may be missed. The effectiveness of this procedure depends not only on the skill of the surgeon or radiologist who performs it, but the breast cytopathologist who specializes in examining individual cells.
  • Fine needle aspiration only provides limited information about the tumor.

Note: Because of these potential inaccuracies, a fine needle aspiration that does not find cancer may need to be followed up with another type of biopsy, like a core needle or surgical biopsy.

Core needle biopsy

This procedure is similar to fine needle aspiration, but the needle is larger, enabling a larger sample to be obtained from the breast. It can be used on both suspicious areas that can be felt (palpable masses) and those that can only be seen on a mammogram (nonpalpable masses). Core needle biopsy may also provide a more accurate analysis and diagnosis than fine needle aspiration because tissue is removed, rather than just cells. Because it is both accurate and does not involve surgery, it is often the biopsy of choice for women.

During the procedure, the doctor uses a small amount of local anesthetic to numb the skin and breast tissue around the suspicious area. Three to six needle insertions are needed to obtain an adequate sample of tissue. A clicking sound may be heard as the samples are being taken and the patient may feel some pressure, but should not feel pain. The procedure takes a few minutes and no stitches are required.

Advantages

  • Core needle biopsy is accurate when done by an experienced radiologist.
  • Quick, relatively inexpensive and only mildly uncomfortable, it does not involve surgery and only rarely leads to complications, such as infection or bruising.
  • Core needle biopsies also provide more important information about the suspicious area, such as the tumor type and tumor grade. Such information helps a patient and her physician plan for treatment.
  • For women with a benign test result, it means they will have avoided the more invasive surgical biopsy.

Disadvantages

  • This procedure is inaccurate for patients with very small or hard lumps.
  • Core needle biopsy can also miss a tumor and take a sample of normal tissue instead when used without the help of stereotactic mammography or ultrasound guidance. Such false negative results occur in up to eight percent of stereotactic mammography or ultrasound-guided core needle biopsies of nonpalpable masses.
  • Core needle biopsy may not provide complete information about the tumor.

Good to know!

It is important to remember that even if your doctor tells you that a biopsy is needed, most women who do it do not have breast cancer. In the US, about 1 in 10 women who have biopsies are diagnosed with cancer.