Finding a lump in your breast can be scary, but keep in mind, breast lumps aren’t necessarily an indication of breast cancer. In order to determine if a breast mass is safe or not, your doctor will likely recommend a breast biopsy.
A biopsy for a lump in the breast involves the removal of a sample of the tissue for further analysis. There are several methods for performing a biopsy, and your physician will recommend one based upon where the mass is located within the breast, or the traits of the mass itself (its size and the degree of abnormality). The biopsy can be performed in one of several ways.
Most breast biopsies are performed using a needle which is inserted into the breast so that a sample of cells can be extracted. The types of needle biopsy include:
- Fine-needle aspiration biopsy. A fine-needle aspiration (FNA) biopsy is the most common type of biopsy procedure. It is performed in a doctor’s office with the patient lying on her back, with the breast numbed but typically without general anesthesia. The physician uses a very thin, hollow needle and syringe. The doctor will use an ultrasound wand to determine the precise location of the mass, and insert the needle into the mass to extract a sample of tissue and/or fluid. While the sample will have to be examined by a pathologist to determine whether or not there are cancer cells present, in some cases the results can be given on the day of the procedure. There may be a bit of bruising or swelling at the site, but there is typically no scarring. FNA biopsies are performed when the physician believes the mass is filled with fluid, and not a solid lump of tissue.
- Core needle biopsy. A core needle biopsy is the standard way to diagnose (or rule out) breast cancer. It is accurate in diagnosing breast cancer and doesn’t involve surgery. It is performed in the office (rather than in an operating room) and a small amount of local anesthetic is used. The provider will then remove a small sample of the lump to send off for testing.
- Stereotactic biopsy. A stereotactic biopsy often involves the patient laying facedown on a special table with holes through which the breast is inserted, though the patient may be put in a seated position. When on the table, the inserted breast is compressed between two mammography plates so that the exact location of the mass may be determined. The surgeon or radiologist then makes a small incision through which a needle is inserted (or a probe), and small amounts of tissue are removed. Stereotactic biopsies are often employed when the mass cannot be detected either by hand or ultrasound.
- MRI-guided core needle biopsy. An MRI-guided core needle breast biopsy is performed in a similar manner as the stereotactic biopsy, only MRI imaging is used to locate the mass. The patient lies face down on a table with the breast inserted into an opening. The MRI uses 3-D imaging to locate the precise location of the mass in the breast. A small incision is made in order to fit a core needle into the breast, which extracts a sample of the mass for further testing.
Most of the surgical biopsies performed are excisional biopsies. In this type of surgery, the whole abnormal area (plus some of the surrounding normal tissue) is removed. This procedure is performed under general anesthesia.
The following are common types of surgical biopsies:
- Open or Excisional biopsy. An incision is made in the breast, and the surgeon either partially or completely removes the suspicious mass. When the lump is difficult to locate, the surgeon may use a wire localization procedure. This is the insertion of a wire towards the lump, guided by X-ray imaging. The surgeon is then able to find and extract the lump or a portion of the lump.
- Skin punch biopsy. This procedure is generally used when a certain type of breast cancer is suspected. The physician removes either a piece of the skin of the breast (as with inflammatory breast cancer), or a portion of the nipple or areola (as with Paget’s disease). The surgical site is then closed with stitches.
- Vacuum-assisted core biopsy. This type of biopsy involves the insertion of a vacuum probe, which cuts a portion of the mass and vacuums it into the probe. This measure allows more than one tissue sample to be extracted simultaneously.
Surgical biopsy results may be ready within several days. If the results do not indicate the presence of cancerous tissue, your physician may recommend further procedures to remove the entirety of the mass. If the results indicate the presence of cancer, your doctor will then develop a treatment course that directly addresses the type and the scope of the cancer.
Bedford Breast Center will help you throughout your journey, from your screening process, to the biopsy for a lump in the breast, to treatment options and strategies. If you have concerns about changes in your breasts and want to schedule a consultation, please contact the team at Bedford Breast center.