Breast Biopsy

By Marty Polovich

(Biopsy-Breast)

Procedure overview

What is a breast biopsy?

A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A breast biopsy is a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery to determine if cancer or other abnormal cells are present.

Biopsies may be performed under local or general anesthesia. There are several types of breast biopsy procedures. The type of biopsy performed will depend upon the location and size of the breast lump or abnormality.

Types of breast biopsy procedures include, but are not limited to, the following:

  • Fine needle aspiration biopsy - a very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help to differentiate a cyst from a lump.

  • Core needle biopsy - a large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.

  • Surgical biopsy (also called an open biopsy) - a surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are two types of surgical biopsies. During an incisional biopsy, a small part of the lump is removed; whereas during an excisional biopsy, the entire lump is removed.

    In some cases, if the breast lump is very small and deep and is difficult to locate, the wire localization technique may be used during surgery. With this technique, a special wire is placed into the lump under x-ray guidance. The surgeon follows this wire to help locate the breast lump.

There are special instruments and techniques that may be used to guide the needles and to assist with biopsy procedures. These include, but are not limited to, the following:

  • Stereotactic biopsy - stereotactic biopsy finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a three-dimensional (3D) picture of the breast. A sample of tissue is removed with a needle.

  • Mammotome® breast biopsy system (also called vacuum-assisted biopsy) - a type of tube is inserted into the breast lump or mass. The breast tissue is gently suctioned into the tube, and a rotating knife removes the tissue. In 1999, the US Food and Drug Administration (FDA) approved the use of the hand-held Mammotome device.

  • Advanced Breast Biopsy Instrument (ABBI®) -  this procedure uses a rotating knife and cylinder to remove a large sample of tissue. Although this type of procedure has not received widespread acceptance, it is often possible to remove the entire breast lesion with this method.

  • Ultrasound-guided biopsy - a technique that uses a computer and a transducer that sends out ultrasonic sounds waves to create images of the breast lump or mass. This technique helps to guide the needle biopsy.

Other breast biopsy techniques are being studied, including ductal lavage. In this procedure, a small catheter is inserted through the nipple into a milk duct in the breast. Saline (salt-water solution) is gently flushed through the catheter into the duct. The saline is then withdrawn back through the catheter, collecting ductal cells in the fluid. The cells are examined in the lab to check for cancer or precancerous changes. This procedure is still considered investigational, but it may be used in clinical trials.

Other related procedures used to evaluate and treat breast problems include mammogram, breast ultrasound, breast scan, lumpectomy, and mastectomy. Please see these procedures for additional information.

Anatomy of the breast

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk.

The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces between lobules and ducts.



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