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Breast Biopsy

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What is a breast biopsy?

A biopsy involves removing a small tissue sample from the breast. This tissue can then be tested at a lab to see if the tissue is normal or abnormal. The testing can help a diagnosis be made and determine if any treatments are needed.

Why is it done?

Your doctor may suggest that you undergo a breast biopsy for one of many reasons including if:

· A lump or thickening is detected and your doctor thinks there is a possibility it could be breast cancer

· Your mammogram or ultrasound of the breast reveals unusual/suspicious areas

· You have any nipple changes like crusting, scaling, dimpling, or bloody discharge

A biopsy can help you see if a mass in your breast is cancer or not.

The different types of biopsies:

· Fine-needle aspiration biopsy

o The most simple type of biopsy used to evaluate a lump in the breast felt during a clinical exam

o For the procedure, you will lie on the table and the doctor will insert a very fine needle, attached to a syringe, into the lump. The surging can then be used to collect cells or fluid from the lump

· Core needle biopsy

o This biopsy often evaluates a lump found on a mammogram, ultrasound, or during a clinical exam

o A radiologist or surgeon takes a thin, hollow needle (a little wider than the needle used in fine-needle aspiration) to sample tissue from the lump

o Mammography, ultrasound, or MRI are usually used to help the doctor guide the needle into the lump

· Stereotactic biopsy

o In this type of biopsy, mammograms are used to precisely locate the suspicious areas of the breast

o During this procedure, the patient usually lies facedown on the biopsy table with one of her breasts positioned in a hole in the table. The radiologist sits below the table during the procedure. The breast is compressed between two plates while mammograms are taken to help guide the doctor to the correct location for the biopsy. A very small incision is made (about ¼ in long) and a needle or vacuum-powered probe is inserted to remove sample tissue to be analyzed

· Ultrasound-guided core needle biopsy

o During this type of biopsy, the patient lies on her back on an ultrasound table and the radiologist uses ultrasound to locate the mass. The doctor then makes a small incision and inserts and needle to sample the tissue.

· MRI-guided core needle biopsy

o In this type of biopsy, the patient lies facedown on an MRI scanning table and images are taken to help determine the location of the mass in order to use a needle to biopsy it. A small incision is made for the needle to obtain sample tissue.

· Surgical biopsy

o During this type of biopsy, a portion of the breast mass or the entire breast mass may be removed. The radiologist may use mammography to place a thin wire tip within the breast mass or within it to help guide the surgeon during the biopsy.

o The patient usually receives some type of sedation and a local anesthetic.

Who is involved in the biopsy?

· Radiologists help interpret the imaging studies used to guide surgeons in obtaining breast tissue samples

· Anesthesiologists are sometimes available, especially if a surgical biopsy is being performed

· Pathologists evaluate the tissue sample

· Nurses, technicians who operate the imaging devices (i.e. ultrasound machine), and other healthcare professionals may also be present to help in the process

What are the risks?

· Bruising and swelling of the breast

· Infection or bleeding at the site of the biopsy

· A change in breast appearance due to tissue removal or how the breast heals

· Additional treatment might be needed depending on the results of the biopsy

What can the results tell me?

The results for a breast biopsy are usually ready within a few days. The biopsied tissue is taken to a pathologist who writes up a detailed report including the size, color, and consistency of the tissue. The report will also include the location of the biopsy site and whether any cancerous cells were present in the tissue.

If the results of the pathology report suggest that you have cancerous cells, the report can tell you what type of breast cancer you have and whether it is hormone receptor positive/negative. The biopsy can also tell you if the cancer is in situ (located within a lobule or duct in the breast) or if it is invasive or infiltrating, suggesting that it may have spread to your lymph nodes and possibly other parts of your body. With this information, you and your doctors can formulate a treatment plan.

If the results are negative, talk with your doctor about when you should follow-up and have your next screening mammogram.

Priyanka Kalapurayil