Breast Biopsy: What to Know Before Your Appointment

If your doctor has scheduled you to have a breast biopsy, you may be wondering what to expect from the procedure.

Here, experts will break down exactly what a breast biopsy is, the different types and what happens during each. Plus, you’ll learn what recovery looks like and what your results may mean.

What is a breast biopsy?

A breast biopsy procedure is when a tissue or fluid sample is taken from an area that shows suspicious growth on a mammogram, ultrasound MRI or other diagnostic test. A doctor called a pathologist will then examine the sample to see if you have breast cancer, according to the National Breast Cancer Foundation (NBCF).

Types of breast biopsies

The NBCF states there are three main types of breast biopsies:

• Fine-needle aspiration
• Core needle
• Surgical

During a fine-needle biopsy, a very thin, hollow needle is used to draw out cells from a fluid-filled sac to check them for cancer. According to the American Cancer Society (ACS), ultrasound imaging may be used to help pinpoint the sac.

In core-needle biopsies, the NBCF and ACS say that a bigger, hollow needle is attached to either a suction or spring-loaded device, and a larger tissue sample is taken. Core-needle biopsies can also be ultrasound-guided, or a doctor may use an MRI or mammogram machine. This latter procedure is called a stereotactic breast biopsy.

The ACS notes if the results of a needle biopsy breast procedure are unclear, your doctor might order a surgical biopsy. Here, an operation is performed to remove the suspicious mass.

What happens during a breast biopsy procedure?

A fine-needle aspiration biopsy is performed in a doctor’s office. The ACS says that the needle is inserted into your breast while you’re lying still on your back, and the entire procedure takes about 20 to 30 minutes. Since the needle is so small, local anesthetic isn’t always needed.

A core biopsy is also an outpatient procedure, but it may be performed with you sitting up or lying on your back or stomach, depending on whether MRI, ultrasound or mammogram imaging is used. You’ll receive a local anesthetic, and a tiny cut that doesn’t require stitches is made over the area where the biopsy needle is inserted. The ACS notes that a tissue marker or clip is also typically inserted with the needle, to mark the exact spot where the sample was taken.

A surgical biopsy is almost always performed in a hospital using both local anesthesia and sedation or general anesthesia. The ACS explains that during the operation, the surgeon will cut into your breast and remove the suspicious mass, and then stitches will be used to close the area.

Breast biopsy recovery

For both fine-needle aspiration and core-needle biopsies, you’ll be asked to avoid physically demanding activities for about a day, and you might notice some slight bruising, bleeding or inflammation in the area of the biopsy, according to the ACS.

“There's not much in the way of recovery. They [patients] could just carry on their normal life,” said Dr. Thomas Buchholz, medical director of Scripps MD Anderson Cancer Center, in Houston.

For surgical biopsies, recovery takes longer and your doctor will give you guidance on how long you can expect to limit your daily activities. In addition to inflammation, bleeding and bruising, the ACS says that you may have a scar after surgery and your breast shape may change.

What do the results mean?

If cancer is found, the NBCF said that a core-needle biopsy will tell you the type of cancer you have and its grade or growth rate. Tests may also be ordered to find out if certain hormone receptors called progesterone and estrogen are present.

A fine-needle biopsy will only tell you if you have cancer. For this reason, Buchholz said that your doctor will likely schedule a core-needle biopsy if cancer is found during a fine-needle biopsy.

For surgical biopsies, you’ll also learn the cancer margin or distance between the surrounding tissue and the tumor. This helps you understand whether the cancer has spread or remains localized. The NBCF states you’ll find out your hormone receptor status as well.

Buchholz explained that information on receptors helps guide cancer doctors’ treatment recommendations. For instance, ER-positive and PR-positive cancers tend to respond very well to anti-hormone treatments, whereas ER-negative and PR-negative cancers respond better to chemotherapy.

What percentage of breast biopsies are cancer?

Only 20% of the over 1 million breast biopsies performed in the United States each year find breast cancer, which totals about 290,000 new cases annually, according to the Agency for Healthcare Research and Quality.

“I think the thing to let people know is that even when you're scheduled for a biopsy, most of the biopsies are not going to show cancer,” Buchholz noted.

SOURCE: Thomas Buchholz, MD, medical director, Scripps MD Anderson Cancer Center, Houston