What It Is
A biopsy is a procedure that removes tissue from an area or lesion of concern. The tissue is studied under a microscope to look for cancer or other abnormal cells.
Types of Biopsies
Image guidance allows for more accurate placement of the biopsy needle within the lump or lesion of concern.
Radioactive Seed Localization
Radioactive seed localization can precisely pinpoint breast tumors that are too small to be felt. A radiologist places a slightly radioactive metal chip, about the size of a sesame seed, in the tumor tissue with the help of medical imaging. The seed guides the surgeon directly to the abnormal tissue to be removed.
This approach helps protect healthy tissue from being harmed by combining advanced imaging techniques with precise targeting of the cancerous cells. The procedure may be used for biopsies to diagnose breast cancer or to remove small lesions.
Fine Needle Biopsy
In a fine needle biopsy, fluid and cells are taken from a lump or lesion through a very thin (fine) needle. If the needle removes mostly fluid, the lump is most likely a cyst and not cancer. The cyst will disappear when all the fluid is removed. If cells are removed from a lump, a specialist will look at them under a microscope. They will see if the cells are cancerous or benign.
Sometimes, a local anesthetic is applied to the breast. This will numb the area before the needle is inserted.
For this type of biopsy, there is no need to make a cut in the breast. Ultrasound or mammogram images may be used to help the doctor locate the lump if it can’t be felt.
Core Needle Biopsy
In a core needle biopsy, a hollow needle is inserted into a lump or lesion. Some of the tissue is taken out using the needle. This tissue is then studied.
First, a local anesthetic is applied to the breast to numb the area before the needle is inserted. Only a very tiny cut is needed to insert the core needle. This cut won’t require stitches.
If the lesion can't be felt, ultrasound, mammorgraphy (stereotactic) or MRI may be used to help the doctor locate it.
This procedure is less involved than an open surgical biopsy because less tissue is usually removed. It also means a much smaller scar. If the results are negative (noncancerous), a surgical biopsy is usually not needed.
A very small radiologic marker is usually placed into the breast biopsy site at the time of the core needle biopsy. This marker is important for future imaging.
Needle (Wire) Localized Surgical Breast Biopsy
Needle (wire) localized surgical breast biopsy helps the doctor pinpoint the correct area in your breast for biopsy. It is used to guide surgical biopsy when a lump is difficult to feel or too small to felt at all. The needle used during the biopsy is thinner than that used for drawing blood.
The area will be numbed using a local anesthetic before the biopsy. A hollow needle is then placed into the breast using mammogram, X-rays, or ultrasound to guide the needle to the area. When the tip is in the correct location, a small amount of blue dye is injected through it. The needle will then be removed or replaced with a wire and you will be taken in for your surgical biopsy.
The dye and wire guides the doctor to the area to be removed. Usually, the wire localization is performed immediately before your surgical breast biopsy.
In an incisional biopsy, a sample of tissue is cut out of the lump or area of concern. This sample is used to determine if the lump is cancer or not.
This type of biopsy is done only when:
- The lump is so large that the all of the breast would need to be removed (mastectomy)
- Completely removing the lump isn’t needed or would result in cosmetic deformity
With this type of biopsy some of the lump is left in the breast. If it is cancer, additional treatment or surgery will be needed to remove the rest of the lump.
In an excisional biopsy, the surgeon removes all of the lump or suspicious area during surgery. Usually, more than local anesthesia is used to keep you comfortable. You usually are able to go home the same day (outpatient surgery). A pathologist then studies the tissue under a microscope to check for cancer cells.
In some cases, this procedure also functions as a lumpectomy, with no further surgery needed.
Stereotactic Breast Biopsy (Mammogram-guided)
The purpose of a stereotactic breast biopsy is to remove a tissue sample from the area of concern identified on your mammogram. Digital images of the breast are taken from several angles and a computer calculates the exact location of the lump. Local anesthetic is used to numb the breast prior to introduction of the biopsy needle. Several core needle samples are removed and a biopsy marker is placed.