Breast Biopsy - Types and Results

What Is a Breast Biopsy?

A breast biopsy is a procedure in which a sample of breast tissue is removed and sent to a laboratory for testing. It is the best way to diagnose if a suspicious lump or portion of the breast is cancerous or non-cancerous.

Why Is a Breast Biopsy Done?

A breast biopsy is recommended when during a routine checkup, ultrasound, or mammogram if the doctor finds any of the following in breast tissues-

• Cysts (fluid-filled cavities).

• Microcalcifications (tiny calcium deposits).

• A lump or mass.

• Bloody discharge from nipples.

• Crusting.

• Scaling or dimpling of the skin.

What Are the Risks Associated With a Breast Biopsy?

The following risks are associated with a breast biopsy-

• Bruising and swelling.

• Mild pain or soreness.

• Infection and bleeding at the biopsy site.

• Altered breast appearance (depending on the amount of tissue removed and healing).

• Additional surgery or other treatment can be done.

How Is a Breast Biopsy Performed?

During the physical examination, the lump or mass is evaluated for the covered area, size, and position. Patients' detailed medical history and consent to perform the procedure are taken. A thin needle or wire is placed into the area of the lump so the surgeon can locate it. The procedure is performed under local anesthesia.

What Are the Different Types of Breast Biopsy?

A breast biopsy can be either a surgical procedure or a minimally invasive. The doctor recommends a particular approach based on the suspicious area's size, location, and other characteristics.

The following types of breast biopsies can be done

• Fine-Needle Aspiration Biopsy - This is a simple, quick, and non-invasive type of breast biopsy to evaluate a lump felt during a clinical breast examination. The doctor inserts a fine needle into the breast lump. The needle is attached to a syringe. The syringe can collect a sample of cells or suction fluid from the lump. Fine-needle aspiration helps to distinguish between a fluid-filled cyst and a solid mass. A procedure to collect a tissue sample is needed if the mass is solid.

• Core Needle Biopsy - To assess a breast lump visible on a mammogram, ultrasound, or during a clinical breast examination. A radiologist or surgeon uses a thin and hollow needle to remove tissue samples from the breast mass, using ultrasound as a guide. Samples are collected and analyzed.

• Stereotactic Biopsy - This type of biopsy uses mammograms to find the location of suspicious areas within the breast. For this type of biopsy, the patient lies face down on a padded biopsy table, and the breast tissues are firmly compressed between two plates. At the same time, mammograms are taken to find the exact location of the area for biopsy. Next, an incision is made into the breast tissues, and then either a needle or a vacuum-powered probe is inserted to remove tissue samples.

• Ultrasound-Guided Core Needle Biopsy - In this type of biopsy, ultrasound is used to locate the mass; a small incision at the site of the lump is made to insert the needle and collect several core tissue samples.

• MRI-Guided Core Needle Biopsy - This core needle biopsy type is done under an MRI's guidance (Magnetic resonance induction). The MRI machine provides images that determine the exact location of the biopsy. Then, an incision is made at the desired site on the breasts to insert the core needle, and several tissue samples are taken.

• Surgical Biopsy - During a surgical biopsy, some or all breast mass is removed using sedation for examination. Before surgery, radiologists use a wire or seed localization technique to map the mass route if the breast mass cannot be felt.

  • Wire Localization - The tip of a thin wire is positioned within the breast mass or just through it.

  • Seed Localization - A small radioactive seed is placed using a thin needle. The seed guides the surgeon to the cancer cells' location. The seed gives off only a very small amount of radiation and is safe.

The surgeon attempts to remove the entire breast mass and the wire or the seed during surgery. The collected tissue is then sent to the laboratory for evaluation to ensure that the entire mass has been removed. Lab pathologists can confirm whether breast cancer is present in the collected mass. Next, they check the edges (margins) of the mass to determine whether cancer cells are present. If the cancer cells are at the margins, another surgery is needed to remove more tissue. Cancer has been removed successfully if the cancer cells are absent at the margins (negative margins).

Breast Biopsy Recovery - After the breast biopsy, the patient must take care of the stitches and bandages. Painkiller medications and a special type of bra are given to the patient. In case of fever, chills, excessive pain, redness, swelling, bleeding, or drainage, the patient should seek help from the doctors.

How to Evaluate the Results of a Breast Biopsy?

The results of the breast biopsy can take a few days to weeks. In the pathology lab, the breast tissues are examined by specialist doctors under a microscope, and then a report is made according to the observations. The report describes the presence of cancerous, non-cancerous, or precancerous cells.

• Non-Cancerous Conditions - If the lab reports show non-cancerous or benign cells, then the lump might be due to adenofibroma (benign tumor of the breast tissue), fibrocystic breast disease (painful lumps in the breast due to hormonal changes), intraductal papilloma (benign tumor of the milk ducts), or mammary fat necrosis (lump formed by bruised, injured, or dead fat cells).

• Cancerous Conditions - If the sample is cancerous, the biopsy results will also reveal the type of cancer. Some types of breast cancers are as follows

  • Ductal carcinoma (cancer of the breast ducts).

  • Inflammatory breast cancer.

  • Lobular carcinoma (cancer of the lobules or the milk glands).

  • Paget's disease.

• The doctor uses the result and information obtained from the biopsy for further treatment planning. The following procedures are done in cancer conditions

• Target and immunotherapy.

  • Lumpectomy (surgical removal of the tumor).

  • Mastectomy (surgical removal of the breast).

  • Radiation therapy.

  • Chemotherapy.

  • Hormone therapy.

• Close observation and follow-up.

Conclusion

Lumps, pain, or discharge in breasts are common conditions experienced by many women. First, one must look for the signs and symptoms of lumps or a breast abnormality. Then, one must seek immediate healthcare assistance for early diagnosis and prompt treatment at the right time before the symptoms get worse. A breast biopsy can be minimally invasive or surgical, depending on the condition. Breast biopsy helps doctors to determine whether the lumps are cancerous or non-cancerous. The outcome and healing after breast biopsy are generally good.