Types of Biopsies
Core Needle Biopsy
The core needle biopsy is a procedure in which the surgeon removes small samples of breast tissue through the skin using a hollow needle. If the area being biopsied is able to be held still, the surgeon will hold the area with one hand while performing the biopsy with the other. In some situations the surgeon will make use of an ultrasound or a mammogram image to help guide the needle to its correct location.
If you are scheduled for a core needle biopsy
The area is frozen throughout the biopsy, so while you may feel some pressure during the procedure, there should be minimal discomfort. On average, three to six insertions of the needle will occur. It is normal to hear a clicking sound when the biopsy is performed. Samples are approximately 2 centimeters by .16 of a centimeter.
The procedure takes only a few minutes and does not typically leave any external or internal scarring. Patients with very small or hard-to-find lumps may be advised to undergo a different type of biopsy. Patients are able to resume normal activities immediately. There may be a small amount of bruising.
You should not use body powder, lotion, perfume or deodorant before the procedure, as these may affect the results.
Fine Needle Aspiration
A fine needle aspiration involves a very fine needle (finer than those used to draw blood) being inserted into the cyst in order to remove fluid or clusters of cells. The fluid or cells are then sent to a laboratory for analysis.
The fine needle aspiration is the easiest and fastest of all the biopsy procedures. This method is perfect if the fluid is benign, but if the biopsy appears suspicious there is no way the for the cell to be evaluated in relation to the surrounding tissue.
If the area being biopsied is able to be held still, the surgeon will hold the area with one hand while performing the biopsy with the other. In some situations the surgeon will make use of an ultrasound or a mammogram image to help guide the needle to its correct location.
If you are scheduled for a fine needle aspiration biopsy:
After placing the needle into the breast, a vacuum-type pressure is formed. The surgeon moves the needle in and out in order to assure that an adequate tissue sample is collected.
The fluid removed from the breast cyst may be clear, straw-colored, green/brown tinged, yellow, white or (infrequently) bloody. The majority of biopsied fluid is benign. Fluid with traces of blood is usually sent to the laboratory, as the blood may indicate cancer; the other fluid is frequently discarded. The samples are smeared on microscopic slides, stained and examined by a pathologist under the microscope.
A bandage will be placed over the biopsy area, and you should be able to resume regular activities.
You should not use body powder, lotion, perfume or deodorant before the procedure, as these may affect the results.
Vacuum-Assisted Biopsy
Vacuum-assisted biopsy is a new procedure that involves a biopsy being taken through a small incision in the skin. This procedure uses ultrasound or mammography projections to assist the surgeon in guiding the instrument into the area in need of biopsy. The vacuum-assisted biopsy allows the surgeon to remove several samples of the tissue with only one insertion of the vacuum and one very small incision in the patient's breast.
If you are scheduled for a vacuum-assisted biopsy
The area of the breast being biopsied is cleaned, and a small amount of local anesthetic is injected into the breast in the area of the biopsy. The mammogram images or the use of an ultrasound enables the technician to place a breast probe in the necessary area. The vacuum brings the breast tissue through the opening of the probe into an area called the sampling chamber. Once the tissue is in the sampling chamber, the rotating mechanism is advanced and a tissue sample is captured. The sample is then carried through the probe to the tissue collection area. The sampling chamber is moved approximately 30 degrees into another position and another sample is taken. Approximately eight to ten samples are taken with the vacuum-assisted biopsy method.
The probe is removed, and pressure is placed onto the incision site. A small bandage will be placed over the incision. In some situations, a small sterile clip will be placed into the biopsy site to mark the location. This is done in case a future biopsy is needed. This clip is left inside the breast and causes no pain, cannot be physically detected and causes no harm to the patient.
The tissue samples will be taken to a laboratory for diagnosis.
After the biopsy you may experience minor bruising and swelling and slight discomfort. Some patients are instructed by their surgeon to take Tylenol for discomfort in the days following the biopsy. If you experience major swelling, draining, leakage, redness, bleeding or "hot" skin on the breast you should contact your surgeon/physician immediately.
You should not wear deodorant, powder, lotion or perfume on the day of the procedure. These can cause image artifacts or other problems. If you take blood thinners or aspirin you should talk to their physicians about whether they should be discontinued prior to vacuum-assisted biopsy.
While the vacuum-assisted biopsy has many advantages over the other biopsy options, it may not be the ideal biopsy type for specific patients and their breast lumps. A qualified surgeon will be able to determine if you are a candidate for vacuum-assisted biopsy.
Large Core Surgical Biopsy
Large core surgical biopsy is a procedure that involves removing the entire breast lesion using image guidance. This procedure is not widely accepted by medical professionals, even though it is less intrusive to the patient than an open surgical biopsy. Large core biopsy requires the removal of a fair portion of normal breast tissue just to reach the lesion. Some critics claim that large core biopsy unnecessarily removes normal breast tissue and does not remove enough tissue around the breast lesion for laboratory analysis.
During the procedure the patient is placed in a face-down position, and mammogram images are used to assist the technician in placing the large core-sampling instrument in the correct area of the breast. The instrument is able to remove 5-20 millimeters of breast tissue, often allowing for the removal of the entire lesion.
If you are scheduled for a large core surgical biopsy
Your physician and/or anesthesiologist may give her instructions before the day of your biopsy. you may be told to avoid aspirin, ibuprofen or other medications such as blood thinners for a week before the biopsy. If you do not receive instructions from her physician, we at BreastHealthOnline recommend that you contact the office of your surgeon and specifically ask which medications need to be avoided prior to the biopsy. you should not wear lotion, powder, deodorant or perfume the day of your biopsy.
Your breast will be cleaned and sterilized prior to the biopsy. A local anesthetic will be injected while the breast is held in compression. A wire is guided into the breast lesion using mammography imaging. A narrow tube with a cutting device is inserted into the breast, using the wire as a guide. The core specimen of tissue is removed with a looped wire and taken to the laboratory for diagnosis.
The normal surrounding breast tissue is protected from the operative site by a cylinder shell that houses the lesion. Mammograms of the breast and the removed specimen are performed after the procedure to confirm the biopsy. Stitches are often required to close the biopsy area. The procedure typically takes an hour, often followed by several hours of recovery.
Patients are often advised to take Tylenol for discomfort or pain following the biopsy. Bruising of the site is also expected. You should contact their physicians if they experience any excessive swelling, bleeding, drainage, redness or heat in the area of the biopsy or breast.
Open Surgical Biopsy
Open Surgical Biopsy is a procedure that not long ago was the norm of breast biopsies. Surgical biopsy involves a 1.5- to 2.0-inch incision in the breast.
The excisional surgical biopsy procedure involves the surgeon removing the area of concern and, often, a surrounding area of normal breast tissue. If the lesion can be felt, excisional biopsy can be a relatively short operating room procedure.
An incisional surgical biopsy is similar to an excisional biopsy except that the surgeon only removes part of the breast lesion. Incisional breast biopsy is usually only performed on large lesions.
If you are scheduled for an open surgical biopsy:
Your breast will be cleaned and covered with surgical drapes. The surgical biopsy does not always require general anesthesia. Sometimes, the patient is given a local anesthetic (to the breast only) or a combination of intravenous (IV) sedation with local anesthetic.
Your surgeon will often use mammogram images to help locate the area of concern. He or she will mark the area with a wire marker, visible dye, or carbon particles. This procedure is called "needle" or "wire" localization and is used when the lesion can only be viewed on imaging tests and cannot be felt by routine examination. With "needle" or "wire" localization, the technician will identify the abnormality seen using a thin, hollow needle. He or she will then insert a thin wire through the center of the hollow needle to indicate the exact area in need of removal. There is a small hook at the end of the wire that keeps it from slipping from the soft breast tissue. The radiologist removes the needle, and the wire will be used as a guide to locate the lesion. Another mammogram may be conducted to make sure the wire is positioned in the correct area of the breast. You will be taken into the operating room, where the surgeon will remove the wire along with an area of breast tissue from around the lesion. Additional imaging x-rays will be conducted to ensure that the lesion area has been removed. The area removed will be sent to the laboratory for diagnosis.
The incision will be stitched closed. If the suture material absorbs, the stitches should dissolve on their own in time. If the stitches don't self-dissolve the physician will remove them at a scheduled follow-up appointment.
Prior to the biopsy, you will be given detailed instructions by your surgeon, which will explain that food should not be consumed after midnight the evening prior to the biopsy. There may also be a list of medications that should be avoided in the week(s) before the biopsy. If you do not receive this information, we at BreastHealthOnline encourage you to contact your surgeon's office and inquire about it. You should not wear deodorant, powder, lotion or perfume on the day of the procedure. These can cause image artifacts or other problems.
Recovery from this biopsy will generally take at least one day.
It is important that women realize that open surgical biopsy requires stitches and can leave a scar, and that this scar formation may occur for longer than a year and can lead to confusing or misleading future mammograms. Complications that could also occur would be bleeding or difficulties in healing such as infection. It is important to discuss all biopsy methods with your surgeon in order to determine which is better suited for you.
