So, I have to have a breast biopsy. Now what?

by Dr. Gage Hicks

 

As seen in Odessa American Medical Matters: http://www.oaoa.com/people/health/medical_matters/article_a5d8b580-d21c-11e7-8f31-9faf6bd0e5e2.html

Maybe an abnormality was detected on your screening mammogram or you were feeling a lump, imaging of your breast most likely showed an abnormality that needs further evaluation with biopsy. This means that additional evaluation of the abnormality is needed in order to determine if cancer cells are present. A biopsy obtains pieces of tissue from the area of concern so that a pathologist can look at it under the microscope and determine if it is (or isn’t) a breast cancer.

A biopsy can be performed in several different ways, and the type of biopsy recommended is often determined by the appearance of the abnormality in question. Most breast biopsies can be performed without surgery, through a tiny incision in the skin (percutaneous biopsy). A small amount of numbing medicine is injected into the skin and below the skin (local anesthesia) so that you don’t feel pain during the biopsy. Some breast biopsies are best performed surgically, and more advanced anesthesia is required in those cases.

The types of biopsies that are performed without surgery (through tiny incisions in the skin and with local anesthesia) are ultrasound-guided biopsies and stereotactic biopsies:

  • An ultrasound-guided biopsy uses ultrasound imaging to visualize the needle as it passes through the area of concern. The doctor is able to watch what is going on inside the breast as the needle takes the small pieces of tissue. In my opinion, these are the easiest biopsies to perform – both for the patient and for the doctor. Most masses can be biopsied in this way.
  • A stereotactic biopsy uses mammogram pictures to guide the biopsy needle to the correct location in the breast. These biopsies tend to be a little bit more difficult for the patient … not because of pain (the numbing medicine takes care of that), but because the breast has to be compressed (like in a mammogram) and because the patient has to be very still during the procedure (just like you have to be still during a mammogram). Stereotactic biopsies are most often used to biopsy calcifications in the breast (these cannot be seen with ultrasound). However, occasionally masses in the breast are not seen with ultrasound and can be biopsied in this manner as well.

Just because a biopsy was recommended, it doesn’t necessarily mean that you have cancer. But the radiologist is concerned enough that a biopsy was recommended for further evaluation. There are several criteria that the radiologist takes into account when recommending biopsy of an abnormality in the breast. Certain abnormalities are highly suggestive for cancer based on their appearance, and a biopsy is needed to determine what type of breast cancer we are dealing with so that the appropriate treatment plan can be put in place prior to surgery. However, this is actually not the most common scenario. More often, a biopsy is recommended for an abnormality that is suspicious for cancer but not necessarily highly suggestive for cancer. This is because there is a lot of overlap between the appearance of abnormalities that are not cancer (called benign) and abnormalities that turn out to be cancer.