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The Different Types of Breast Biopsy Explained

When other tests show that you might have breast cancer, your doctor will probably suggest you have a biopsy. Being told that something might not be normal in your breast and that you need a biopsy can be absolutely terrifying. But, do not panic. A biopsy is a quick, easy, and pain-free procedure. Also, most biopsy results are not cancer, but the procedure is required to find out for sure. To help you ease your concerns, it is important that you understand everything about the procedure, particularly the different types of breast biopsy so you can choose one based on your preference. Not all breast biopsies are surgical, some are done using a hollow needle instead of an incision. However, each type of breast biopsy has its own pros and cons. So, what are these different types of a breast biopsy?

Needle Biopsy

The different types of breast biopsy are:

  • Fine needle aspiration biopsy
  • Core needle biopsy
  • Open (surgical) biopsy
  • Vacuum-assisted biopsy
  • Stereotactic biopsy
  • Ultrasound-guided biopsy
  • MRI-guided biopsy.

The type of breast biopsy you have depends on a number of things, including the size of the breast lump, the location of the breast lump, if there is more than one, any medical problems you might have, and your personal preferences. 

To find out what these different types of breast biopsy mean and everything else you need to know about the procedure, including the best place to have it, keep reading!

What is a breast biopsy?

A breast biopsy is a procedure in which a small piece of tissue is removed from the breast for laboratory testing. It is performed to evaluate a suspicious area in your breast to determine whether cancer or other abnormal cells are present. A breast biopsy is the only diagnostic procedure that can definitely determine whether the suspicious area is cancerous.

The good news is that about 80% of women who have a breast biopsy actually do not have breast cancer. Since a breast biopsy is designed to be highly sensitive, it means that the chance of it missing even the smallest tumors is actually very low.

Breast Biopsy

Why might I need a breast biopsy?

You may need a breast biopsy if:

  • There is a lump or thickening in your breast and your doctor suspects breast cancer.
  • Your mammogram reveals a suspicious area in your breast, such as small calcium deposits in breast tissue or a fluid-filled mass (cyst).
  • A suspicious finding is revealed after an ultrasound scan and/or breast MRI.
  • You experience unusual changes of the nipple or areola, such as dimpling skin, crusting, and a blood discharge, as these are symptoms of a tumor in the breast.

A lump or other suspicious areas in the breast may be caused by cancer, but it may also be caused by another problem that are less serious. There may also be other reasons why your doctor recommends a breast biopsy.

What are the different types of a breast biopsy?

As mentioned before, there are several types of breast biopsy. The type of biopsy that you will have depends on:

  • The size of the suspicious area or the breast lump
  • Where the suspicious area is located
  • If there is more than one suspicious area
  • If you have other medical problems
  • Your personal preferences.

Below are the types of breast biopsy procedures.

Fine needle aspiration biopsy

If a lump is felt during a clinical breast exam, your doctor may perform fine needle aspiration biopsy (FNAB) to examine it. In most cases, this type of biopsy is chosen when the lump is likely to be filled with fluid. During FNAB, the surgeon, radiologist, or pathologist uses a very thin needle and a syringe to take a few samples of fluid cells from a palpable lump (meaning it can be felt with the hands). 

FNAB is a quick way to distinguish between a solid mass and a fluid-filled cyst. The needle used is usually smaller than the type of needle used in the blood test and the patient may not need a local anesthetic. However, since the needles are very thin, there is a possibility of missing nearby cancerous cells. Therefore, if the diagnosis is unclear, the doctor may recommend a different type of biopsy. 

Core needle biopsy

Core needle biopsy is normally used to assess a breast lump that is visible on an ultrasound or mammogram. It may also be used if your doctor feels a breast lump during a clinical breast exam. The radiologist or surgeon removes tissue samples from the breast mass using a thin, hollow needle, and often guided by an ultrasound. The needle may enter the area for up to six times in order to remove several cores of tissue. Therefore, your doctor may give you a local anesthetic to numb the area. During the procedure, the surgeon or radiologist may also insert a very small marker inside the breast to mark the location to make it easier for the surgeon to locate the abnormal area should further surgery is required.

This type of biopsy takes a lot longer than a fine needle aspiration biopsy, but its chance of missing cancerous cells is lower, so the results of core needle biopsy are more reliable.

Open (surgical) biopsy

An open biopsy, also called surgical biopsy or excisional biopsy, involves the surgical removal of a breast mass. This procedure can be performed under local or general anesthesia. The surgeon makes a cut of around 1 to 2 inches in the breast to remove all or part of the lump, as well as a small amount of normal tissue, for further examination under a microscope. 

If the lump cannot be found by touch, X-rays are used to guide a thin and hollow needle to the mass. Then, a very thin wire is threaded with a hook at the end of the needle and attach the hook to the lump. Once the needle is removed, the wire stays in place to guide the surgeon to the target area. Since this type of biopsy involves cuts, there will be a scar. Also, if a significant amount of tissue is removed, there may be a change in the shape of the breast.

In some cases, special tools and methods may be needed to guide the needles to help with the procedure. This type of biopsy include:

Vacuum-assisted biopsy

In this type of biopsy, the surgeon creates a tiny incision to insert a hollow probe, which is then guided using X-Ray, ultrasound, or MRI to the breast lump. Then, the breast tissue is gently sucked into the probe using a vacuum. This type of biopsy allows the surgeon to collect several samples as the probe can be rotated.

Stereotactic biopsy

Stereotactic biopsy uses a computer and mammogram to create a 3D image of the breast. The 3D image is then used to guide the biopsy needle to the suspicious area or the exact site of the breast lump. 

Ultrasound-guided biopsy

This type of biopsy uses ultrasound images of the breast lump to help guide the needle to the biopsy site. The procedure is performed exactly the same as a core needle biopsy, but with the help of an ultrasound.

MRI-guided biopsy

During an MRI-guided biopsy, an MRI machine will help the surgeon to guide the needle to the lump. A small incision is made around the area and a sample is taken with a core needle.

What happens after a breast biopsy?

If the breast biopsy involves general anesthesia, you will be taken to a recovery room to be monitored. You will be allowed to leave the hospital when your heart rate, breathing, and blood pressure are stable, and when you are mentally alert. 

If the breast biopsy involves local anesthesia, you can leave as soon as the effects of the anesthesia subside.

Recovery

How long it takes for you to recover will depend on the type of breast biopsy you had and the type of anesthesia involved. In general, you should rest for the remainder of the day and continue your normal activities the day after. However, you may need to avoid any strenuous physical activity for several days. You may experience some bruising, but you can take a non-aspirin pain reliever to ease any discomfort. It is important that you keep the biopsy area clean and dry.

Your surgeon will schedule a follow-up visit to explain the results of the biopsy. If there are any stitches, they will be removed during this follow-up visit. 

Results

After a breast biopsy, the tissue sample needs to be analyzed under a microscope in a laboratory by a pathologist (a doctor who specializes in analyzing blood and body tissue), which can take a few days to complete. Once the pathologist is done analyzing the sample, they will prepare a report and send it to your doctor, who will share the results with you. 

Your test result may come back as benign (noncancerous), precancerous, or cancerous. If the sample is found to be cancerous, the result will also be able to show the type of cancer. The type of cancer that can be detected by a breast biopsy is as follows.

  • Cancer of the breast ducts known as ductal carcinoma
  • Inflammatory breast cancer
  • A rare cancer affecting the nipples (Paget’s disease)
  • Cancer of the lobules (lobular carcinoma).

The type of cancer and other information obtained from the biopsy will be used to help plan your treatment, which may include:

  • A lumpectomy (a surgical procedure to remove the tumor and preserve the breast)
  • A mastectomy (a surgical procedure to remove the breast)
  • Chemotherapy
  • Radiation therapy
  • Hormone therapy.

If the sample revealed that the lump is noncancerous, the test will also be able to tell the conditions that cause the lumps, such as:

  • Adenofibroma (benign tumor of the breast tissue)
  • Fibrocystic breast disease
  • Mammary fat necrosis (a lump formed by injured, bruised, or dead fat tissue)
  • Intraductal papilloma (a small and benign tumor of the milk ducts).

Where should I get a breast biopsy?

While a breast biopsy is available in many hospitals around the world, many medical tourists, particularly those who come from the United States, choose to undergo a breast biopsy in the Dominican Republic. The country is known to have excellent hospitals with highly skilled doctors and pathologists who can perform the procedure safely and analyze the sample accurately. What’s more, you can get high-quality breast biopsy for half the price of what you would pay in your home country. There is also no waiting list, so you can have the procedure on your preferred date without having to wait. Also, the beautiful surroundings will make the whole procedure a lot less stressful.