Types of Breast Biopsies

When a breast lump is detected, it is important to determine some things about it, most importantly, if the lump is cancerous. Some lumps are common and harmless, such as the lumps that occur in fibrocystic breast disease. Other lumps, however, can be small cancers and need to be managed by a physician or team of physicians. Under a microscope and when coated with various stains and markers, the cells that make up a breast lump can often be classified as malignant, benign, metastatic, cystic, etc. However in order to examine the cells, a sample of the tissue will need to be removed and sent to a pathologist for detailed analysis. When a piece of tissue is removed from the body for diagnosis, it is called a biopsy. When it comes to breast cancer diagnosis, there are several types of breast biopsy that can be performed.

 

 

For many years, fine needle aspiration (FNA) was the “gold standard” in breast biopsy techniques. As the name implies, a fine needle is advanced into the breast, into the lump, and a small bit of it is aspirated or drawn up into the syringe. The benefit of this approach is that the patient experiences relatively little discomfort since the needle is a small diameter (fine needle). Unfortunately, as the tissue is drawn up into the syringe, it fractures and cells are scattered in the sample. From a pathologist’s perspective this is not ideal since an important part of cancer diagnosis is seeing the cells in context, so to speak. How certain cells appear within the tissue is invaluable for diagnosis. As a result, many fine needle aspiration biopsies are not diagnostic.

 

The breast biopsy that has supplanted fine needle aspiration in many cases is the core needle biopsy. In a core biopsy and rather large bore (diameter) needle is advanced into the lump and withdrawn without disrupting the biopsy with excessive suction. Just as one would use a corer on an apple or pear, the core remains intact as the device is removed from the breast. A core biopsy gives the pathologist a fantastic sample on which to perform diagnostic studies. Unfortunately since the needle used is of much larger diameter, the process can be slightly more uncomfortable than fine needle aspiration. A local anesthetic is administered during a core needle biopsy and most women agree that an accurate diagnosis is worth some brief discomfort.

 

One technological advancement to core needle biopsy is the use of a stereotactic biopsy approach. A stereotactic breast biopsy simply refers to the fact that some form of imaging, usually mammogram, ultrasound or MRI is used to help the practitioner guide the needle to the lump. Stereotactic core needle biopsy has greatly improved the diagnostic power of needle biopsy procedures.

 

The use of needles for breast biopsy leaves the overall structure of the breast intact, which is highly preferred by patients. However some situations call for incisional or excisional breast biopsy. These types of biopsy are surgical procedures that remove part (incisional) or all (excisional) of the breast lump. If the decision is made to perform a surgical biopsy, rarely will it simply be an incisional biopsy alone. Most often the entire lump will be removed which is why the term excisional biopsy is often used interchangeably with lumpectomy. Excisional biopsies are ideal from a pathologist’s perspective since the tissue is removed intact. Further, an excisional biopsy may obviate the need for further mastectomy if the enough surrounding tissue is taken. The drawback to an excisional biopsy, aside from being a surgical procedure, is that the breast may become slightly deformed after the lump is excised (removed). Thus many patients opt for a stereotactic core needle biopsy to make the diagnosis before moving to a lumpectomy procedure.

 

You should discuss the benefits and risks of needle biopsy procedures and surgical biopsy with your physician to determine which approach is best for you.