Breast Needle Biopsy

A breast biopsy procedure is done for the following reasons:

• To check a lump or mass that can be felt (is palpable) in the breast
• To check a problem seen on a mammogram, such as small calcium deposits in breast tissue (microcalcifications) or a fluid-filled mass (cyst)
• To evaluate nipple problems, such as a bloody discharge from the nipple
• To find out if a breast lump or mass is cancer (malignant) or not cancer (benign)]

There may be other reasons for your doctor to recommend a breast biopsy.

A needle biopsy is the standard of care and preferred way to diagnose breast cancer and other conditions in the breast. The procedure is low-risk and can be performed as an outpatient.  

It helps to get an accurate diagnosis and treatment plan for breast issues. It may also help to reduce anxiety about the issue, as it can provide answers about the presence or absence of cancer or other conditions.

Getting an accurate diagnosis this way can help to avoid surgery or multiple surgeries.

What are the risks associated with a breast biopsy?

Some possible risks of a breast biopsy include:

• Bruising and mild pain at the biopsy site
• Prolonged bleeding at the biopsy site
• Infection near the biopsy site

If the biopsy is done using an X-ray, the amount of radiation used is small. The risk for radiation exposure is very low.

You may have other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider before the biopsy is done.

There are several types of breast biopsy procedures. The type of biopsy that you have will depend on the location and size of the finding of concern in your breast.

Needle biopsies are done under local anesthesia. For local anesthesia, medicine is injected to numb your breast. You will be awake but feel no pain. For general anesthesia, you will be given medicine to put you into a deep sleep during the biopsy. 

Types of Breast Biopsies

• Fine needle aspiration biopsy (FNA). A very thin needle is placed into the breast lump or area of concern. A small sample of fluid or tissue is removed. No cut (incision) is needed. An FNA biopsy may be done to help see if the area is a fluid-filled sac (cyst) or a solid breast lump.
• Guided core needle biopsy. A hollow needle is guided into the breast lump or area of concern. Small pieces of tissue, called cores, are removed. No cut (incision) is needed. A vacuum-assisted device (VAD) can be used during core needle biopsies to help collect the tissue cores. This is called a vacuum-assisted core biopsy.
• Surgical biopsy. A cut is made in the breast. The surgeon removes part or all of the lump or area of concern. In some cases, the lump may be small, deep and hard to find. Then a method called wire localization may also be used. For this, a thin needle with a very thin wire is put into the breast. X-ray images help guide it to the lump. The surgeon then follows this wire to find the lump.

Special tools and methods may be used to guide the needles and help with biopsy procedures. These include:

• Stereotactic biopsy. With this method, you will be sitting upright in a chair and your breast placed into the mammogram unit. A 3D image of the breast is made using a computer and a mammogram. With the breast in compression, the 3D image then guides the biopsy needle to the exact area of concern in the breast.
• MRI-guided biopsy. This type of biopsy is done under the guidance of magnetic resonance imaging (breast MRI). During this procedure, you lie face down on a padded scanning table and your breast will need to be compressed (similar to a mammogram). An IV will be placed in your arm to give contrast dye so that the doctor can locate the area to be biopsied.
• Ultrasound-guided biopsy. This method uses ultrasound technology, which creates images of the breast using high-frequency sound waves, to help guide the needle to the exact biopsy site. During this biopsy, you will be lying on your back on the ultrasound bed. The radiologist—your doctor—will then guide the needle to the target using the breast ultrasound images.

A breast biopsy is recommended for women who have any of the following:

• A suspicious breast lump.
• Abnormal findings on a mammogram, ultrasound or MRI.
• Signs and symptoms of breast cancer, such as nipple discharge or skin changes.
• An area of possible infection.
• A palpable area of concern within the breast.
• Women who have had a previous biopsy can also benefit from a repeat biopsy.

Anyone who can be imaged can also have a biopsy performed under imaging guidance if they are comfortable and as long as there is not a high risk of bleeding.

Your provider will explain the procedure to you. Ask any questions you have about the procedure.

• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• You can eat and drink before the procedure.
• Don’t use lotion, cream, powder, deodorant or perfume on your arm, underarms or breast on the day of the procedure.
• Tell your provider if you are pregnant or think you may be pregnant.
• Tell your provider if you are sensitive or allergic to any medicines, latex, tape, skin cleaners, soaps and anesthesia medicine.
• Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, coumadin, Plavix or other medicines that affect blood clotting.

Your healthcare provider may have other instructions for you based on your medical condition.

A breast needle biopsy is done in the breast imaging center. It is done on an outpatient basis, which means you go home the same day. These biopsies only require local anesthesia. Procedures may vary depending on your condition and your provider’s practices.

Generally, a needle breast biopsy follows this process:

1. You will be asked to remove any clothing from the waist up, and given a gown to wear.
2. You will lie down or sit up depending on your provider’s preference and if X-ray or ultrasound guidance will be used.
3. The skin over the biopsy site will be cleaned with a sterile solution.
4. When a local anesthetic is used, you will feel a needle stick when the medicine is injected. You may feel a brief stinging feeling. The biopsy will not start until the area is numb.
5. When ultrasound is used, the probe will be placed on your breast to find the area of interest.
6. When stereotactic imaging is used, you will sit in a biopsy chair with your breast placed in compression in the mammography machine. Your doctor will use a computer to find the exact area of concern.
7. You will need to be still during the procedure. But you won’t need to hold your breath.
8. The provider will place the needle right into the biopsy site or through a tiny cut (incision). He or she will remove a tissue sample. You may feel pressure when the doctor takes the tissue sample.
9. A tiny stainless steel or titanium marker will be placed in the breast at the biopsy site so that its exact location can be easily found in the future. You will not be able to feel this marker, it is safe in an MRI machine, and it will not set off any metal detectors.
10. Pressure will be applied to the biopsy site until the bleeding stops.
11. The opening will be closed with adhesive strips or skin glue. No stitches are needed.
12. A sterile bandage or dressing will be applied.
13. The removed tissue will be sent to the lab for examination.

With all types of breast needle biopsies, you will go home with only bandages and an ice pack over the biopsy site.

At home, you should take it easy on the day of the biopsy and the following day by avoiding any strenuous activities. Keep the biopsy area clean and dry. You may remove the bandage or dressing when instructed to do so, and shower as normal. Avoid submerging the breast under water for 5–7 days after the biopsy.

The biopsy site may be sore for several days. Take a non-aspirin pain reliever containing acetaminophen (Tylenol) as recommended by your doctor. Aspirin or certain other pain medicines may increase your chance of bleeding. Apply a cold pack as needed to reduce swelling and pain. Wearing a supportive bra may also help with mild pain.

Call your healthcare provider if you have any of the following:

• Fever or chills
• Redness, swelling, bleeding or other drainage from the biopsy site
• Increased pain around the biopsy site

Your healthcare provider may give you other instructions, depending on your situation.

Understanding the Results of your Breast Biopsy

We will call you when we get your results from the pathologist, usually within 2–3 business days. The results will also be sent to you directly on the My UC Health patient portal. You may see your biopsy results before your provider has a chance to call you. Be assured that you will receive a call from your radiologist.

The pathology report includes details about the tissue samples and whether cancer cells, precancerous cells or noncancerous changes were present.

• Cancer (malignant) cells—If the biopsy shows cancer, the pathology report will include information about what type of breast cancer you have and additional information, such as whether the cancer is positive or negative for estrogen, progesterone and/or Her-2 receptors.
• Precancerous (atypical) cells—If the biopsy shows precancer or atypia, the pathology report will include information about what type and how much is present.
• Noncancerous (benign) changes—If the biopsy shows benign changes, this is usually good news. However, you will need to see if your radiologist agrees with the pathologist. If the radiologist disagrees with a benign result, you may need surgery to obtain more tissue to rule out cancer.