Your doctor has various procedures available for taking a tissue sample. As a rule, he or she will use minimally invasive methods such as a core needle biopsy or a vacuum-assisted biopsy.
Very rarely will they resort to a surgical or open biopsy. Which procedure is used for you depends on the following factors:
Depending on the answer, the following procedures may be used:
- Core biopsy (high-speed core biopsy)
If the lump is palpable or clearly visible on ultrasound (solid-appearing finding), the doctor will typically perform a core needle biopsy.
During this procedure, the doctor inserts a 1.5-millimeter-thick hollow needle into the suspicious area of the breast under ultrasound guidance and at high speed (high-speed punch).
The doctor removes three to five small, cylindrical tissue samples from different locations. The skin is punctured only once. The procedure is painless and leaves no scar. You will receive a local anesthetic during the procedure.
The core needle biopsy is the standard method for obtaining tissue samples from lumps and lesions @ ST.art /AdobeStock
To examine the lymph nodes, the doctor uses an extremely thin hollow needle (fine-needle aspiration) to extract cells from the lymph node.
A vacuum-assisted biopsy is used to obtain larger tissue samples.
During a vacuum-assisted biopsy, the doctor uses a 3.5-millimeter-thick hollow needle. Guided by mammography, ultrasound, or MRI, the doctor aspirates about 20 tissue samples. These are then excised using a tiny rotating blade.
To ensure safe tissue removal, a computer calculates the exact path of the needle.
The procedure takes longer than a core biopsy. Because the doctor removes a relatively large tissue sample, the diagnostic accuracy is very high.
The doctor can then X-ray the tissue sample to detect microcalcifications in the breast. Microcalcifications are usually harmless, but they can indicate benign conditions or breast cancer.
- Surgical or Open Breast Biopsy
If minimally invasive procedures do not yield clear results, the doctor removes tissue surgically. A surgical breast biopsy is very rarely necessary today.
To locate the abnormal tissue, the surgeon marks the suspicious areas in advance with a thin wire. To pinpoint the exact location, the surgeon uses mammography, MRI, or ultrasound guidance. If the lump is palpable, the doctor marks the suspicious area with a colored pen.
During an open breast biopsy, the doctor removes part of the abnormal tissue (incisional biopsy) or the entire area (excisional biopsy). In most cases, the doctor completely removes the suspicious area. The patient is under general anesthesia during the procedure.
A pathologist then examines the removed tissue under a microscope and classifies it according to the following B classification:
- B1: normal
- B2: benign (e.g., cyst)
- B3: Benign, but it is uncertain how the lesion will develop
- B4: Suspected malignant lesion (requires further evaluation)
- B5: Malignant, invasively growing tumor requiring treatment
A specialized laboratory analyzes the tissue samples that were collected @ luchschenF /AdobeStock
This classification does not yet constitute a definitive diagnosis. However, it determines what steps the gynecologist should take next.
If the finding is benign (B2), your doctor will base the next steps on your symptoms. If the lump is bothering you, the doctor can remove it surgically. Otherwise, you’ll need to have it checked regularly to detect any possible changes early on.
If cancer or a tumor in the breast that requires treatment is suspected, the doctor will remove it via an open biopsy.
To locate the area again, the doctor has already placed a marker clip during the breast biopsy (regardless of whether it was a punch or vacuum biopsy). This clip can remain in the breast if no further action is required.
If cancer is diagnosed, the doctor will order further tests. This is because not all breast cancers are the same; individual tumors differ in their characteristics.
Based on the information obtained, the doctor compiles a “tumor profile.” The specialized clinic then tailors the treatment based on the “tumor profile.”
Follow-up care depends on the breast biopsy procedure used.
Minimally invasive methods do not require any special follow-up care. The doctor will discuss the findings with you in detail and explain the necessary treatment options.
An open biopsy requires outpatient care or a short hospital stay. The procedure leaves a scar inside the breast, which makes mammographic evaluation of the breast more difficult.
Vacuum-assisted and core needle biopsies are minor surgical procedures with few complications or side effects.
These include:
- Allergic reactions to the anesthetics used
- Bleeding
- Bruising
- Nerve damage
- Excessive scarring
In addition, the breast will be tender to pressure in the first few days following the procedure. The mild pain will subside as soon as the wound heals. There is no risk of tumor cells spreading or becoming active as a result of the breast biopsy.
- Do not drive for 24 hours after the tissue sample is taken
- Do not operate any dangerous equipment
- Also, avoid strenuous activities such as sports or housework
- You should also wait until the following day to take a shower.
- Refrain from taking baths, swimming, and using the sauna for 10 days
A breast biopsy is a minor procedure with a low risk of complications. It provides you and your doctor with clarity on whether the changes in your breast are benign or malignant. Your doctor can then decide what treatment is necessary.
