Your doctor has various procedures available for taking tissue samples. As a rule, he will use minimally invasive methods such as punch or vacuum biopsy.
Very rarely, he will resort to a surgical or open biopsy. Which procedure is used in your case depends on the following questions:
- Is the lump palpable?
- Is the lump clearly visible in the ultrasound image?
- Do microcalcifications detected in the mammogram require a detailed examination?
Depending on this, the following procedures are used:
- Punch biopsy (high-speed punch biopsy)
If the lump is palpable or clearly visible on ultrasound (solid-appearing findings), the doctor performs a punch biopsy as standard.
He shoots a 1.5 millimeter thick hollow needle into the suspicious breast area under ultrasound guidance and at high speed (high-speed punch) .
He takes three to five small, cylindrical punches at different points. He punctures the skin only once. The procedure is painless and leaves no scar. You will be given a local anesthetic during the procedure.
Punch biopsy is the standard method for removing tissue from lumps and foci @ ST.art /AdobeStock
- Fine-point needle puncture
To examine the lymph nodes, the doctor removes cells from the lymph node using a wafer-thin hollow needle (fine needle aspiration).
Vacuum biopsy is used to take larger tissue samples.
During a vacuum biopsy, the doctor uses a 3.5 millimeter thick hollow needle. With the help of mammography, ultrasound or MRI monitoring, he sucks out around 20 tissue samples. These are then cut off with a tiny rotating knife.
A computer calculates the exact path of the needle to ensure that the tissue is removed safely.
The procedure takes longer than a punch biopsy. As the doctor takes a comparatively large tissue sample, the diagnostic reliability is very high.
He can then X-ray the tissue sample to detect microcalcifications in the breast. Microcalcifications are usually harmless, but can indicate benign diseases or breast cancer.
- Surgical or open breast biopsy
If minimally invasive procedures do not provide clear results, the doctor will perform a surgical biopsy. A surgical breast biopsy is very rarely necessary today.
To find the abnormal tissue, the surgeon marks the suspicious areas in advance with a thin wire. For localization, he uses mammography, MRI or ultrasound monitoring. If the lump is palpable, the doctor marks the suspicious area with a colored pen.
In an open breast biopsy, the doctor removes the tissue change partially (incisional biopsy) or completely (excisional biopsy). The doctor usually cuts out the suspicious area completely. The patient is under general anesthesia during this procedure .
A pathologist then examines the tissue removed under a microscope and assigns it to this B classification:
- B1: normal
- B2: benign (e.g. cyst)
- B3: benign, but not sure how the change will develop further
- B4: suspected malignant change (requires clarification)
- B5: malignant, invasive, growing tumor that requires treatment
A specialized laboratory analyses the tissue samples taken @ luchschenF /AdobeStock
The classification does not yet represent a final diagnosis. However, it does determine what measures the gynecologist should subsequently take.
If the findings are benign (B2), your doctor will decide how to proceed depending on your symptoms. If the lump bothers you, the doctor can remove it surgically. Otherwise, you will need to have it checked regularly to detect any changes at an early stage.
If there is a suspicion of cancer or a tumor in the breast that requires treatment, the doctor will remove it by means of an open biopsy.
In order to find the area again, a marker clip is attached during the breast biopsy (regardless of whether it is a punch or vacuum biopsy). This can also remain in the breast if no further measures are required.
In the case of cancer, the doctor will order further examinations. This is because not all breast cancers are the same. The individual tumors differ in terms of their characteristics.
The doctor uses the information obtained to compile a "tumor profile". The specialist clinic then decides on the treatment based on the "tumor profile".
Aftercare depends on the breast biopsy procedure.
Minimally invasive methods do not require any special aftercare. The doctor will discuss the findings with you in detail. He will also inform you about the necessary treatment measures.
An open biopsy requires an outpatient or short inpatient stay. The procedure leaves a scar inside the breast, which makes mammographic assessment of the breast more difficult.
Vacuum and punch 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
The breast is also sensitive to pressure in the first few days after the operation . The slight pain subsides as soon as the wound heals. There is no risk of tumor cells being carried over or activated by the breast biopsy.
- Do not drive for 24 hours after the tissue has been removed
- Do not operate any dangerous equipment
- Alsoavoid strenuous activities such as sports or house cleaning
- Do not shower until the following day.
- Avoid bathing, swimming and saunas for 10 days
A breast biopsy is a minor procedure with a low risk of complications. It provides you and your doctor with clarity as to whether the changes in your breast are benign or malignant. Your doctor can then decide what treatment is required.
