A biopsy is a procedure performed to remove tissue or cells from the body for examination under a microscope. A breast biopsy is a procedure in which samples of breast tissue are removed with a special biopsy needle or during surgery to determine if cancer or other abnormal cells are present.
Biopsies may be performed under local or general anesthesia. There are several types of breast biopsy procedures. The type of biopsy performed will depend upon the location and size of the breast lump or abnormality.
TYPES OF BIOPSY PROCEDURES
Types of breast biopsy procedures include, but are not limited to, the following:
- fine needle aspiration biopsy - a very thin needle is placed into the lump or suspicious area to remove a small sample of fluid and/or tissue. No incision is necessary. A fine needle aspiration biopsy may be performed to help to differentiate a cyst from a lump.
- core needle biopsy - a large needle is guided into a lump or suspicious area to remove a small cylinder of tissue (also called a core). No incision is necessary.
- surgical biopsy (also called an open biopsy) - a surgeon removes part or all of a lump or suspicious area through an incision into the breast. There are two types of surgical biopsies. During an incisional biopsy, a small part of the lump is removed; whereas during an excisional biopsy, the entire lump is removed.
In some cases, if the breast lump is very small and deep and is difficult to locate, the wire localization technique may be used during surgery. With this technique, a special wire is placed into the lump under x-ray guidance. The surgeon follows this wire to help locate the breast lump.
BIOPSY TOOLS AND TECHNIQUES
There are special instruments and techniques that may be used to guide the needles and to assist with biopsy procedures. These include, but are not limited to, the following:
- stereotactic biopsy - Stereotactic means "image guided" and, true to its name, stereotactic breast biopsy finds the exact location of a breast lump or suspicious area by using a computer and mammogram results to create a three-dimensional (3D) picture of the breast. A sample of tissue is removed with a needle.
- Mammotome® breast biopsy system (also called vacuum-assisted biopsy) - a type of tube is inserted into the breast lump or mass. The breast tissue is gently suctioned into the tube, and a rotating knife removes the tissue. In 1999, the US Food and Drug Administration (FDA) approved the use of the hand-held Mammotome device.
- ultrasound-guided biopsy - a technique that uses a computer and a transducer that sends out ultrasonic sounds waves to create images of the breast lump or mass. This technique helps to guide the needle biopsy.
- advanced breast biopsy instrumentation (ABBI) - uses a rotating knife and cylinder to remove a large sample of tissue. Although this type of procedure has not received widespread acceptance, it is often possible to remove the entire breast lesion with this method.
- Sentinel node biopsy- used to determine if cancer cells have spread to the lymph nodes. This surgical procedure may be performed during the initial diagnostic period to aid in staging of the breast cancer, or it can be done during a mastectomy. This injection helps to locate the lymph node closest to the tumor (sentinel node) - the one that is most likely to have cancer cells present if the cancer has spread. The surgeon removes the lymph node that absorbs the dye and radioactive substance and sends it to the pathologist to examine it closely for the presence of cancer cells. If cancer cells are present in the sentinel node, the surgeon may remove more lymph nodes and send them to pathology. This is called lymph node dissection.
- There are some risks involved in a lymph node dissection, such as:
- temporary loss of sensation in the armpit or back of the arm
- tingling, numbness, weakness, or swelling in the arm
- inflammation of the veins in the arm
- increased risk of infection
- winged scapula (a rare complication that occurs when the nerves that hold the shoulder blade in place are damaged); this causes the shoulder blades to stick out when the arms are straight
- lymphedema